Osgood Schlatter's disease

Osgood Schlatter's disease (osteochondropathy tuberosity of the tibia) is more often recorded in the age group 11-16 years, characterized by a violation of ossification of the apophysis tuberosity of the tibia. Often sick teenagers, actively involved in sports. Repeated microtraumas of the hypophyseal apophyses during this period lead to persistent pathological afferentation and disturbances of the neurocirculatory function, accompanied by its discirculatory changes. However, in some cases, the pain in the area of apophyses is indicated by subjects that do not have the height of sports activity. A one-sided and two-sided process is possible.

[1], [2], [3]

How is Osgood Schlatter's disease manifested?

The disease of Osgood Schlatter is manifested by pain in the region of tuberosity of the tibia. The pain increases with active extension with resistance, jumping, running across rough terrain, climbing and descending the stairs.

What are the complications of Osgood Schlatter's disease?

Disease of the Schlatter's Cold is complicated by the high standing patella alts, caused by the detachment of a part of the proboscis process and its displacement from its own removed patella proximally. This condition creates unfavorable biomechanical conditions in the knee joint, leads to early development of patellofemoral arthrosis and leads to the need for more serious surgical correction.

How is Osgood Schlatter's disease recognized?

Local change is noted in the contours of the anterior surface of the upper metaphyseal zone of the tibia. Characteristic increase in tuberosity in size. In a one-sided process, this is the most obvious.

With palpation, pain is noted: more often when the apophyses are loaded on the apex, the soreness of the tuberosity is less often. Pain can also appear with pressure on the patellar's own ligament, it is caused by increased traction of the ligament behind the proboscis process (radiologically visible formation, separated from the base of tuberosity by the growth plate). In some cases, inflammation of the bag under its own patella ligament is noted, which greatly increases the pain.

Laboratory and instrumental research

The main method that allows to diagnose Osgood Schlatter's disease is X-ray. Patients, united by a clinical picture, depending on the age and the radiographic picture, can be divided into three main groups:

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

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

• ischemically necrotic stage - decrease in apophysial mineral density, local radiographic increase in bone density, characteristic of osteonecrosis;
• revascularization stage - X-ray manifestation of fragmentation of the proboscis process;
• the restoration stage - the normalization of the bone structure, the replacement of necrotic fragments with parts of the normal bone structure.

Among diagnostic methods that recognize Osgood Schlatter's disease, computer thermography should also be noted that characterizes the stage of the process. The initial, acute stage is characterized by hyperthermia, which is then replaced by hypothermia, characteristic of osteonecrosis with an appropriate radiographic picture.

In the process of treatment, as the recovery of the trophic segment is marked normalization of the thermotonic picture.

Ultrasonography

Despite the visual radiographic picture, the presence of the fragments and areas of the apophysis that are not recorded on X-rays is sonographically revealed, which allows us to obtain a more complete picture of the degree of the process and the state of the cartilaginous model of the proboscis process.

CT scan

They are used extremely rarely. This study is expedient for patients who have had a free bone fragment that is not associated with the underlying apophysis, which confirms the literature data on the presence of a kind of pseudoarthrosis between the bone fragment and tuberosity.

Most often, CT should be used when deciding on a surgical method for treating Osgood Schlatter's disease.

[4], [5], [6],

Treatment of Osgood Schlatter's Disease

Conservative treatment of Osgood Schlatter's disease

Osgood Schlatter's disease treatment is predominantly conservative, aimed at arresting the pain syndrome: reducing the signs of inflammation in the area of attachment of the patellar ligament, normalizing the process of ossification of the apophysis of the tibia.

Patients suffering from Osgood Schlatter's disease are prescribed a sparing regimen. For those actively engaged in sports, absolute cessation of sports activities is mandatory for the period of the course of conservative therapy. It is desirable to fix the tuberosity with a bandage with a pad or to wear a tight bandage to reduce the amplitude of the displacement of the proboscis process, which is carried out by a powerful patellar patella during the movement.

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

Physiotherapeutic treatment of Osgood Schlatter's disease is prescribed depending on the radiographic pattern.

• With the first X-ray group, Osgood Schlatter's disease is treated by taking a course of UHF and magnetotherapy.
• Patients of the second group - Osgood Schlatter's disease is treated by electrophoresis of a 2% solution of procaine on the region of tuberosity of the tibia and on the L3-L4 region, followed by a course of calcium chloride electrophoresis with nicotinic acid and magnetotherapy.
• Patients of the III group Osgood Schlatter's disease are treated with aminophylline electrophoresis, a course of potassium iodide electrophoresis or hyaluronidase followed by a course of calcium chloride electrophoresis with nicotinic acid and magnetotherapy. After the course of conservative therapy in most cases, there is an improvement: there is no or significantly reduced pain syndrome both at rest and during exercise. Sometimes it is noted that it persists with vigorous palpation of apophyses apex region, but less pronounced intensity, and lateral parts of tuberosity are more often painless. Treatment terms range from 3 to 6 months.

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

[7], [8]

Surgical treatment of Osgood Schlatter's disease

Indications for surgical treatment are as follows:

• prolonged course of the disease;
• inefficiency of conservative treatment:
• complete demarcation of bone fragments from the underlying apophysis;
• age of the patient is 14 years and older.

The basic principles of surgical treatment are as follows:

• minimal operating injury;
• maximum efficiency of the procedure.

To date, Osgood Schlatter's disease is treated with such operational methods:

• Stimulation of the apophysis ossification to Beck (1946). It is the tunneling of the region of tuberosity with the bone fragment for the fusion of the latter with the underlying bone.
• Stimulation of tuberosity by Pease (1934) - the creation of incisions on tuberosity,
• Implantation of autografts (for example, from the iliac wing) to stimulate osteoreparation.
• Movement of attachment sites for individual parts of the apophysis.
• Extended decortication (Shoilev D., 1986).

The effectiveness of revascularization osteoperforation in the following variants is shown.

• Tunnelization of the proboscis spine to the growth plate under X-ray control (patients II, partially III radiological group) leads to faster maturation of the cartilage model without premature closure of the growth zone. Recurrent deformation of the tibia during growth was not noted,
• Tunnelization of the proboscis spine passing through the growth plate directly to the tibia (III radiological patients with a free bone fragment in the region of the proboscis process or fragmentation of the proboscide process in the synostosis of the causal region of the latter with the tibia). The recurrent deformation of the tibia during growth was also not noted.

Extended decortication is performed in patients older than 20 years in the presence of chronic bursitis in the region of tuberosity of the tibia. With this intervention, remove not only the free bone fragment, but also its inflamed mucous bag.

In the postoperative period, it is advisable to use a pressure bandage (bandage with a pad or tight bandage for up to 1 month) on the region of tuberosity of the tibia. As a rule, early pain relief is noted. Will at rest no longer disturb patients in 2 weeks after the operation. Gypsum immobilization in the postoperative period, as a rule, is not performed.

After the operation for Osgood Schlatter's disease, it is advisable to conduct a course of medicinal treatment of trophoregenerative direction, as well as physiotherapy procedures aimed at accelerating the rate of osteorecarrection of the proboscide process of tibial tuberosity.

Estimated period of incapacity for work

The duration of treatment after surgery is approximately 4 months. Return to sports loads is possible 6 months after the operation.

[9]