Osgood-Schlatter disease (OSD) is a chronic fatigue injury due to repeated microtrauma at the patellar ligament insertion onto the tibial tuberosity, usually affecting boys between ages 10-15 years.
Osgood-Schlatter disease is seen in active adolescents, especially those who jump and kick, which is why it is seen more frequently in boys. It is bilateral in 25-50% of patients 1-3. Typical age of onset in females may be slightly earlier (boys 10-15 years; girls 8-12 years) 8.
Clinically, patients present with pain and swelling over the tibial tuberosity exacerbated with exercise.
Soft tissue swelling with loss of the sharp margins of the patellar tendon are the earliest signs in the acute phase; thus, a compatible history is also essential in making the diagnosis. Bone fragmentation at the tibial tuberosity may be evident 3 to 4 weeks after the onset.
It is important not to equate isolated 'fragmentation' of the apophysis with OSD, as there may well be secondary ossification centers.
Ultrasound examination of the patellar tendon can depict the same anatomic abnormalities as can plain radiographs, CT scans, and magnetic resonance images. The sonographic appearances of Osgood-Schlatter disease include 3:
- swelling of the unossified cartilage and overlying soft tissues
- fragmentation and irregularity of the ossification center with reduced internal echogenicity
- thickening of the distal patellar tendon
- infrapatellar bursitis
MRI, as expected, is more sensitive and specific, and will demonstrate:
- soft-tissue swelling anterior to the tibial tuberosity
- loss of the sharp inferior angle of the infrapatellar fat pad (Hoffa fat pad)
- thickening and edema of the distal patellar tendon
infrapatellar bursitis (clergyman's knee)
- a distended deep infrapatellar bursa can be a frequent finding 6
- bone marrow edema may be seen at the tibial tuberosity
Treatment and prognosis
Treatment is usually conservative and involves rest, ice, activity modification (decreasing activities that stress the insertion, especially jumping and lunging sports), and quadriceps and hamstring strengthening exercises. Analgesia and padding to prevent pressure on the tibial tuberosity are also useful. Only rarely are therapeutic casts required 4,5.
The condition spontaneously resolves once the physis closes.
In rare cases, surgical excision of the bone fragment(s) and/or free cartilaginous material may give good results in skeletally mature patients who remain symptomatic despite conservative measures.
Unresolved OSD is the term given to clinical and radiological findings of OSD that persist into adulthood.
History and etymology
It is named after American orthopedic surgeon Robert B Osgood (1873-1956) and Swiss professor of surgery Carl Schlatter (1864-1934).
Imaging differential considerations include:
- Sinding-Larsen-Johansson disease (SLJ): similar condition involving the inferior pole of the patella
- jumper's knee: involves the patellar tendon rather than the bone, and is essentially a tendinopathy with focal tenderness, although it may eventually be associated with bony changes (some authors do not distinguish between SLJ and jumper's knee)
- infrapatellar bursitis
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- 5. Prentice WE, Voight ML. Techniques in musculoskeletal rehabilitation. McGraw-Hill Medical. (2001) ISBN:0071354980. Read it at Google Books - Find it at Amazon
- 6. Rosenberg ZS, Kawelblum M, Cheung YY et-al. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology. 1992;185 (3): 853-8. doi:10.1148/radiology.185.3.1438775 - Pubmed citation
- 7. Hirano A, Fukubayashi T, Ishii T et-al. Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease. Skeletal Radiol. 2002;31 (6): 334-42. doi:10.1007/s00256-002-0486-z - Pubmed citation
- 8. Gholve PA, Scher DM, Khakharia S et-al. Osgood Schlatter syndrome. Curr. Opin. Pediatr. 2007;19 (1): 44-50. doi:10.1097/MOP.0b013e328013dbea - Pubmed citation
- 9. Dunn JF. Osgood-Schlatter disease. Am Fam Physician. 1990;41 (1): 173-6. Pubmed citation
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The knee is a complex synovial joint that can be affected by a range of pathologies:
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- arcuate complex avulsion fracture (arcuate sign)
- anterior cruciate ligament avulsion fracture
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
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- reverse Segond fracture
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- chondromalacia patellae
- osteoarthritis of the knee
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- knee fractures
- anterior cruciate ligament tear
- anterior cruciate ligament ganglion cyst
- anterior cruciate ligament mucoid degeneration
- posterior cruciate ligament tear
- medial collateral ligament tear
- lateral collateral ligament tear
- medial patellofemoral ligament tear
- posterolateral corner injury
- posteromedial corner injury
- meniscal lesions
- meniscal tear
- meniscal contusion
- meniscal/parameniscal cyst
- meniscal flounce
- meniscal fraying
- meniscal maceration
- meniscocapsular separation
- floating meniscus
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- fat pad
- popliteal fossa