Knee pain affects one in three adolescents. Knee pain is the most common musculoskeletal pain complaint in adolescents (7) Persistent knee pain is associated with reduced quality of life and physical activity.
Osgood Schlatter (OS) is the most frequent type of knee pain in adolescents and affects approximately 10% of adolescents, and as much as 20% of the active adolescents in some sports (3) (7) (4). Osgood-Schlatter disease (also known as OSD) refers to pain isolated to the bump just below the front of the knee in active, growing children (usually aged 9-13 years). (6)
Adolescents during their growth spurt are highly susceptible to clinical conditions of the musculoskeletal system, including OSD (2). OSD as a growth-related condition. OSD most frequently occurs between the ages of 8 and 13 years in girls, and between 10 and 15 years in boys. (4)(1)(5)(2)(7) OSD affects 21% of athletic adolescents, while it is seen in 4.5% of age matched nonathletic controls. The disease is bilateral (both sided) in 20–30% of patients. (1) OSD was originally reported to occur more frequently in boys than in girls. With the increasing number of young female athletes, this disease is now being seen at a similar rate to young males. (2) Osgood–Schlatter disease is generally regarded as a self-limited disease and generally will resolve within 12-18 months or with growth skeletal maturity when the tibial growth plate closes. (3) (2) (7)
It is well known, that OSD is associated with sports that involve repetitive strain on the patellar tendon and the tibial tubercle such as jumping, squatting, kicking and running / sprinting. Sports like basketball, volleyball and soccer come with an increased risk (2)(7) Additionally, it has been seen that early specialisation in sports is assosciated with increased risk of OSD. This is likely due to repetitive sports specific loading. (3)(10)
OSD is part of a group of conditions called osteochondrosis. These are a family of orthopaedic disease that occur in children and involve areas of significant tensile or compressing stress effecting the growing epiphysis (growth plate) (8) OSD is the most common apophysitide disorder among children (10) The exact cause and aetiology of OSS is still debated but there is consensus in literature that it is probably caused by one or more biological, biomechanical, and physiological factors.
Osgood–Schlatter disease (OSD) is an apophysitis (inflammation or stress injury to the areas on or around growth plates) of the tibial tubercle and the adjacent patella tendon in young active patients with an open physis (growth plate). It is widely accepted that OSD is caused by the repetitive action of the knee extensor mechanism causing strain and chronic avulsion (pulling) of the tibial apophysis. (4) (1) (2) (5) (11) (7). The shortening of the rectus femoris (quad) muscle was also reported to be one of the main factors associated with the presence of OSD in adolescents. (1) Another common hypothesis on the aetiology of OSD is that there is a mis - matched development of bone and soft tissue during a growth spurt. This results in irritation and in severe cases, a partial avulsion (tearing away) of the tibial tubercle apophysis (4)
Although not commonly required, as diagnosis is normally decided from a detailed history and consultation (1), imaging findings may show cartilage swelling, partial avulsion of the secondary ossification centre of the tibial tuberosity and patellar tendon changes (7)
The treatment of OSD is guided by the severity of the symptoms (1). Conservative management has been seen to be effective in approximately 90% of cases. (2) Currently, there are no universal OSD treatment protocols for young athletes (5)(7). There is a lack of high-quality evidence, and therefore limited knowledge on how to manage OS most effectively could potentially lead to ineffective or potentially harmful care in patients with OS (7)
Numerous modalities of conservative treatment have been suggested, all of which have been seen to have a level of success. In a systematic review by Neuhaus et. al (2021) the most commonly noted conservative methods of OSD management were activity modification – non – impact activities such as swimming and cycling (15/15 studies) quadriceps and hamstring stretching (13/15 studies) medication (NSAIDs) (11/15 studies) ice (11/15 studies) (quadriceps strengthening (9/15 studies) and knee straps or braces (8/15 studies) Parent and patient education was mentioned 5 times in the review. Surgery was indicated only for painful bony protrusion. (4)(1)(2)(3)
One of the only protocols that was described in detail was the “Strickland protocol”. This protocol is mainly a combination of myofascial release massage (2 min daily) and active stretching of the quadriceps femoris muscle. It was seen to have a positive effect, with almost all participants returning to their sport. (4).
Before OSD occurs, it has been strongly suggested that an injury prevention programme should be implemented. (5) Many modifiable risk factors have been identified. Implementing balanced training programmes and encouraging adolescents to cross train where possible should be encouraged. (2)
References:
1. Circi, E., Atalay, Y. and Beyzadeoglu, T., 2017. Treatment of Osgood–Schlatter disease: review of the literature. Musculoskeletal surgery, 101(3), pp.195-200.
2. Ladenhauf, H.N., Seitlinger, G. and Green, D.W., 2020. Osgood–Schlatter disease: a 2020 update of a common knee condition in children. Current opinion in pediatrics, 32(1), pp.107-112.
3. Rathleff, M.S., Winiarski, L., Krommes, K., Graven-Nielsen, T., Hölmich, P., Olesen, J.L., Holden, S. and Thorborg, K., 2020. Pain, sports participation, and physical function in adolescents with patellofemoral pain and Osgood-Schlatter disease: a matched cross-sectional study. journal of orthopaedic & sports physical therapy, 50(3), pp.149-157.
4. Neuhaus, C., Appenzeller-Herzog, C. and Faude, O., 2021. A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Physical Therapy in Sport
5. Bezuglov, E.N., Tikhonova, А.А., Chubarovskiy, P.V., Repetyuk, А.D., Khaitin, V.Y., Lazarev, A.M. and Usmanova, E.M., 2020. Conservative treatment of Osgood-Schlatter disease among young professional soccer players. International orthopaedics, 44(9), pp.1737-1743.
6. Krause, B.L., Williams, J.P. and Catterall, A., 1990. Natural history of Osgood-Schlatter disease. Journal of pediatric orthopedics, 10(1), pp.65-68.
7. Lyng, K.D., Rathleff, M.S., Dean, B.J.F., Kluzek, S. and Holden, S., 2020. Current management strategies in Osgood Schlatter: A cross‐sectional mixed‐method study. Scandinavian Journal of Medicine & Science in Sports, 30(10), pp.1985-1991#
8. Uzunov, V., 2008. A look at the Pathophysiology and Rehabilitation of Osgood-Schlatter Syndrome. Gym Coach, 2, pp.39-45.
9. Vaishya, R., Azizi, A.T., Agarwal, A.K. and Vijay, V., 2016. Apophysitis of the tibial tuberosity (Osgood-Schlatter disease): a review. Cureus, 8(9).
10. Kabiri, L., Tapley, H. and Tapley, S., 2014. Evaluation and conservative treatment for Osgood-Schlatter disease: A critical review of the literature. International Journal of Therapy and Rehabilitation, 21(2), pp.91-96.
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