Osgood-Schlatter disease is a disorder of ossification (the process of ossification of cartilaginous structures) in the knee area, which primarily affects young people between the ages of nine and fifteen, especially in connection with growth spurts. Osgood-Schlatter affects boys more frequently than girls, with a ratio of 3:1 to 7:1.
What is Osgood Schlatter?
Osgood-Schlatter or Osgood-Schlatter disease is a comparatively common aseptic (non-infectious) osteochondrosis of the tibial tuberosity, which forms the patellar tendon attachment (shinbone roughness) as a rough bony process on the front edge of the tibia. See usvsukenglish for What does the abbreviation LMBBS stand for.
Disturbed ossification can also lead to detached ossicles (small bone segments) when the knee is overloaded, which can subsequently die off (osteonecrosis). As a result of the irritation of the patellar tendon, Osgood-Schlatter initially manifests as movement and pressure-related pain in the area of the shinbone roughness.
The disease can also cause pronounced swelling, which leads to severe pain when the patellar tendon is pulled. In the advanced stage, Osgood-Schlatter disease can cause protrusions in the affected knee area, some of which can be moved.
Causes
The exact etiology of Osgood-Schlatter disease has not yet been elucidated. It is assumed that aseptic osteochondrosis is caused by overloading the affected knee area.
Overloading is caused by a discrepancy between resilience and the actual load on the cartilaginous core of the tibial tuberosity due to micro-injuries caused by training or being overweight. The discrepancy, in turn, results in impaired ossification of the cartilage core and impaired fusion of the same with the adjacent tibial bone.
The hormonal changes during puberty can also result in a reduced resilience of the tibia (shin bone) and thus an unequally distributed load in the knee as well as increased patellar tendon tension. It is also assumed that localized circulatory disorders can cause Osgood-Schlatter.
Symptoms & Signs
Osgood-Schlatter disease is characterized by pain that occurs primarily below the kneecap and at the top of the tibia. This pain increases with exertion. Kneeling, stretching the leg, jerky kicking movements and so on are sometimes severely restricted. Children between the ages of 11 and 14 who are active in sports are particularly affected.
There is a small curve that eventually becomes visible. This is usually located at the lower end of the kneecap and represents a swelling. If pressure is exerted on it, it also causes pain. The rounding can change very strongly. Rest breaks make them quickly shrink and go back inside. Stress – even short-term – causes them to swell again and become more sensitive.
Overall, the symptoms of Osgood-Schlatter are very specific. So there is no nocturnal pain or heat development. The first pain in Osgood-Schlatter disease is usually only felt indirectly through pressure on the patellar tendon. The other pains develop over a certain period of time and can also remain very weak for a long time. The limitations in extending the knee joint is also an early symptom.
Diagnosis & History
Characteristic symptoms such as stress-dependent pain and pronounced sensitivity to pressure in the typical knee areas are the first indications of Osgood-Schlatter disease.
Within the scope of sonographic and radiological examinations, the fusion disorder of the nucleus of the tibial tuberosity with the adjacent bony structures, which is typical for Osgood-Schlatter, can be demonstrated on the basis of the loosening of the bony structures and detached ossicles. In addition, the disease should be differentiated from an iliotibial band syndrome (runner’s knee).
If necessary, in ambiguous cases, the diagnosis is backed up by magnetic resonance imaging and/or scintigraphy, which at the same time allows statements to be made about possible metabolic disorders. If Osgood-Schlatter disease is diagnosed early and treated consistently, the disease usually has a good prognosis and almost always heals without consequences at the latest after the end of the growth phase.
Complications
In most cases, sufferers of this disease suffer from bone problems. This leads to a very strong ossification, which has a very negative effect on the quality of life of those affected. As a rule, children in particular suffer, so that the growth and development of the child are also significantly delayed by the disease. The disease can also have a very negative effect on adulthood and lead to complications.
The patients suffer from pain, which can occur mainly in the knees. In most cases, tensing the muscles is also associated with pain, so that the children cannot easily take part in sports. There is also severe pain in the legs themselves, which can also occur in the form of rest pain even without strain. In many cases, the regions are also swollen or bruised.
Treatment of this disease is carried out without complications with the help of physiotherapy. The complaints can be limited. Shock wave therapy can also help to heal. However, whether a complete cure will occur cannot be predicted. However, the life expectancy of the patient is not reduced due to the illness.
When should you go to the doctor?
If your knees hurt when you exercise, especially when doing sports or kneeling, you should see a doctor. Osgood-Schlatter needs to be diagnosed quickly so treatment can begin before pieces of bone detach from the tibia. Severe pain in the shinbone area indicates an advanced condition that needs to be clarified immediately. It is best for those affected to talk to their family doctor, who can make an initial suspected diagnosis and, if necessary, call in other specialists. The symptoms usually appear between the ages of nine and fourteen.
