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Osgood-Schlatter disease

Osgood-Schlatter disease

Doctor

Mitsutoshi Hayashi

Doctor of Medicine, specialist in the Japanese Society of Rehabilitation Medicine, specialist in the Japanese Society of Orthopaedic Surgery, specialist in the Japanese Society of Rheumatology, staff to strengthen JOC, and sports physician certified by the Japan Sports Association
Osgood-Schlatter disease

Osgood-Schlatter disease

In Osgood-Schlatter disease, the tibial tubercle is strongly pulled by the knee flexion and extension during jumping, and dash and kick movements. And the patient feels pain due to peeling off and irritation of the tibial tubercle.

Disease Overview

Osgood-Schlatter disease is a representative sports disorder at growth phase caused by overuse of the knee, which is common among male elementary and junior high school students. During growth spurts, height increases rapidly and bones grow rapidly, but unfortunately, soft tissues, such as muscles and tendons, do not grow likewise. Loss of quadriceps muscle flexibility (so-called muscles of thigh are stiff) causes strain, pulling the patella by repeated movements, such as jumps and dashes, to the tibial tuberosity. The growing tibial tuberosity contains new bones (epiphyseal nuclei) that are required for bone growth. However, strong traction by the quadriceps muscle prevents the development of the epiphyseal nuclei and it causes pain.

Cause and mechanism of onset

Mechanism

The mechanism of knee extension at the front of the femoral part of the knee
(1) attaches the quadriceps muscle to the upper end of the patella,
(2) passes through the patella,
(3) passes through the lower end of the patella through the patellar tendon, and
(4) attaches to the tibial tuberosity.
Thus, the strength of the quadriceps muscle ultimately passes on to the tibial tuberosity. Since the tibial tuberosity is only about 1.5×2.0 cm2 in size, the growth of the epiphyseal nucleus is inhibited by the traction force of the quadriceps muscle, and the structure is weak enough to peel off.

Symptoms

Osgood-Schlatter disease is one of the most common symptoms which can occur during all sports activities particularly during knee flexion and extension in jumping (volleyball, basketball), and in dash and kicking (soccer). Pain limited to the tibial tuberosity below the patella and severe tenderness are the main symptoms. Local warmth, swelling, and bony prominences (Photo 1) are noted. Occasionally, both sides are affected. Pain during jumping may lead to a decrease in jumping ability or a worse time due to pain during the dash. However, it is difficult to determine breaks from sports because it is not an acute injury (sudden injury), and some athletes continue to engage in sports activities while holding pain.
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Photo 1 Bony prominence

Diagnosis

X-rays are the most helpful, which shows changes in the epiphyseal nuclei and free fragments localized to the tibial tuberosity (Photo 2), but they vary in size depending on the stage of disease. Magnetic resonance imaging (MRI) is even more useful in detecting thickening of the patellar tendon over the cartilage and surrounding inflammatory changes (Photo 3). Ultrasound can also show enlarged bones and tendons, as well as new blood vessels. (Photos 4 and 5)

Difference between the sexes

Most of the patients are boys who are 10 and 16 years olds.

Popular sports

The disease is most common in truck and field, soccer, volleyball, basketball, badminton, and in motion sports involving jumps, dashes, kicks, and full squats.

Related disease

Jumper’s knee occurs above and below the patella and affects slightly elder people.
Photo 2 X-ray
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Photo 3 MRI images
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Photo 4 Screening by echo
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Photo 5 Echo Screening Image
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Treatment and rehabilitation

Treatment

Icing is the most effective way for first aid. Anti-inflammatory analgesics (external or internal medicine) and physical therapy, such as ultrasound and low-frequency waves, may also effective. Quadriceps muscle stretching is important for prevention, and knee braces for Osgood-Schlatter disease may also help. Rarely, removal of bone fragments or bone fenestration in which a piece of bone is drilled to bleed and be refreshed are operated.

Prognosis

Passed through growth spurts, the bones become firm, and the symptoms usually become milder. However, in adulthood, exertional forces can cause pain in the area of abnormal bone formation when the knees are overused, which is called sequela of Osgood-Schlatter disease. One point of advice: Please continue stretching even if the symptoms getting better.
Doctor

Yasuhiro Nakajima

Head coach of Shonan Bellmares Sports Club Triathlon Team, Head coach of Triathlon Team of Nippon Sport Science University, and Chairman of the Japan Triathlon Union Multi-sports Committee
Osgood's disease (Osgood-Schlatter's disease)

Prevention

Please suspect Osgood-Schlatter disease if you feel pain when you press the below part of patella. It is recommended to consult a sports doctor. You can’t adjust the amount of exercise for themselves, so the coach should control them carefully. For this reason, athletes in growth period need to check for flexibility (Figure) and pain (Photo 6) and to monitor their condition regularly. Warm-up, cool-down, stretching, or icing are essential and athletes should make those a habit for their future.

