Tibial tubercle avulsion fracture following preexisting Osgood-Schlatter disease in an adolescent: a case report.

Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis. However, few publications have reported the relationship between OSD and TTAF. A 16-year-old healthy male adolescent presented with pain, swelling and limited range of motion of the right knee following sudden acceleration while running. Based on the radiographic evidence, the patient was diagnosed with an avulsion fracture of the right tibial tubercle and OSD. Open reduction and internal fixation were performed using two cannulated screws and two Kirschner wires. The patient returned to preinjury activity levels at the 12-month follow-up postoperatively. This case report aimed to highlight this unique injury pattern. For patients with TTAFs, not only should the fracture be treated, but the cause of the fracture, such as OSD, should also be given appropriate treatment.

Role of Physiotherapy in Osgood-Schlatter's Disease in Adolescent Volleyball Smasher: A Case Report.

A 14-year-old female presented to the sports physiotherapy with a diagnosis of Osgood-Schlatter's disease (OSD), a condition particularly prevalent in adolescents engaged in sports with repetitive knee motions, such as volleyball. This ailment commonly manifests at the tibia, directly beneath the patella, eliciting discomfort and inflammation. The chronic overuse injuries involve repetitive activities inducing fatigue in specific anatomical structures. Adequate recovery mechanisms allow for tissue adaptation, mitigating the risk of injury. In the absence of proper recovery, microtrauma ensues, instigating inflammation mediated by substances like histamines. The release of inflammatory cells and enzymes inflicts damage on local tissue, and prolonged stress contributes to degenerative changes, resulting in weakness, diminished flexibility, and chronic pain. These manifestations are intimately associated with OSD in chronic or recurrent instances. The primary symptom of OSD is knee pain, often of sufficient severity to induce limping. Patients report discomfort during activities such as kneeling, descending stairs, prolonged stationary positions, prolonged episodes of sitting with the knee rendered immobile, and engagement in sporting activities. This case study specifically underscores the efficacy of tailored physiotherapy in the management of OSD among adolescent volleyball players. The study's findings indicate that the patient successfully alleviated symptoms, facilitating recovery with improved outcomes. Furthermore, the physiotherapy regimen appears instrumental in enhancing the patient's functional mobility, as evidenced by the study's outcomes.

Correlation of Tibial Tubercle Overgrowth With Increased Posterior Tibial Slope: A Novel Radiographic Assessment.

Background: An elevated posterior tibial slope (PTS) is associated with an increased risk for anterior cruciate ligament and meniscal injury. Recent evidence suggests that the PTS is elevated in patients with Osgood-Schlatter disease. Purpose: To determine whether there is an association between objective measures of anterior tibial tubercle growth and PTS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 100 radiographs were randomly selected from a sample of patients who had received a lateral knee radiograph that captured at least 15 cm of the tibia distal to the knee joint line at a single institution between December 2020 and March 2022. The PTS was measured, and tibial tubercle growth was quantified with 2 novel measurements. For these measurements, a line was drawn on the radiograph from the most anterosuperior point on the tibia to the point on the anterior cortex of the tibia 10 cm distal from the starting point. The tibial tubercle height (TTH) was measured as the perpendicular distance from this line to the most prominent portion of the anterior tibia. The anterior tibial tubercle angle (TTA) was measured as the angle between the endpoints of the line made previously and the most prominent portion of the tibial tubercle, with a more acute angle indicating a more prominent tibial tubercle. The relationship between TTA, TTH, and PTS was evaluated using a univariate linear regression model. Results: The mean patient age was 33.1 ± 14.1 years. The mean TTA was 158.6°± 4.7°, the mean TTH was 8.8 ± 2.0 mm, and the mean PTS was 9.7°± 2.6°. A significant correlation was found between PTS and TTA (r = -0.46; ß = -0.46; P < .001) as well as TTH (r = 0.43; ß = 0.43; P < .001). Conclusion: Objective measures of anterior tibial tubercle overgrowth correlated with an elevated PTS. Every 2.2° of anterior TTA deviation from the mean and every 2.3 mm in TTH deviation from the mean correlated with a 1° difference in the PTS. This suggests a link between the development of the tibial tubercle and PTS, and it potentially helps to explain why the PTS is elevated in certain patients.

Relationship between coordination variability and Osgood-Schlatter disease in male junior youth soccer players -cross-sectional study using an inertial measurement unit.

