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Osgood Schlatter Disease


Osgood-Schlatter is defined by a characteristic soreness and swelling at the tibial tuberosity. It usually originates in those between the ages of 9 and 16 who are both physically active and in a "growth spurt". If unresolved it can be painful, of long duration, and have permanent detrimental effects both on the bone, as well as on a young athlete’s potential for both immediate performance and future college scholarships.

 

A recent Finnish study found that 13% of the teenagers of that country had symptoms of Osgood-Schlatter Disease. The disease was named after two physicians who defined it in 1903, Dr. Robert Osgood and Dr. Carl Schlatter. Currently there are over 25 million children in the United States of America who are in the susceptible age group. With over half of them engaging in some athletic activity, it is possible that 2 million American boys and girls may contract OS yearly. The initial injury is probably caused by the powerful quadriceps muscle pulling on the attachment point of the patellar tendon during activities such as soccer, basketball, track and other sports. The subsequent inflammation makes it stubbornly persistent. Once found mainly in boys, it now happens almost as frequently in girls.

 

Doctors think that the pull of the large powerful muscles in the front of the thigh (called the quadriceps) is what causes Osgood-Schlatter disease. The quadriceps join with the patellar tendons, which run through the knee and into the shin bone, to connect the muscles to the knee. When the quadriceps contract, the patellar tendons can start to pull away from the shin bone, causing pain.

 

The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be extremely painful when hit.

The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relate a history of precipitating trauma.

In a retrospective study of adolescents, young athletes actively participating in sports showed a frequency of 21% reporting the syndrome compared with only 4.5% of age-matched nonathletic controls.[3] Very intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and especially ascending or descending stairs and during kneeling. The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. Pain is mild and intermittent initially. In the acute phase the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of patients.

 

Activities that require running, jumping or going up or down stairs can make the pain worse. Osgood-Schlatter is most common in young athletes who play football, soccer or basketball or are involved in gymnastics and ballet.

 

Osgood-Schlatter disease is probably the most frequent cause of knee pain in children. The condition occurs most commonly in children between the ages of 9 and 16 years but it can occur in younger children. Both boys and girls are equally vulnerable to its debilitating effects. Osgood-Schlatter disease is always characterized by activity-related pain that occurs a few inches below the knee-cap, or patella, on the front of the knee. The child will have swelling in the area, and tenderness to touch. Sports requiring lots of running, jumping, kneeling, and squatting are particularly associated. Many children first signal the start of the problem by rubbing the top of their "shinbones" with their hands, or even ice cubes, at practice sessions.

 

The surgical repair usually involves fixing the displaced bone with one or two screws. Surgery is then followed by four to six months of rehabilitation.

 

 

 

   

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