On-site evaluation and first aid

Please suspect Osgood-Schlatter disease if you feel pain when you press the below part of patella. It is recommended to consult a sports doctor. You can’t adjust the amount of exercise for themselves, so the coach should control them carefully. For this reason, athletes in growth period need to check for flexibility (Figure) and pain (Photo 6) and to monitor their condition regularly. Warm-up, cool-down, stretching, or icing are essential and athletes should make those a habit for their future.
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Figure: Flexibility check of the thigh

Please check whether the heel can touch the buttocks while lying prone and bent your knee. The knee is bent while prone to check if the heel (heel) can touch the buttocks. It is usually easy to do, but the poor of quadriceps muscle flexibility creates a space between the heels and buttocks, and, in severe cases, the buttocks rise to force the knees to bent.
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Photo 1 Check for pain

Press the tibial surface to check for pain, warmth, or swelling

Reconditioning

Osgood-Schlatter disease is a sports disorder due to bone growth and overuse in sports activities. It is caused by the decrease of quadriceps muscle flexibility and the strain on the tibial tuberosity. Stretching, icing, warm-up, and cool-down are therefore important in improving quadriceps muscle flexibility.

Phase 1 (Mild symptoms)

Warm-ups and cool-downs are used when the person feels pain after a sports activity or waking up and does not feel pain during activities of daily life. And please stretch quadriceps muscle, two to three sets with 30 seconds per set.
This is caused by a decrease in the flexibility of the quadriceps muscle. In particular, carefully stretching the quadriceps muscle and two to three sets, with 30 seconds per set.
The quadriceps muscle consists of the vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris muscles. Because the rectus femoris originates in the pelvis (anterior inferior iliac spine) across the hip joint, stretching which not only flexing knee but also extending the hip joint is required (Photo 1). Because the floor touches the affected area and may cause soreness and pain (Photo 2).Stretching standing position is also required. After training, it is recommended to icing the affected area.
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Stretching the quadriceps muscle placing a knee on the floor (Photo 2). One person can do it alone, but it is more effective if another one holds the ankle and helps to flexe the knee. Please be aware that this stretching may cause a strong load.
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Stretching of the quadriceps muscle standing and extending hip joint (Photo 3). Atheltes with low back pains may have pain and tense abdominal muscles.

Phase2 (moderate symptoms)

If pain does not interfere with sports activities but becomes more painful after completion, and does not interfere with daily activities, it is not needed to stop sports activities entirely. However, the amount of exercise (frequency, intensity, and time) must be controlled to the extent that pain is not intense.
As of team sports for children, it is difficult to handle specifically for only athlete, but it is necessary to control the team’s atmosphere by explaining it to the teammates. Warm-up, cool-down, and stretching are also recommended as well as for mild symptoms. Because intense stretching can increase stress on the affected area, mild stretching should be done more frequently in a short time to relax rather than stretch the muscles.
Growing child athletes become increasingly strong, and which tend to let them powerful training.
It is also a time when the nervous system develops, so it is important to provide instructions as it is a period of learning about “dexterity”. When adjusting the amount of exercise for an athlete in pain, training to improve dexterity and exercise instruction focusing on the upper body may be helpful. Swimming is an exercise mainly for upper body, but when the pain is caused by hitting a kick, an athletes can hold a pull buoy or kickboard between the legs and which enable them to swim only using the upper body.

Phase 3 (Severe symptoms)

If pain interferes with sports activities and causes inconvenience in their daily activities, it may be needed to stop sports activities according to a doctor’s instructions. However, exercises that do not involve the lower extremities may be performed, so swimming with the upper body alone, using a pull buoy, as described above, minimizes decreasing physical power.
Please don’t increase rapid intensity or volume as symptoms subside and return to sports activities. Running on the ground can also be stressful to the knee, so it should be performed on such as grass or soil, but at a slower rate it can be started with symptoms, with the speed gradually increased. Jumps, running speeds, rapid deceleration, and sudden turns also place a strong burden on the quadriceps muscle, the speed is adjusted according to the pain.
Movements that increase the burden on the quadriceps muscle, such as poor posture and different landing points during running, need to be adjusted at this time to prevent other problems.

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