BACKGROUND: Osgood-Schlatter disease is a common overuse injury, and motor coordination is discussed as a risk factor; however, no reports have examined motor coordination in young soccer players with Osgood-Schlatter disease. This study aimed to investigate the difference in motor coordination between Osgood-Schlatter disease-affected and non-affected soccer players on a junior youth soccer team. METHODS: This cross-sectional study investigated 35 young soccer players of 12-15 years of age, who completed a self-administered questionnaire covering general information, injury history, and athletic experience. An inertial measurement unit was attached to the participant's thoracic spine, lumbar spine, pelvis, thigh, and lower leg. The sagittal plane tilt angle of each body segment during squatting was analyzed. The continuous relative phase was calculated using the sagittal plane tilt angle. The mean absolute relative phase and continuous relative phase variabilities were calculated and compared between Osgood-Schlatter disease-affected and non-affected players. FINDINGS: The sagittal plane tilt angle of each body segment during static standing and maximum flexion did not differ between the two groups. However, the Osgood-Schlatter disease group had significantly less continuous relative phase variability between the lumbar spine and pelvis (P < 0.01, Cohen's d = 0.91). The Osgood-Schlatter disease group had significantly fewer participants with other sports experience (P = 0.032, φ = 0.36). INTERPRETATION: Dysfunctional lower trunk and hip muscles may be leading to Osgood-Schlatter disease. It is suggested that a variety of physical activities should be performed in the junior age group to allow players to acquire a variety of movement patterns.

ENPP1 downregulation and FGF23 upregulation in growth-related calcification of the tibial tuberosity in rats.

During tibial tuberosity growth, superficial and deep portions can be observed; however, the deep portion is not observed after the growth period, as it develops into bone tissues. Calcification in vivo is known to be constitutively suppressed by ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) but promoted by tissue-nonspecific alkaline phosphatase (TNAP). FGF23 promotes calcification of enthesis. Gene expression of FGF23 increased rapidly at 13W in this study. Therefore, the tibial tuberosity is speculated to develop via Enpp1 downregulation and Tnap upregulation; however, the understanding of these processes remains unclear. Hence, in the present study, we aimed to explore the age-related structural changes and underlying gene expression changes in the tibial tuberosity of rats. Male Wistar rats were divided into three groups (3-, 7-, and 13-week-old; eight each). The tibial tuberosity superficial and deep portions were clearly observed in 3- and 7-week-old rats, but the presence of the deep portion was not confirmed in 13-week-old rats. The extracellular matrix of hypertrophic chondrocytes was calcified. Furthermore, the Enpp1 expression was the highest in 3-week-old rats and decreased with growth. The TNAP expression did not differ significantly among the groups. The deep portion area was significantly lower in 3-week-old rats than in 7-week-old rats. Generally, the extracellular matrix of the immature chondrocytes is not calcified. Therefore, we speculated that the cartilaginous tibial tuberosity calcifies and ossifies with growth. The Enpp1 expression decreased with growth, whereas the Tnap expression remained unchanged. Thus, we surmise that the tibial tuberosity calcifies with growth and that this process involves Enpp1 downregulation and FGF23 upregulation. As Osgood-Schlatter disease is closely related to the calcification of the tibial tuberosity, these findings may help clarify the pathogenesis of this disease.

Maturation-dependent patterns of knee injuries among symptomatic pediatric soccer players on MRI.

OBJECTIVE: To systematically investigate the prevalence of knee MRI findings among symptomatic pediatric soccer players with respect to skeletal maturity and to identify predictors of surgery. METHODS: This IRB-approved, HIPAA-compliant retrospective study included soccer players (< 18 years of age) who underwent MRI examinations in the past 5 years (2018-2023). Two radiologists retrospectively and independently reviewed all examinations to categorize skeletal maturity and to identify osseous and soft tissue findings. Findings were compared between maturation groups, and logistic regression models were used to identify predictors of surgery. RESULTS: Ninety-seven players (45 boys, 52 girls) included 39 skeletally immature, 21 maturing, and 37 mature knees. Kappa coefficient for interobserver reliability ranged between 0.65 and 1.00. Osgood-Schlatter disease (OSD) was more common among immature than maturing and mature knees (25% vs 14% and 5%, p = 0.04); anterior cruciate ligament (ACL) injury was more common among maturing and mature than immature knees (59% and 48%, vs 15%, p < 0.01); and meniscal tears were more common among mature than immature and maturing knees (medial, 41% vs 18% and 14%, p = 0.03; lateral, 43% vs 21% and 19%, p = 0.04). Players in the mature group were more likely to undergo surgery (p = 0.01). The presence of an effusion (OR = 19.5, 95% CI 2.8-240.9, p = 0.01), ACL injury (OR = 170.0, 95% CI 1.3-6996.9, p < 0.01), and lateral meniscal tears (OR = 10.8, 95% CI 1.8-106.1, p = 0.02) were independent predictors of surgery. CONCLUSION: Differential patterns of injury were found among symptomatic pediatric soccer players; the presence of an effusion, ACL injury, and lateral meniscal tears were independent predictors of surgery, likely contributing to the higher rates of surgery among skeletally mature players.

