Osgood-Schlatter disease is a disorder of ossification (the ossification of cartilaginous structures) in the knee that primarily affects adolescents between the ages of nine and fifteen, particularly in association with growth spurts. Boys are more commonly affected by Osgood-Schlatter than girls, with a ratio of 3:1 to 7:1.
What is Osgood-Schlatter?
Osgood-Schlatter or Osgood-Schlatter disease is the name given to a comparatively common aseptic (noninfectious) osteochondrosis of the tibial tuberosity, which is a rough bony process of the anterior edge of the tibia that forms the patellar tendon insertion (tibial roughness). The disturbed ossification can also lead to detached ossicles (small bone segments) when the knee is overloaded, which can die in the further course (osteonecrosis). As a result of irritation of the patellar tendon, Osgood-Schlatter is initially manifested by pain in the area of the tibial roughness due to movement and pressure. Furthermore, the disease can cause pronounced swelling, which leads to pronounced pain when traction is applied over the patellar tendon. In advanced stages, Osgood-Schlatter disease may cause protrusions in the affected knee area that can be partially displaced.
Causes
The exact etiology of Osgood-Schlatter disease is as yet unclear. It is suspected that aseptic osteochondrosis is caused by overloading of the affected knee area. The overload results from a discrepancy between load-bearing capacity and actual loading of the cartilaginous core of the tibial tuberosity due to exercise-related micro-injuries or overweight. The discrepancy in turn results in impaired ossification of the cartilaginous core as well as impaired fusion of the same with the adjacent tibial bone. Hormonal changes during puberty may also result in a reduced load-bearing capacity of the tibia (shin bone) and thus an unevenly distributed load in the knee as well as increased patellar tendon pull. In addition, it is thought that localized circulatory disturbances may condition Osgood-Schlatter.
Symptoms, and signs
Osgood-Schlatter disease is primarily manifested by pain that occurs mainly below the kneecap and at the top of the tibia. This pain intensifies further with weight-bearing. Kneeling, stretching the leg, jerky stepping movements and so on are sometimes severely restricted. Children between the ages of 11 and 14 who are active in sports are particularly affected. There is a small rounding that eventually becomes visible. This is usually located at the lower end of the kneecap and represents a swelling. If pressure is applied to it, pain also occurs. At the same time, the rounding can change a lot. Resting quickly causes it to shrink and move back inward. Stress – even short-term – causes it to swell again and become more sensitive. Overall, the symptoms of Osgood-Schlatter are very specific. For example, there is no pain at night or heat development. In Osgood-Schlatter’s disease, the first pain is usually felt only indirectly through pressure on the patellar tendon. The other pain develops over a period of time and may remain very mild for a long time. Limitations in extending the knee joint are also an early symptom.
Diagnosis and course
Characteristic symptoms such as load-dependent pain and marked tenderness in the typical knee areas provide the first clues to Osgood-Schlatter disease. In the course of sonographic and radiographic examinations, the fusion disorder of the core of the tibial tuberosity with the adjacent bone structures, which is typical for Osgood-Schlatter, can be demonstrated on the basis of the loosening of the bony structures as well as detached ossicles. In addition, the disease should be differentiated from iliotibial band syndrome (runner’s knee) in terms of differential diagnosis. If necessary, in ambiguous cases, the diagnosis is confirmed by magnetic resonance imaging and/or scintigraphy, which at the same time allows statements about possible metabolic disorders. If Osgood-Schlatter’s disease is diagnosed early and treated consistently, the prognosis is generally good and the disease almost always heals without consequences at the latest after completion of the growth phase.
Complications
In this disease, in most cases, the affected person suffers from bone discomfort. There is a very strong ossification, which has a very negative impact on the quality of life of the affected person. As a rule, it is mainly children who suffer, so that the child’s growth and development are also significantly delayed by the disease. The disease can also have a very negative effect on adulthood and lead to complications. Patients suffer from pain, which can occur mainly in the knees. Tightening the muscles is also associated with pain in most cases, so that the children cannot participate in sports without further ado. The legs themselves also suffer from severe pain, which can occur in the form of pain at rest even without exertion. In many cases, the regions are also swollen or bruised. The treatment of this disease is carried out without complications with the help of physiotherapy. This can limit the discomfort. Shock wave therapy can also be used for healing. However, it cannot be predicted whether a complete cure will occur. However, the life expectancy of the patient is not reduced due to the disease.
When should you see a doctor?
If the knees hurt with exertion, especially during sports and when kneeling down, a doctor should be contacted. Osgood-Schlatter must be diagnosed quickly so that treatment can be initiated before pieces of bone become detached from the tibia. Severe pain in the tibia indicates an advanced condition that should be addressed immediately. Those affected are best advised to speak to their family doctor, who can make an initial tentative diagnosis and, if necessary, involve other specialists. The symptoms usually appear between the ages of nine and fourteen. Adolescents and adult extreme athletes are particularly affected. Anyone who belongs to these risk groups should go to the doctor immediately with the symptoms mentioned. Osgood-Schlatter can be treated well if it is detected early. Sufferers should therefore contact their doctor at the first suspicion. In addition to the family doctor, sports physicians, orthopedists and physical therapists can be consulted. Depending on the severity, treatment can be surgical or pain medication and preventive measures such as sparing.
