yogabook / pathologie / osgood-schlatter disease

osgood-schlatter disease / Morbus Osgood-Schlatter / rugby knee / juvenile Osteochondrosis

Definition of

Painful irritation of the osseous insertion of the lig. Patellae on the tibia, possibly with partial avulsion and aseptic bone necrosis. This is not an insertional tendinopathy, but an aseptic osteochondrosis/osteonecrosis as in the case of Scheuermann’s disease, Perthes‘ disease and Köhler’s disease. Mostly male adolescents and athletes are affected, M:W 10:1, slowly equalizing, as girls are increasingly involved in intensive sport, they are affected on average 1 – 2 years earlier. Typical age W: 11-12, M: 13-14. 5-20% of people, depending on sporting activity: sporting adolescents are affected 4:1 more frequently. Only in 25% on both sides. As a rule, Osgood-Schlatter disease is an overuse syndrome resulting from a genetic predisposition. It occurs in 20% of athletic adolescents, but only in 5% of non-athletic adolescents. The disease is self-limiting, i.e. it burns out at the end of the growth phase, possibly with thickened tibial tuberosity.

The disorder in the area of the tibial tuberosity with secondary changes at the apophysis of the attachment of the patellar ligament is related to growth spurts of the tibia and especially the distal epiphysis of the femur as well as sports that place particular demands on the affected muscles, such as ball sports with kicking and stopping movements like soccer. Ossicles that form and persist can remain painful in the long term and should be removed. Rest or suspension of sporting activities – insofar as they put strain on the knee joint – as well as a diagnosis of the musculoskeletal system with regard to muscular imbalances is then required.

ICD M92

Cause

1. Presumably training-related overload in genetically predisposed individuals

Predisposing

1. Jumpers and sprinters
2. Overweight
3. Puberty

Diagnosis

1. the symptom is sufficient for diagnosis in typical cases, otherwise X-ray, ultrasound, MRI. In the pre-osseous stage, the disorder is not visible on X-ray, then diagnosis by X-ray is very difficult. If the detached cartilage ossifies, it appears as a bone fragment.
2. Painful knee extension against resistance

Symptoms

1. ventral knee pain over the tibial tuberosity, often lasting for months, during and after sporting activity, especially when jumping, running, with forced knee flexion
2. Pain on exertion and pressure, pain when kneeling
3. Recovery at rest
4. Local swelling of the tibial tuberosity

Complications

1. Formation of ossicles requiring resection (bone bodies within the tendon) after completion of the growth phase
2. rare: bony avulsion of the patellar ligament

Therapy

1. Can be treated conservatively in 90% of cases with a good prognosis if treated early: the earlier the start of treatment, the better
2. Rest, orthosis or plaster sleeve if necessary
3. Cooling, essential oils, tapes, bandages
4. Static quadriceps training, stretching
5. Temporary change of sport if necessary(cyclical sports such as cycling, swimming)
6. Anti-inflammatory drugs if necessary
7. Analgesics if necessary
8. PT if necessary
9. Platelet-rich plasma if necessary
10. NO cortisone infiltration!
11. Surgery only if conservative surgery fails or after completion of the growth phase to remove the thickened tibial tuberosity