Analysis of Quadriceps Muscle Tightness as a Risk Factor for Osgood-Schlatter Disease: A Prospective Cohort Study.

Background: The prevalence of Osgood-Schlatter disease (OSD) is unknown. Tightness of the quadriceps femoris has been reported to be a risk factor for OSD. Hypothesis: Quadriceps muscle tightness would not contribute to the development of OSD. Study Design: Cohort study; Level of evidence, 2. Methods: We enrolled 150 Japanese male junior high school soccer players (N = 300 knees), with a mean age at first examination of 12.5 years (range, 12-13 years). All players were assessed annually and evaluated for 2 years. Ten players (n = 14 knees) had a history of OSD before the first medical examination. After excluding these 10 players (n = 20 knees), the remaining 140 players (n = 280 knees) were included in this prospective analysis. Age at the time of starting soccer, history of injury (including OSD and time missed), height, weight, annual increase in height, body mass index (BMI), straight-leg raise angle, heel-buttock distance (HBD), and ultrasound images of the tibial tuberosity (maturity and morphology) were compared between players who developed OSD and those who did not. Results: OSD was identified in 8 knees of 6 players, with an incidence of 2.9% of knees (8/280) and 4.3% of players (6/140). Univariate analysis revealed significant differences between the OSD and non-OSD groups regarding BMI (17.1 ± 1 kg/m2 vs 18.5 ± 1.6 kg/m2, respectively; P = .018), HBD (1.5 ± 1.6 cm vs 4.8 ± 4.5 cm; P < .001), and stage of tibial tuberosity maturity (P < .001). The maturity of the tibial tuberosity was the only independent risk factor for the development of OSD in multivariate logistic regression analysis (odds ratio, 9.848 [95% CI, 3.297-29.41]; P < .001). Conclusion: Study findings indicated that quadriceps muscle tightness did not contribute to the development of OSD.

Focused extracorporeal shockwave therapy for youth sports-related apophyseal injuries: case series.

BACKGROUND: Apophyseal overuse injuries are self-limited with skeletal maturity; however, they may be a source of significant pain and time lost from training. There is a lack of consensus for its management with the current available treatment, which might lag behind the ongoing development of regenerative medicine. The current retrospective case study aimed to assess the potential effectiveness and short-term safety of extracorporeal shockwave therapy (ESWT) in apophyseal injuries. METHODS: Data from 22 growing athletes [15 patients with Osgood-Schlatter disease and seven patients with Sever's disease] who received ESWT at a sports medicine unit in a university hospital were reviewed. All patients received low energy (= 0.1 mJ/mm2) level-focused ESWT using electrohydraulic generation technology. The clinical focusing technique was used upon applying ESWT. RESULTS: The number of sessions received to achieve full recovery ranged from 1 to 3 sessions. The time from treatment initiation to previous activity level was 2 weeks in 14 patients (63.3%), 4 weeks in seven patients (31.8%) and 11 weeks in one patient (4.5%). No adverse events were reported. No recurrence occurred up to 3 months after the last session. CONCLUSION: ESWT is a potentially safe and effective treatment for apophyseal injuries. It may facilitate an early return to sport activities.

Quality of life in adolescents with longstanding non-traumatic knee pain: An analysis of 316 adolescents with Patellofemoral Pain and Osgood-Schlatter Disease.

