Updated: 5/31/2021

Osgood Schlatter's Disease (Tibial Tubercle Apophysitis)

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https://upload.orthobullets.com/topic/3029/images/osgood-schlatter_moved.jpg
https://upload.orthobullets.com/topic/3029/images/lat xr.jpg
https://upload.orthobullets.com/topic/3029/images/t2 mri.jpg
https://upload.orthobullets.com/topic/3029/images/xr slj.jpg
https://upload.orthobullets.com/topic/3029/images/mri t2 slj.jpg
  • Summary
    • Osgood-Schlatter disease is osteochondrosis or traction apophysitis of the tibial tubercle, commonly presenting as anterior knee pain in the pediatric population. 
    • Diagnosis is made clinically with an enlarged tibial tubercle and supplemented with radiographs of the knee that reveal irregularity and fragmentation of the tibial tubercle.
    • Treatment is nonoperative with NSAIDs, activity modification with quadriceps stretching and typically resolves with physeal closure.
  • Epidemiology
    • Demographics
      • male:female ratio
        • more common in boys
      • age bracket
        • boys 12-15y
        • girls 8-12y
    • Anatomic location
      • bilateral in 20-30%
    • Risk factors
      • jumpers (basketball, volleyball) or sprinters
  • Etiology
    • Pathophysiology
      • stress from extensor mechanism
  • Anatomy
    • Tibial tubercle is a secondary ossification center
      • age <11y, tubercle is cartilaginous
      • age 11-14y, apophysis forms
      • age 14-18y, apophysis fuses with tibial epiphysis
      • age >18y, epiphysis (and apophysis) is fused to rest of tibia
  • Presentation
    • Symptoms
      • pain on anterior aspect of knee
      • exacerbated by kneeling
    • Physical exam
      • inspection
        • enlarged tibial tubercle
        • tenderness over tibial tubercle
      • provocative test
        • pain on resisted knee extension
  • Imaging
    • Radiographs
      • recommended views
        • lateral radiograph of the knee
      • findings
        • irregularity and fragmentation of the tibial tubercle
    • MRI
      • indications
        • not essential for diagnosis
        • diagnosis can be made based on history, presence of tender swelling and radiographs alone
      • findings
        • soft tissue swelling
        • thickening and edema of inferior patellar tendon
        • fragmentation and irregularity of ossification center
  • Differential
    • Sinding-Larsen-Johansson syndrome
      • chronic apophysitis or minor avulsion injury of inferior patella pole
      • occurs in 10-14yr old children, especially children with cerebral palsy
    • Osteochondroma of the proximal tibia
    • Tibial tubercle fracture
    • Jumpers knee
  • Treatment
    • Nonoperative
      • NSAIDS, rest, ice, activity modification, strapping/sleeves to decrease tension on the apophysitis and quadriceps stretching
        • indications
          • first line of treatment
        • outcomes
          • 90% of patients have complete resolution
      • cast immobilization x 6 weeks
        • indications
          • severe symptoms not responding to simple conservative management above
    • Operative
      • ossicle excision
        • indications
          • refractory cases (10% of patients)
          • in skeletally mature patients with persistent symptoms
  • Complications
    • Complications of cast immobilization
      • quadriceps wasting
  • Prognosis
    • Self-limiting but does not resolve until growth has halted
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(OBQ13.21) A 13-year-old male patient presents with complaints of bilateral knee pain. He notes that the pain is increased with jumping, squatting or running up a flight of stairs. No other joints are affected. On physical exam, he has tenderness to palpation directly over his tibial tubercles. No effusion is noted. Radiographs are shown in Figures A and B. What is the most likely diagnosis?

QID: 4656
FIGURES:
1

Lyme disease

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(13/6676)

2

Stress fractures of the tibial plateau

0%

(16/6676)

3

Osgood-Schlatter disease

98%

(6531/6676)

4

Patellar tendinopathy

1%

(42/6676)

5

Sinding-Larsen-Johansson syndrome

1%

(48/6676)

L 1 B

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