Treatment and therapy
Because Osgood-Schlatter disease is attributed to overuse, therapeutic measures are primarily aimed at relieving the affected structures. For this purpose, in the early stages, weight-bearing rest, anti-inflammatory analgesics (anti-inflammatory drugs), cooling, and physiotherapy are generally indicated. Knee or patellar braces can additionally contribute to pain relief. In addition, affected children and adolescents may be excused from school sports. If more severe changes or a more advanced stage of the disease are present, immobilization of the knee by means of a Gipstutor (plaster cast), which restricts the rotation of the knee joint, may be indicated. This cast tutor is custom-fitted to the affected knee to prevent pressure on the patella (kneecap) and potential slippage. In some cases, forearm supports are also recommended to completely relieve pressure on the affected knee. Locally applied ointments may be used as a supportive measure. Likewise, a negative heel (heel lowering) of the shoe sole can help relieve patellar pressure. Recently, extracorporeal shock wave therapy has also been used to accelerate healing, although it has not yet been possible to clarify which factors are responsible for the individual success or failure of the therapy. In exceptional cases, surgical intervention may be indicated for detached ossicles such as sequestra (dead and demarcated bone tissue), joint mice (free joint bodies), or bone avulsions that irritate the ligaments and limit the mobility of the knee joint. In this case, surgical removal of the ossicles should be performed only after the growth phase has been completed. Furthermore, in children affected by Osgood-Schlatter disease who also have obesity, weight loss should be attempted.
Prevention
Because the underlying etiology for Osgood-Schlatter disease has not been fully elucidated to date, no prophylactic measures exist with respect to the disease.However, avoiding excess weight as well as one-sided strain on the muscles that support the knee joint can prevent Osgood-Schlatter or minimize the symptoms.
Aftercare
In most cases, the person affected by Osgood-Schlatter has only a few and also limited aftercare measures available to him or her. Because it is a genetic disease, it also usually cannot be completely cured. Therefore, affected individuals are usually always dependent on medical treatment by a physician. If the patient or the parents wish to have children, a genetic examination should be carried out first and foremost in order to prevent the recurrence of the disease. The treatment itself can be done by measures of physiotherapy or physiotherapy. The affected person can also perform some of the exercises at home, which may speed up the treatment. Many of those affected are dependent on the help and support of their own family in their everyday lives, whereby care and psychological support in particular can have a positive effect on the further course of the disease. In general, a healthy lifestyle is also to be strived for, whereby overweight should be avoided. In some cases, this disease reduces the life expectancy of the affected person.
Outlook and prognosis
Osgood-Schlatter offers a relatively good prognosis. The disease often resolves on its own. Many patients are symptom-free again after six to 18 months. In individual cases, however, Osgood-Schlatter can develop into a chronic disease. In addition, a large proportion of patients suffer from persistent pain when kneeling. If the pain persists for more than one to two years, a radiological examination is recommended. The physician can make the diagnosis and give the patient a reliable prognosis. The outlook for Osgood-Schlatter is good. Mild pain can be treated with medication. In addition, the disease progresses only slowly and does not significantly restrict the affected person in everyday life. An orthopedist or osteopath must determine the prognosis. For this purpose, he consults the examination results as well as the findings from the patient interview. Last but not least, the patient’s financial and social status also determines the prognosis. Expensive therapy procedures are not always covered by health insurance. All these factors must be taken into account in the prognosis. Due to the protracted course of the disease, the prognosis must be adjusted to the patient’s state of health at regular intervals.
What you can do yourself
In the case of Osgood-Schlatter, it is not necessary to consult a doctor. If the symptoms are mild, it is sufficient to take it easy on the knee and not subject it to any further stress for some time. The pain should subside after a few days to weeks. If Osgood-Schlatter does not subside on its own, medical advice is required. The physician will initially also recommend resting the affected limb and will also prescribe painkillers, anti-inflammatories and other medications. Patients can relieve the pain by regularly cooling the affected area. Curd compresses and other home remedies may also be used in consultation with the physician to reduce Osgood-Schlatter. If these measures have no effect, the doctor must be consulted again. It is possible that Osgood-Schlatter is based on a serious condition. If the course is positive, sports may be resumed after one to two weeks. Physiotherapy and massages contribute to a rapid recovery. Which therapy helps best should be worked out with the orthopedist. If there are repeated complaints, possible causes should be determined and remedied. Often it is already sufficient to warm up the muscles better before sports or to wear different shoes.