OBJECTIVES: To describe the Quality of Life (QoL) among adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD) and investigate characteristics associated with QoL. STUDY DESIGN: Cross-sectional. PARTICIPANTS: 316 adolescents with PFP or OSD. MAIN OUTCOME MEASURES: QoL subscale of The Knee injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol 5-dimensions (EQ-5D). RESULTS: The KOOS-QoL was 51 ± 18, and the total index score for the EQ5D was 0.67 ± 0.21. KOOS-QoL subscale showed that 60% reported being aware of their knee problems daily or constantly, 38% reported severe to extreme lack of confidence in their knees, 28% reported severe to extreme difficulty with their knees, and 20% reported severely or totally modifying their lifestyle to avoid potentially damaging activities to their knee. EQ-5D showed that 79% experienced problems with everyday activities, 48% reported mobility problems, 17% felt worried, sad, or unhappy, and 7% reported problems looking after themselves. CONCLUSIONS: Many adolescents with longstanding non-traumatic knee pain experience low QoL. More than half were aware of their knee problems at least daily, one in three reported a severe lack of confidence in their knee, and one in six felt worried, sad, or unhappy.

Developmental stage and lower quadriceps flexibilities and decreased gastrocnemius flexibilities are predictive risk factors for developing Osgood-Schlatter disease in adolescent male soccer players.

PURPOSE: This study aimed to elucidate the influential predictive risk factors of Osgood-Schlatter disease (OSD) on the support (non-kicking) leg among adolescent soccer players considering peak height velocity (PHV) age and investigate the cut-off values of the predictive variables. METHODS: A cohort of 302 Japanese adolescent male soccer players aged 12-13 years were followed over 6 months. All players underwent physical examination, tibial tubercle ultrasonography, anthropometric and whole-body composition measurements, and muscle flexibility test of the support leg at the baseline. The developmental stage was evaluated from the PHV age. The OSD of the support leg was diagnosed 6 months later; players were divided into the OSD and control (CON) groups. The predictive risk factors were analyzed by multivariate logistic regression analysis. RESULTS: There were 42 players who had developed OSD at baseline and they were excluded from the study. Among the 209 players, 43 and 166 belonged to the OSD and CON groups, respectively. The predictive risk factors of OSD development were PHV age ± 6 months at baseline (p = 0.046), apophyseal stage of tibial tuberosity maturity at baseline (p < 0.001), quadriceps flexibility ≥ 35° at baseline (p = 0.017), and decrease in gastrocnemius flexibility in 6 months (p = 0.009). CONCLUSION: PHV age ± 6 months at baseline, apophyseal stage of the tibial tuberosity at baseline, quadriceps flexibility ≥ 35° at baseline, and decrease in gastrocnemius flexibility in 6 months are predictive risk factors of OSD development in the support leg among adolescent male soccer players. It is crucial to know the PHV age of each player, and not only the flexibility of quadriceps muscle but also the gastrocnemius should be monitored to predict OSD. LEVEL OF EVIDENCE: II.

The mid-term effect of Osgood-Schlatter disease on knee function in young players from elite soccer academies.

BACKGROUND: The aim of the study was to evaluate the effect of Osgood-Schlatter disease (OSD) on knee joint function in elite young soccer players. Our hypothesis was that knee joint function in elite young soccer players was impaired following OSD compared with soccer players with no history of OSD. METHOD: In young male soccer players (n = 36) from elite academies (mean ±SD, age: age: 15,3 ± 1,7 years; height: 1,7 ± 0,06 m; weight: 63,5 ± 8 kg; BMI: 20,7 ± 2). The duration between the completion of treatment or the last complaint to the study commencement was 31 ± 19 months. RESULTS: The average treatment duration of OSD among study participants was 18,5 ± 12 days (95%, 14-23), and the disease most often manifested in winter and spring, 33% and 31% of cases, respectively. Soccer players with a history of OSD were statistically different in IKDC and KOOS scores when compared with soccer players with no previously reported OSD (Mann-Whitney, p < 0,0001). The soccer players with a history of OSD also use NSAIDs more frequently compared with soccer players with no history of OSD (36% vs 3% respectively). CONCLUSIONS: OSD among young soccer players, when symptoms resolve, continue about one month and they can return to regular training and participation in games. Wherein, the negative effects in knee joint function were significantly more likely in soccer players with previous OSD history when compared with their peers with no history of OSD. While oral non-steroidal anti-inflammatory drugs was also more widely employed in soccer players with previous OSD history. Potentially this may lead to performance deficits and disadvantages for their future careers and coaches and physicians should be informed.

Stress Injuries of the Knee.

