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
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.
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
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.
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.
Photo 1 Bony prominence
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.
The disease is most common in truck and field, soccer, volleyball, basketball, badminton, and in motion sports involving jumps, dashes, kicks, and full squats.
Jumper’s knee occurs above and below the patella and affects slightly elder people.
Photo 2 X-ray
Photo 3 MRI images
Photo 4 Screening by echo
Photo 5 Echo Screening Image
Treatment and rehabilitation
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.
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.
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)