Osgood-Schlatter Disease

Osgood-Schlatter disease is one of the most common causes of knee pain in adolescents. It is a benign condition, self-limited traction apophyses associated with tibial tubercle by repetitive sprain secondary ossification center of tibial tuber.
Histological studies suggest a traumatic etiology of Osgood-Schlatter disease. Bone growth is faster than that of soft tissue causes thickening of the tendon that crosses the joints and loss of flexibility. During periods of rapid growth by the contraction of the quadriceps stress is transmitted through the patellar tendon in a small area of ​​the tibial tuberosity still undeveloped. This lead to partial avulsion fracture through the ossification center. Possibly secondary heterotopic bone formation occurs in the tendon near the insertion producing a visible mass.
Surgery is rarely indicated and is generally reserved for patients with recurrent debilitating pain unresponsive to conservative therapy. In general surgery have good results, especially in patients with ossification of cartilage. Conservative therapy is usually only necessary. Avoid physical activities that require repetitive knee bicep curls for 2-4 months. Quadriceps strengthening exercises are given therapeutic. Orthopedic devices such as rods knee walking cast or strip infrapatelare cylinder may be recommended.To control pain and inflammation indicate analgesics.
Osgood-Schlatter disease is a self-limited evolution. 90% of patients treated with conservative therapy had symptomatic improvement in about a year after onset. Occasionally patients may present problems in adulthood or knelt osiculi developed in the patellar tendon to be excised. There is still controversy over the planned surgery to treat patients before skeletal maturity. Due to the risks and abeneficiilor it is not recommended.
Pathogenesis
Osgood-Schlatter lesion initially was considered to be the result of cartilage or bone avulsiei the tibial tuberosity. Studies show that most aczuri disease are caused by microtrauma deep fibers of the patellar tendon and tibial tuberosity its insertion.
Quadriceps muscle, the largest in the body is inserted in a relatively small area of ​​the tibial tuberosity. As a result there is a natural high blood pressure at insertion. For children placed additional stress on the cartilage as a result of vigorous physical activity, leading to changes of traumatic insertion.
During running, gymnastics and other sports that require repeated quadriceps contractions occur or microavulsii osteochondral fracture stress. Proximal patellar tendon insertion area is separated by lifting the tibial tubercle. During the repair phase of this fracture to make space for new bone avulsion forcing a prominent tuber and diverted. When a person with damage to the tuber continues to participate in sports are developing more and more damage and repair process cause an abnormal tuberosity with implications for long-term cosmetic and functional.
CausesThe etiology is controversial, but the condition is clearly exacerbated by exercise. 50% of patients have a history of trauma in history. Microtrauma tibial tuberosity secondary chronic quadriceps muscle overload is suspected etiology. The widely accepted etiological hypothesis is subject microfracturarea traction during adolescence with tibial tubercle. Apophyses tubercle occurs in children of 7-9 years. Hauling tenodnul repeated microfractures in determining patellar apophyses.
Risk factors include:8-15 years-old-Male, rapid skeletal growthSports that involve jumping, repeatedly.
Signs and symptoms
The disease is usually described in adolescents after a period of rapid growth. Girls aged between 10-11 years were affected, and boys between 13-14 years. Pain is the clinical symptom onset.Pain can be reproduced by extending the knee against a tough, quadriceps contraction. Running, jumping, ingenuncheatul, squat exacerbate pain. Relief of symptoms occurs intermittently over a period of several months before the patient to the doctor. Pain is bilateral in 25% of cases. Approximately 50% of patients have a history of trauma.
The physical examination includes:Soft-tissue swelling of the proximal tibial tuberosity visible aboveTibial tuberosity, and tenderness at the patellar insertion-Can feel a firm mass-Pain is reproduced by extension against a resistance-Examination of the knee joint is normal, the disease is extraarticular-Absence of effusion or sensitivity is typical condilieneTibial tuberosity-erythema may be present-Some patients may have quadriceps atrophy.
Complications-Nonuniunea tibial tubercle, patella lifting-Patellar tendon avulsion, genu recurvatumPatelofemurala-degenerative arthritis-Patellar subluxation, patella another Chondromalacia.
Classification of disease severity:Grade 1-activity resolves pain after 24 hours inGrade 2, pain during and after physical activity that resolves within 24 hours and does not limit activityGrade 3 pain-limiting activities continue.
Disease progression:The prognosis for Osgood-Schlatter disease patients is excellent.Symptoms resolve spontaneously in one year. Discomfort may persist for 2-3 years before the tibial growth plate closure.Approximately 10% of patients symptoms continue until the age of adult in spite of conservative treatment. This phenomenon is due widening osiculi tuberosity or by forming the patellar tendon.