Stress injuries to the bone and physis of the knee are common in the active adolescent patient and can be broken down into bone stress injuries (BSIs) and chronic physeal stress injuries. BSIs result from prolonged, repetitive bone loading, whereas chronic physeal stress injuries develop from repetitive loading to the apophysis or epiphysis. Most stress injuries of the knee resolve with relative rest but will occasionally need surgical intervention in more severe cases. Early and accurate identification is paramount for optimal management and to avoid long-term consequences.

Characteristics of the Kicking Motion in Adolescent Male Soccer Players Who Develop Osgood-Schlatter Disease: A Prospective Study.

Background: Osgood-Schlatter disease (OSD) is an apophysitis of the tibial tubercle caused by repeated traction of the patellar tendon during adolescence. Although OSD is associated more with sports such as soccer, it remains unclear whether the kicking motion itself is related to OSD onset. Purpose: To prospectively evaluate the kicking motion in adolescent soccer players who later developed OSD. Study Design: Case-control study. Methods: The authors observed 47 Japanese adolescent male soccer players (mean age, 12 years) over 6 months in 2018-2019; none of the participants had OSD at study onset. The players underwent tibial tubercle ultrasound at baseline, and their kicking motion was evaluated using 3-dimensional (3D) motion analysis with 65 reflective markers. The 3D angle of the lumbar spine, thorax, and pelvis and the angular velocity of the hips, knees, and ankles were calculated for the support leg. The kicking motion was divided into 8 phases, and ball speed, kicking time, and positions of the support (nonkicking) leg and center of mass (COM) from the ball were calculated for each phase. Six months later, the players underwent another ultrasound and were divided into 2 groups: those diagnosed with OSD in the support leg (OSD group) and those without OSD (normal [NRL] group). All factors calculated using the kicking motion analysis at the baseline were compared between groups. Results: There were 19 players in the OSD group and 28 players in the NRL group. Anthropometric measurements, ball speed, and kicking time were similar between the 2 groups. The forward translation of the COM and the support leg, the flexion angle of the thorax, and the rotation angle of the pelvis before impact with the ball were all significantly smaller in the OSD group than in the NRL group (P < .05). Moreover, the knee extension angular velocity of the support leg was significantly larger in the OSD group (P < .05) at ball impact. Conclusion: A kicking motion with small COM translation, small thoracic flexion, and small pelvic rotation before ball impact, as well as large knee extension angular velocity of the support leg at ball impact, may be associated with OSD onset.

Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors.

BACKGROUND: Osgood-Schlatter Disease is the most common cause of knee pain in youth. Scientific research in youth elite football is limited. OBJECTIVES: To assess clinical and ultrasonographic factors associated with Osgood-Schlatter Disease and calculate point prevalence of clinical diagnosis and time-loss in youth elite male football. STUDY DESIGN: Nested case-control study and cross-sectional prevalence study; Level of evidence: 3. METHODS: We obtained data during the pre-season periodic health evaluation. Osgood-Schlatter Disease diagnosis was defined as (1) athlete-reported anterior knee pain and (2) clinical confirmation by pain provocation at the tibial tuberosity. Time-loss was defined as inability to participate in team training and/or competition. For the nested-case control study, we examined clinical and ultrasonographic factors in the U13 to U16 teams. We matched on calendar-age. The clinical factors were: self-reported history of Sever's disease, growth measures, leg muscles flexibility and strength and ultrasonographic bone maturity stages according to Ehrenborg, For the cross-sectional study, we included players of the U13 to U19 teams to calculate the point prevalence. RESULTS: The case-control study consisted 30 players and the cross-sectional study 127 players. Previous Sever's disease was strongly associated with Osgood-Schlatter Disease (OR = 16.8; p = 0.02; 95% CI = 1.6-174.5). None of the other clinical or ultrasonographic factors were associated. The point prevalence was 17% and 80% had no time-loss despite presence of clinical symptoms. CONCLUSION: Considering the 16.8OR, previous Sever's disease indicates a strong association with Osgood-Schlatter Disease. Although generally suggested, growth velocity and bone maturity are not associated in an age-matched comparison.

Deep Infrapatellar Bursitis in Preadolescent Baseball Players: A Cross-Sectional Study.

