Presentation about Osgood-Schlatter-Disease for Clinical Officers working in a Tanzanian hospital.

1. Osgood-Schlatter Syndrome
Dr Christian van Rij, 8 July 2010

3. Case Report
• 12 year old boy
• Fell on a stone five
weeks ago
• Still swelling and pain
of the right knee
• X-ray gave the
impression fracture of
the ‘lateral condyl’
(POP was incorrectly given)

4. What is Osgood-Schlatter Syndrome
• Described in 1903 by Dr Osgood & Dr Schlatter
– Incidence up to 12% in children
• Traction Apopohysistis of the Tuberositas Tibia,
• Caused by micro-alvulsions on the secondary
ossification centre due to excessive strength on
the patellar tendon
• This leads to excessive growth of the
tuberositas and often pain complaints

5. Patellar Tendon

6. Bone Ossification Centers
• Diaphyse: Primary Center of Ossification
• Epiphyse: Secondary Center of Ossification
• Apophyse: like SCO but develops on traction spot
(therefore sometimes called a traction epiphyses)

7. Tuberositas Tibia Ossification
• Tuberositas ossification
starts at 7-9 years
• Ossification starts distal
and grows first towards
the epiphysis
• Patellar tendon
connects at the
tuberositas’ distal end

8. Etiology
• Rapid growth of the bones causes increased
traction force on the patellar tendon
– Children involved in sport activities like running and
jumping have are exposed to even higher traction
• The Tuberculum starts to ossify from 7 years
onwards but when the traction forces are to
excessive, microalvulsions can occur where the
bone connects with the epifyis of the tibia

9. Patellor Tendon Attachment

10. MRI showing site of the alvulsions

11. Symptoms Osgood-Schlatter
• Tuberositas : local pain & sometimes swelling
• Sometimes a higher tension of the quadriceps
and hamstrings muscles palpable
• Symptoms aggravated by exercises like kneeling,
running, jumping
• 50% of patient have slow onset of complaints,
in the other half there was a luxating injury
• About 25% of patients have bilateral complaints

12. Treatment
• Conservative treatment:
– Rest, Ice, NSAIDs and stretching exercises
– Some patient benefit from a brace
• Complaints reoccur frequently in the following
year, but 1 year 90% of patients is cured as the
ossification centers fuse

13. Persistent complaints
• 10% of patients have persistent complaints even
when the skeleton has matured; often due to:
– Bursitis above the tuberositas
– An incomplete fusion leaving an ossicle
• In special cases surgical
resection

14. Differential
• Fractures
• Jumpers knee: Sinding-Larsen-Johansson syndr.
• Osteochondritis dissecans of the knee
• Patellar instability
• Bursitis
• Tendinitis
• Referred pain

15. References
1. AK Chang, Osgood-Schlatter Disease, Emedicine.medscape.com,
2005, http://emedicine.medscape.com/article/827380-overview
2. PA Gholve, DM Scher, S Khakharia, RF Widmann, DW Green; Osgood
Schlatter syndrome; Curr Opin Pediatr. 2007 Feb;19(1):44-50
3. Kujala UM, Kvist M, Heinonen O. Osgood-Schlatters disease in
adolescent athletes. Retrospective study of incidence and duration.
Am J Sports Med. Jul-Aug 1985;13(4):236-41
4. JA Sullivan, Osgood-Schlatter Disease, Emedicine.Medscape.com,
2009, http://emedicine.medscape.com/article/89569-overview
5. Engel A, Windhager R (1987), Importance of the ossicle and therapy
of Osgood-Schlatter disease, Sportverletz Sportschaden 1 (2): 100–8
6. Krause BL, Williams JP, Catterall A. Natural history of Osgood-
Schlatter disease. J Pediatr Orthop. Jan-Feb 1990;10(1):65-8