Young people and adult extreme athletes are particularly affected. Anyone who belongs to these risk groups should see a doctor immediately if they have the symptoms mentioned. Osgood-Schlatter can be treated well if caught early. Patients should therefore contact their doctor at the first suspicion. In addition to the family doctor, sports physicians, orthopedists and physiotherapists can be consulted. Depending on the severity, treatment can be surgical or pain medication and preventive measures such as rest.
Treatment & Therapy
Since Osgood-Schlatter disease is attributed to overloading, the therapeutic measures are primarily aimed at relieving the affected structures. For this purpose, in the early stages, stress avoidance through rest, anti-inflammatory painkillers (antiphlogistics), cooling and physiotherapy is usually indicated.
Knee or patella straps can also help relieve pain. In addition, affected children and young people may be exempted from school sports. If there are more serious changes or a more advanced stage of the disease, immobilisation of the knee with a plaster tutor (plaster cast) that restricts the rotation of the knee joint may be indicated. This cast tutor is custom fitted to the affected knee to eliminate pressure on the patella (kneecap) and potential slippage.
In some cases, forearm braces are also recommended to fully relieve the affected knee. Locally applied ointments can be used to support this. Likewise, a negative heel (heel reduction) of the shoe sole can contribute to patellar relief. For a short time, extracorporeal shock wave therapy has also been used to accelerate healing, although it has not yet been clarified which factors are responsible for individual therapy success or failure.
In exceptional cases, surgical intervention may be indicated for detached ossicles such as sequestrums (dead and demarcated bone tissue), joint mice (loose joint bodies) or bone protrusions that irritate the ligaments and limit the mobility of the knee joint. The surgical removal of the ossicles should only be carried out after the end of the growth phase. Furthermore, weight reduction should be aimed for in children affected by Osgood-Schlatter disease who are also obese.
Prevention
Since the underlying etiology of Osgood-Schlatter disease has not yet been fully elucidated, there are no prophylactic measures in relation to the disease. However, avoiding obesity and one-sided strain on the muscles that support the knee joint can prevent Osgood-Schlatter or minimize the symptoms.
Aftercare
With an Osgood-Schlatter, in most cases the affected person has only a few and only limited aftercare measures available. Since this is a genetic disease, it usually cannot be completely cured. Therefore, those affected are usually always dependent on medical treatment by a doctor.
If the patient or the parents wish to have children, a genetic test should primarily be carried out to prevent the disease from recurring. The treatment itself can take the form of physiotherapy or physiotherapy. The person concerned can also do some of the exercises at home, which may speed up the treatment.
Many of those affected are dependent on the help and support of their own families in their everyday lives, whereby care and psychological support in particular can have a positive effect on the further course of the disease. In general, a healthy lifestyle should also be strived for, whereby obesity should be avoided. In some cases, this disease reduces the life expectancy of the affected person.
Outlook & Forecast
Osgood-Schlatter offers a relatively good prognosis. The disease often goes away on its own. Many patients are symptom-free again after six to 18 months. In isolated cases, however, Osgood-Schlatter can develop into a chronic disease. In addition, a large proportion of patients suffer from persistent pain when kneeling. If the pain persists for more than one to two years, a radiological examination is recommended. The doctor can make the diagnosis and give the patient a reliable prognosis.
The prospects at Osgood-Schlatter are good. Mild pain can be treated with medication. In addition, the disease progresses slowly and does not significantly restrict those affected in everyday life. An orthopedist or an osteopath must make the prognosis. For this purpose, he consults the examination results as well as findings from the patient consultation.
Last but not least, the financial and social status of the patient also determines the prognosis. Expensive therapy procedures are not always covered by health insurance companies. All these factors must be included in the forecast. Due to the protracted course of the disease, the prognosis must be adjusted at regular intervals to the patient’s state of health.
You can do that yourself
At Osgood-Schlatter, it is not necessary to consult a doctor. In the case of minor complaints, it is sufficient to rest the knee and not expose it to any further strain for a while. The pain should subside after a few days to weeks.
If Osgood-Schlatter does not go away on its own, medical advice is required. The doctor will initially also recommend resting the affected limb and will also prescribe painkillers, anti-inflammatory drugs and other drugs. Patients can relieve the pain by regularly cooling the affected area. Quark wraps and other home remedies may also be used in consultation with the doctor to reduce Osgood-Schlatter.
If these measures are ineffective, you should see your doctor again. Osgood-Schlatter may have a serious underlying condition. If the course is positive, you can start exercising again after one to two weeks. Physiotherapy and massages contribute to a speedy recovery. Which therapy works best should be worked out with the orthopaedist. If complaints recur, possible causes should be identified and remedied. It is often enough to warm up the muscles better before exercising or to wear different shoes.