Osgood-Schlatter Disease ( Teen-Age Knee Pain)

Osgood-Schlatter disease is a common cause of knee pain in growing adolescent An inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia).

Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. * Physical activity puts stress on bones and muscles Growth plates are areas of cartilage located near the ends of bones. When a child is fully grown, the growth plates harden into solid bone. Children who participate in athletics — especially running and jumping sports - increased risk for this condition.

Pathophysiology : Growth plates serve as attachment sites for tendons, the strong tissues that connect muscles to bones. A bony bump ( tibial tubercle ) covers the growth plate at the end of the tibia. The group of muscles in the front of the thigh ( quadriceps) attaches to the tibial tubercle. When a child is active, the quadriceps muscles pull on the patellar tendon which in turn, pulls on the tibial tubercle. In some children, this repetitive traction on the tubercle leads to inflammation of the growth plate. The prominence, or bump, of the tibial tubercle may become very pronounced.

Risk factors : * Male sex (3:1) * Rapid skeletal growth * Age: female 8-12 years & male between 12-15 years * Male sex (3:1) * Rapid skeletal growth * Repetitive sprinting and jumping sports

Symptoms : Painful symptoms are often brought on by running, jumping, and other sports-related activities. In some cases, both knees have symptoms, although one knee may be worse than the other. Knee pain and tenderness at the tibial tubercle Swelling at the tibial tubercle Tight muscles in the front or back of the thigh

Diagnosis : : Physical examination Plain X film Ultrasound MRI

Treatment : Standing quadriceps stretch. Reducing pain and swelling Limiting exercise activity until your child can enjoy activity without discomfort or significant pain Rest from activity is required for several months Strength conditioning program

Conclusion : The cause of Osgood-Schlatter disease is unknown A traction phenomenon resulting from repetitive quadriceps contraction through the patellar tendon at its insertion upon the immature tibial tubercle. Repeated knee extensor mechanism contraction that causes partial microavulsions of the chondrofibro-osseous tibial tubercle. The repetitive runner, jumper athletic patient population OSD occurs most commonly.

Conclusion： The prognosis in Osgood-Schlatter disease (OSD) is excellent. OSD is usually self-limiting and resolves by the time the patient is aged 18 years, when the tibial tubercle apophysis ossifies. In approximately 10% of patients, however, the symptoms continue unabated into adulthood despite all conservative measures. This may be from residual enlargement of the tuberosity or from ossicle formation in the patellar tendon.

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