Background: Deep infrapatellar bursitis (DIB) has been detected in cases of Osgood-Schlatter disease (OSD). However, the clinical implications of DIB in the apophyseal stage, during the period when OSD has not yet developed, remain unclear. Purpose: To investigate the factors related to DIB in the apophyseal stage in preadolescent baseball players. Study Design: Cross-sectional study, Level of evidence, 3. Methods: The study participants were junior baseball players who participated in a medical checkup in 2020. We included knees in the apophyseal stage evaluated using ultrasonography, and classified them into the bursitis and no-bursitis groups using color-enhanced Doppler ultrasonography. We also investigated bone lesions of the tibial tuberosity, determined by fragmentation of the bone and irregularity of the ossification center. Demographic data, practice duration, pressure pain on tuberosity, pain while playing baseball (visual analog scale), heel-buttock distance (HBD), straight-leg raise angle, and range of hip internal and external rotation were evaluated. Group comparisons were performed using the Mann-Whitney U test and Fisher exact test, and a logistic regression analysis was performed. Results: A total of 261 knees (139 male players; age 10.5 ± 1.1 years) were included, 30 in the bursitis group and 231 in the no-bursitis group. Bone lesions were present in 4 knees in the bursitis group and in 32 knees in the no-bursitis group; there was no significant relationship between the presence of bone lesions and bursitis. Compared with the no-bursitis group, the bursitis group had a significantly longer practice duration (12.9 ± 3.3 vs 15.2 ± 3.8 hours/week, respectively; P = .003) and larger HBD (0.5 ± 1.3 vs 1.4 ± 2.4 cm, respectively; P = .003). The logistic regression analysis showed that practice duration (P = .001) and HBD (P = .004) were significantly related to the presence of bursitis. Conclusion: DIB in the apophyseal stage was related to practice duration and thigh muscle tightness. These findings may help predict overload and thigh muscle tightness at a very early stage.

Incidence and management of Osgood-Schlatter disease in general practice: retrospective cohort study.

BACKGROUND: Osgood-Schlatter disease (OSD) is a non-traumatic knee problem that is primarily observed in sports-active children and adolescents aged 8-15 years. AIM: To determine the incidence of OSD and to gain an insight into the management of children and adolescents with OSD in general practice. DESIGN AND SETTING: A retrospective cohort study was conducted using a healthcare database containing full electronic health records of over 200 000 patients in general practice in and around the Dutch city of Rotterdam. METHOD: Patients with a new diagnosis of OSD from 1 January 2012 to 31 December 2017 were extracted using a search algorithm based on International Classification of Primary Health Care coding and search terms in free text. Data on the management of OSD were manually interpreted. RESULTS: The mean incidence over the study period was 3.8 (95% confidence interval [CI] = 3.5 to 4.2) per 1000 person-years in those aged 8-18 years. Boys had a higher incidence rate of 4.9 (95% CI = 4.3 to 5.5) compared with girls (2.7, 95% CI = 2.3 to 3.2). Peak incidence was at 12 years of age for boys and 11 years for girls. Advice was the most commonly applied strategy (55.1%), followed by rest (21.0%), referral for imaging (19.5%), and physiotherapy (13.4%). CONCLUSION: To the authors' knowledge, for the first time the incidence of OSD has been calculated using GP electronic medical files. There is a discrepancy, especially for imaging and referral to a medical specialist, between the current Dutch general practice guidelines and how GPs actually manage the condition in clinical practice.

The posterior tibial slope and Insall-Salvati index in operative and nonoperative adolescent athletes with Osgood-Schlatter disease.

INTRODUCTION: Osgood-Schlatter disease (OSD) is a common cause of anterior knee pain in adolescent athletes due to repetitive stress on the tibial tubercle. The posterior tibial slope angle (PTSA) and the Insall-Salvati Index (ISI) play a role in knee biomechanics. However, to our knowledge, the posterior tibial slope and patellar height have not been compared in operated versus nonoperative OSD patients. The purpose of the current study is to compare the differences in the PTSA and the ISI between operative and nonoperative patients with OSD. MATERIALS AND METHODS: The study was approved by the College of Medicine's Institutional Review Board. A retrospective review was performed on 75 adolescent athletes with OSD between 2008 and 2019. The data extracted included: age, sex, body mass index (BMI), sporting activity and type, mechanism of injury (MOI), chronicity of symptoms, PTSA, and the ISI. Descriptive and quantitative statistics were used. RESULTS: Seventy-five patients (88 knees) with OSD were studied (28 boys, 47 girls). The average age was 12.2 years and the average BMI was 22.3. The mechanism of injury (MOI) included repetitive stress (77%) and trauma (23%). The duration of knee pain averaged 10.3 months. Sixty-six patients were included in the nonoperative cohort. Nine patients were included in the operative cohort and underwent surgery due to persistent symptoms after skeletal maturity with tubercleplasty and/or ossicle excision. The average PTSA was 12.1° ± 1.7° and average ISI was 1.05 ± 0.15. Comparing the operative and nonoperative patients, we found no significant difference in PTSA (11.2° ± 0.73° versus 12.8° ± 1.8°, p < 0.064). However, we did find that patients treated operatively had a lower ISI (0.95 ± 0.18 versus 1.14 ± 0.13, p < 0.001). CONCLUSION: In patients with OSD, operative and nonoperative patients demonstrated a similar PTSA. On the other hand, the ISI was higher in nonoperative patients. In the current paper, a decreased ISI was helpful in predicting the need for operative intervention in symptomatic patients after skeletal maturity.

