Osgood Schlatter's disease

Osgood-Schlatter disease (osteochondropathy of the tibial tuberosity) is most often registered in the age group of 11-16 years, characterized by a violation of ossification of the apophysis of the tibial tuberosity. Teenagers who are actively involved in sports are more often affected. Repeated microtraumas of the apophysis, which is hypersensitive during this period, lead to persistent pathological afferentation and disorders of the neurocirculatory function, accompanied by its discirculatory changes. However, in some cases, pain in the apophyseal area is indicated by subjects who do not have a high level of sports activity. A unilateral and bilateral process is possible.

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How does Osgood-Schlatter disease manifest itself?

Osgood-Schlatter disease is characterized by pain in the area of the tibial tuberosity. The pain increases with active extension with resistance, jumping, running over rough terrain, and climbing and descending stairs.

What are the complications of Osgood-Schlatter disease?

Ostude-Schlatter disease is complicated by a high position of the patella (patella alts), caused by the rupture of a part of the proboscis process and its displacement from the patella itself proximally. This condition creates unfavorable biomechanical conditions in the knee joint, leads to the early development of patellofemoral arthrosis and necessitates more serious surgical correction.

How is Osgood-Schlatter disease recognized?

Locally, a change in the contours of the anterior surface of the upper metaphyseal zone of the leg is noted. An increase in the size of the tuberosity is characteristic. In a unilateral process, this is most obvious.

Pain is noted on palpation: most often when the apex of the apophysis is loaded, less often there is pain at the base of the tuberosity. Pain can also appear when pressing on the patellar ligament, it is caused by increased traction of the ligament by the proboscis process (a radiographically visible formation, separated from the base of the tuberosity by the growth plate). In some cases, inflammation of the bursa under the patellar ligament is noted, which significantly increases the pain.

Laboratory and instrumental studies

The main method that allows diagnosing Osgood-Schlatter disease is radiological. Patients united by a clinical picture, depending on age and radiological picture, can be divided into three main groups:

• with an X-ray picture of age-related ossification of the tibial apophysis;
• with delayed ossification of the apophysis;
• with the presence of a free bone fragment in the projection of the anterior surface of the proboscis process.

D. Shoylev (1986) identifies four successive stages of the process: ischemic-necrotic, revascularization, recovery stage and the stage of bone closure of the apophysis. Radiologically, each of the stages has changes characteristic of osteochondropathy:

• ischemic-necrotic stage - a decrease in the mineral density of the apophysis, a local radiological increase in bone density, characteristic of osteonecrosis;
• revascularization stage - radiologically evident fragmentation of the proboscis process;
• stages of recovery - normalization of bone structure, replacement of necrotic fragments with areas of normal bone structure.

Among the diagnostic methods that recognize Osgood-Schlatter disease, it is also worth noting computer thermography, which characterizes the stage of the process. The initial, acute stage is characterized by hyperthermia, which is subsequently replaced by hypothermia, characteristic of osteonecrosis with a corresponding radiographic picture.

During the treatment, as the trophism of the segment is restored, the thermotonographic picture is normalized.

Ultrasonography

Despite the clear radiographic picture, sonography reveals the presence of fragments and the apophysis region that are not registered on radiographs, which allows for a more complete picture of the extent of the process and the condition of the cartilaginous model of the proboscis process.

Computer tomography

It is used extremely rarely. This study is advisable to perform on patients whose X-ray examination revealed the presence of a free bone fragment not associated with the underlying apophysis, which confirms the literature data on the presence of a kind of pseudoarthrosis between the bone fragment and the tuberosity.

Most often, CT should be used when deciding on any surgical treatment for Osgood-Schlatter disease.

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Treatment of Osgood-Schlatter disease

Conservative treatment of Osgood-Schlatter disease

Treatment of Osgood-Schlatter disease is predominantly conservative, aimed at relieving pain: reducing signs of inflammation in the area of the attachment of the patellar ligament, normalizing the process of ossification of the tibial apophysis.

