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Tuesday, June 10, 2014

Patient Information Article: What is Osgood Schlatter Disease?

Osgood Schlatter Disease, also known as "Knobby Knees" is actually not a disease at all, but rather an overuse syndrome. This condition is named after two Orthopaedic Surgeons (Robert Osgood, Carl Schlatter) who discovered it. It is the most common cause of knee pain in adolescents.

What is Osgood Schlatter Disease?

Osgood Schlatter Disease (OSD) is a chronic inflammation of one of the knee ligaments, called the "Patellar Ligament" where it anchors to the Tibia Bone (Tibial Tuberosity) just below the Knee Joint. Repetitive activities such as sports (soccer, basketball, football, volleyball, gymnastics) cause strain on this ligament which in turn irritates the bone where it attaches. It is thought that overuse of the quadriceps muscle in the front of the thigh is the main culprit of OSD. The Knee Joint itself or its function is not involved in OSD.

Lets first take a look at the Anatomy of the Knee to better understand this disease and all the medical terms. Pay specific attention to the location of the Tibial Tuberosity which is the upper front part of the Tibia, just below the Knee Joint. This Color X-Ray is Interactive. Move your mouse cursor over the Image and see Interactive Image tags come to life. Each Tag displays text to explain a specific structure.


Lateral Color X-Ray of the Knee Joint Anatomy
Interactive Color X-Ray of the Knee Anatomy

We can see more detail of the Anatomy on this Color MRI of the Knee Joint. This MRI shows the Patellar Ligament which is strained in Osgood Schlatter Disease. This Image is also interactive.



Sagittal Color MRI Knee Joint meniscus, patellar ligament, quadriceps tendon
Interactive Color MRI of the Knee Joint Anatomy

 
Now that we have seen the Normal Anatomy, let take a look at a Color X-Ray of a patient with Osgood Schlatter Disease. Notice the red area in front of the Tibia. Chronic irritation at the attachment point of the Patellar Ligament has caused a large bone callus. This Image is also Interactive.



Lateral Color X-Ray of Osgood Schlatter Disease
Interactive Color X-Ray of Osgood Schlatter Disease

Who Gets Osgood Schlatter Disease?

This condition is common in adolescents at the beginning of their growth spurt: Girls ages 8-13; Boys ages 10-15. It is uncommon for a teenager to develop OSD after the age of 16. Boys are more likely to develop OSD than girls. Athletes are far more common to get OSD than those not consistently involved in sports.


What are the common Symptoms of Osgood Schlatter Disease?

Patients usually develop pain and swelling just below the Knee Joint. This is due to the inflammation of the Patella Ligament and the Bone where the Ligament attaches to the Tibia.
The pain is commonly worse after exercise since this irritates the ligament and bone. In the early stages of the disease, the symptoms are usually mild and intermittent. Later, it can be more consistent even without straining the knee.


What are the potential Complications of Osgood Schlatter Disease?

Some OSD patients develop small fractures (avulsion fracture) of the excess bone callus which forms in the front of the Tibia at the Tibial Tuberosity. This is called an "avulsion fracture". The Color X-Ray below shows this type of fracture. The Patellar Ligament has pulled off a large piece of Bone. This Image is Interactive.



Lateral Color X-Ray of the Knee Joint showing an Avulsion Fracture due to Osgood Schlatter Disease
Interactive Color X-Ray of an Avulsion Fracture due to Osgood Schlatter Disease
 
Here is a Color MRI which shows this type of fracture in more detail. This Image is Interactive.


Sagittal Color Knee Joint MRI of Osgood Schlatter related Avulsion Fractures
Interactive Color MRI of an Avulsion Fracture from Osgood Schlatter Disease


How is Osgood Schlatter Disease treated?

OSD usually resolves on its own over the course of several months. However in some patients the symptoms can last for much of the growth spurt, but rarely beyond. The most important treatment is to either avoid or limit the physical activity (sports, etc.) which causes the symptoms. During painful episodes, ice and mild anti-inflammatory medications can help. Wearing Knee pads during sports is also helpful.

Hamstring and Quadriceps stretches can balance the muscles, ligaments and tendons around the Knee Joint. The "Strickland Protocol" has been shown to reduce the downtime from sports activities significantly. This protocol is a combination of myofascial release massage and quadriceps stretches.

Surgery is rarely needed for OSD and is reserved for severe or long-term cases lasting past the growth spurt. The Surgery removes the excess bone which has formed on the Tibial Tuberosity. The outcomes of this Surgery are reported to be quite good.

The long-term consequences of OSD are usually limited to a bump below the Knee. Some mild knee pain with kneeling can remain into adulthood.


If you enjoyed this Blog, here some recent MMI Blogs of related topics:

What is the Knee Joint? Shown and Explained with Color X-Ray Images!
What is Hip Joint Arthritis? Shown and Explained with Color X-Ray and Color MRI Images!

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