The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes.

PURPOSE: The aims of this prospective study were to define sport specific incidence rates in a large Osgood-Schlatter-disease group, to follow the natural course, and to determine late effects, i.e., changes in sport activities and resting pain. METHODS: A total of 126 consecutive patients with functional pain in and after physical activity and local TT swelling were included in a longitudinal study. Physical examination, ultrasound, and a lateral X-ray were performed in a standardized clinically common manner. Sport participation, growth rate, BMI, and muscle status were recorded and assigned statistically. Follow-up took place after subsidence of functional pain. RESULTS: Exactly 101 boys and 25 girls showed a mean age at diagnosis of 12.8 years (boys 13.2, girls 11.4 years) complaining an average period of pain of 6.7 months before diagnosis. A sport distribution displayed 64 football (soccer) players, 18 basketball players, seven athletes in track and field, six martial arts sportsmen, and five handball players, all participating in organized sport clubs, 16 patients in other and ten patients in no sports. The standing leg was affected in 69.6% of all football players, whereas the other disciplines did not show any significance. A total of 105 patients could be followed up after a median of 3.6 years; six of them were still symptomatic. Final outcome could be recorded for 99 patients (79 boys, 20 girls). Osgood-Schlatter disease (OSD) symptoms in or after sport activity were reported to last an average of 19.1 months (3-48 months) without differences according to sex nor sport. Exactly 50% of the patients may expect to be free of functional symptoms after the 16th month, 75% after the 25th month. A total of 78.8% of the patients still complained of persistent but not impairing pain in kneeling or on direct TT contact. Exactly 28.3% of all patients responded having switched their sport activity to other disciplines due to OSD. CONCLUSION: OSD affects mainly adolescent boys active in football and basketball and represents a structural answer to repeated biomechanical stress. Only in football, the statically dominant side is more prone to develop OSD. Age at onset, growth rate, BMI, and muscle imbalance are not significantly predisposing. OSD runs a self-limiting course without specific treatment.

Hyperosmolar dextrose injection for Osgood-Schlatter disease: a double-blind, randomized controlled trial.

OBJECTIVE: Osgood-Schlatter disease (OSD) is one of the common causes of long-term knee pain, leading to functional limitations, long-term deformity of the tubercle interfering with kneeling, and impaired peer-important sport participation. Nonetheless, patient management continues to rely on the usual conservative methods. This study examined the use of hyperosmolar dextrose injection in patients with OSD. METHODS: We conducted a randomized, double-blind clinical trial involving 70 patients with OSD. One group received a hyperosmolar dextrose injection (12.5%), while the other received a saline injection. The injections were conducted under ultrasound guidance. The Victorian Institute of Sport Assessment (VISA) score was used to assess each patient's pain and sport level. RESULTS: The dextrose group outperformed the saline group in improvement in the VISA-Patella (VISA-P) score from baseline to 3 months (27.1 ± 6.5 vs. 1.4 ± 2.6; mean difference 25.4 (22.4 to 28.3); p < .0001), 6 months (31.7 ± 7.9 vs. 25.2 ± 7.8; mean difference 6.2 (3.2 to 9.4); p < .0001), and 12 months (34 ± 9.0 vs. 28.2 ± 7.5; mean difference 5.5 (1.9 to 9.1); p = .0026). The changes in both groups were clinically important, suggesting that both therapies were active treatments. The dextrose group improved too rapidly for spontaneous improvement to explain much of this change. CONCLUSION: After three injections, at the 6-month and 12-month follow-up visits, the VISA-P scores of the two groups were significantly improved; the dextrose group score was better than the saline group score, and there were significant differences between the two groups.