1. Osgood-Schlatter Disease
( Teen-Age Knee Pain)

2. 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).

3. 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.

4. 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.

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

6. 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

7. Diagnosis : :
Physical examination
Plain X film
Ultrasound
MRI

8. 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

9. 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.

10. 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.

11. Q & A
Dr. 熊永萬
Dr. Bear