Patients suffering from Osgood-Schlatter disease are prescribed a gentle regimen. For those actively involved in sports, absolute cessation of sports activities is mandatory for the period of the conservative therapy course. It is advisable to fix the tuberosity with a bandage with a platform or wear a tight bandage to reduce the amplitude of the displacement of the proboscis process, carried out by a powerful patellar ligament when performing movements.

Osgood-Schlatter disease treatment involves the administration of anti-inflammatory and analgesic drugs. It is advisable to use bioavailable forms of calcium preparations in a dosage of up to 1500 mg/day, calcitriol up to 4 thousand U/day, vitamin E, group B, antiplatelet agents.

Physiotherapeutic treatment for Osgood-Schlatter disease is prescribed depending on the radiographic picture.

• In the case of radiological group I, Osgood-Schlatter disease is treated by a course of UHF and magnetic therapy.
• For patients in group II, Osgood-Schlatter disease is treated with electrophoresis of a 2% procaine solution on the tibial tuberosity area and on the L3-L4 area, followed by a course of electrophoresis of calcium chloride with nicotinic acid and magnetic therapy.
• Patients of group III - Osgood-Schlatter disease are treated with aminophylline electrophoresis, a course of potassium iodide or hyaluronidase electrophoresis followed by a course of calcium chloride electrophoresis with nicotinic acid and magnetic therapy. After a course of conservative therapy, improvement occurs in most cases: pain syndrome is absent or significantly reduced both at rest and under load. Sometimes its preservation is noted with vigorous palpation of the apophysis apex area, but with less pronounced intensity, and the lateral parts of the tuberosity are often painless. The treatment period is from 3 to 6 months.

It should be noted that a course of conservative treatment in the presence of an isolated bone fragment in the area of the tibial tuberosity is ineffective in most cases. Conservative treatment of Osgood-Schlatter disease without a pronounced clinical effect is one of the indications for surgical intervention.

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Surgical treatment of Osgood-Schlatter disease

Indications for surgical treatment are as follows:

• prolonged course of the disease;
• ineffectiveness of conservative treatment:
• complete demarcation of bone fragments from the underlying apophysis;
• the patient is 14 years old or older.

The basic principles of surgical treatment are as follows:

• minimal surgical trauma;
• maximum efficiency of the procedure.

Today, Osgood-Schlatter disease is treated with the following surgical methods:

• Stimulation of ossification of the apophysis by Beck (1946). Consists of tunneling of the tuberosity area with a bone fragment for fusion of the latter with the underlying bone.
• Pease's tuberosity stimulation (1934) - creating notches on the tuberosity,
• Implantation of autografts (eg, from the iliac wing) to stimulate osteoreparation.
• Movement of the attachment sites of individual parts of the apophysis.
• Extended decortication (Shoilev D., 1986).

The effectiveness of revascularizing osteoperforations has been shown in the following variants.

• Tunneling of the proboscis process to the growth plate under X-ray control (patients of the II, partially III radiological group) leads to acceleration of maturation of the cartilaginous model without premature closure of the growth zone. No recurvation deformation of the tibia was noted during growth,
• Tunnelization of the proboscis process with passage through the growth plate directly into the tibia (patients of the III radiographic group with the presence of a free bone fragment in the area of the proboscis process or fragmentation of the proboscis process in conditions of synostosis of the causal part of the latter with the tibia). Recurvation deformation of the tibia during growth was also not noted.

Extended decortications are performed in patients over 20 years of age with chronic bursitis in the area of the tibial tuberosity. This intervention involves removing not only the free bone fragment, but also the inflamed mucous bursa.

In the postoperative period, it is advisable to use a pressure bandage (a bandage with a platform or a tight bandage for up to 1 month) on the area of the tibial tuberosity. As a rule, early relief of pain is noted. Pain at rest ceases to bother patients already 2 weeks after surgery. Plaster immobilization in the postoperative period is usually not performed.

After surgery for Osgood-Schlatter disease, it is advisable to undergo a course of drug treatment in the trophoregenerative direction, as well as physiotherapy procedures aimed at accelerating the rate of osteoreparation of the proboscis process of the tibial tuberosity.

Approximate period of incapacity

The treatment period after surgery is approximately 4 months. Return to sports activities is possible 6 months after surgery.

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