Osgood-Schlatter disease: Causes, Symptoms, and Treatment

Osgood-Schlatter disease is a painful irritation of the insertion of the patellar tendon (patellar tendon) at the front of the tibia. It can cause the detachment and death (necrosis) of bone fragments from the tibia. This results in a dead bone area (osteonecrosis). As this osteonecrosis is not infectious (not caused by bacteria, viruses, or others), it is classified as aseptic osteonecrosis.

Osgood-Schlatter disease can occur on one side or both sides. Young people between the ages of 10 and 14 are particularly affected. Boys are more frequently affected in a ratio of 4:1 than girls.

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Summary

Osgood-Schlatter disease is a non-infectious (aseptic) death of bone (osteonecrosis) at the tibia, namely at the point where the patellar ligament (patellar tendon) attaches below the patella (tibial apophysis). It mainly affects boys between 10 and 14 years of age who are active in sports. The cause is unclear, but there are various theories of its development, e.g., overloading, overweight, and local circulatory disorders.

In the case of M. Osgood-Schlatter, young people mostly feel the pain that is dependent on movement and which improves when they are at rest. However, there are also asymptomatic courses, i.e., the disease is discovered by chance, but there are no complaints.

Only in exceptional cases does Osgood-Schlatter disease require surgery. It usually heals without consequences once growth has been completed at the latest.

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Causes

The real cause of Osgood-Schlatter disease is unknown. It is assumed that, for example, sporting activities, obesity, or reduced tibial capacity during the hormonal changes in puberty cause an imbalance in the load on the knee or increased tension of the patellar ligament (ligamentum patellae).

A further assumption is that overloading or training-related micro-injuries are the cause since overweight or particularly athletically active adolescents often suffer from this disease during puberty.

It is possible that M. Osgood-Schlatter is also caused by local circulatory disorders.

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Symptoms of the Osgood-Schlatter disease

Various courses of Osgood-Schlatter disease are observed. Patients often complain of movement-dependent pain when tensing the thigh muscles, when applying manual pressure below the kneecap on the edge of the shin bone, when bending and stretching the knee joint.

This pain can be accompanied by swelling of the upper tibia. They improve at rest, but usually do not disappear completely. At rest, it permanently irritates the knee. It decreases over time, but there is a risk that the knee can no longer be fully loaded. This results in weakness, and the knee “bends away.” However, completely asymptomatic courses can also occur, in which Osgood-Schlatter disease is only a random finding on an X-ray.

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Pain with Osgood-Schlatter disease

The pain in Osgood-Schlatter disease occurs in the front part of the knee (see: anterior knee pain), usually directly below the kneecap.

In this area, there is usually a bony protrusion that is particularly painful when pressure is applied. However, they can also become more extensive, especially after loading.

The pain generally intensifies after sports or other forms of exercise. Since the disease itself usually heals by itself, pain therapy is an essential part of the treatment. This can be achieved by cooling the knee, but also by professional cryotherapy. Also, the so-called TENS method and targeted strengthening of the muscles can help to reduce the pain. Sports, after the pain is increased, should be avoided.

Painkillers are also used, especially NSAIDs such as ibuprofen or diclofenac, which in addition to pain inhibition, also inhibit the inflammatory reaction.

Whether externally applied pain gels and ointments help can be tried out. Other complementary treatments, such as massage and stretching of the thigh muscles or acupuncture, can also help to reduce the pain.

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Diagnosis of the Osgood-Schlatter disease

The diagnosis of Osgood-Schlatter disease is coming through:

  • ultrasound examination (sonography) and
  • X-ray of the knee joint in 2 planes (from the front and the side)
  • Magnetic resonance imaging (MRI) of the knee
  • Scintigraphy, with which a statement about the metabolic function can be made, may be necessary.

X-ray and MRT

In most cases, the diagnosis of Osgood-Schlatter disease can be made very well by a simple x-ray image in conjunction with the typical symptoms.

This usually reveals a typical growth plate, as well as free so-called ossicles (bone particles) and loosening in the affected area. However, today, it is often not necessary to perform an X-ray, and instead, an MRI is used.

This has the advantage that the very young patient can be spared the radiation of an X-ray.

A further advantage of the MRI examination of the knee is that the MRI can usually provide a good picture of the initial stage of the disease, which can often be easily overlooked in an X-ray. The MRI also offers the possibility to better estimate the exact extent of the disease and also to show the surrounding inflammation, if present. In principle, it is also possible to depict the disease using ultrasound, but whether this is used depends very much on the preferences and experience of the individual examiner. In principle, the disease can be depicted and diagnosed well with all possibilities.

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Therapy of the Osgood-Schlatter disease

Freedom from pain is the predominant treatment goal of Osgood-Schlatter disease.

In most cases, the reduction or discontinuation of sport with additional anti-inflammatory (antiphlogistic) medication is sufficient.

In overweight children, a reduction in weight should also be aimed for.

In the inflammatory phase, with redness, swelling, and pain in the knee, systemic anti-inflammatory medications are prescribed, and local cryotherapy using cold packs and curd wraps is performed. Also, local gel applications, e.g., with Dolobene Gel, have a pain-relieving effect.

During this time, sport is also to be restricted. What does this mean exactly? A general ban on sport is not necessary. Only the duration and the maximum load should be reduced. However, indoor sports with extreme braking load should be prohibited by the parents. The temporary relief should only be short-term. For the treatment of Osgood-Schlatter disease, bandages are often used. A plaster cast should never be applied, as it has not shown good results in the past.

As soon as the inflammatory phase is over, a build-up program should be started. These are exercises that train and thus strengthen the thigh and hip muscles. Low-intensity endurance training by bicycle is often suggested as it is intended to improve blood circulation in the damaged area, which should lead to accelerated regeneration. In cases of transformation processes that cause bone loss and cause discomfort despite existing pain therapy, surgical removal of the exostoses becomes necessary. Here, if possible, the completion of growth is awaited.

Only in the rarest cases is surgery necessary, namely when free bone parts (sequestra, joint mouse) or bone extractions occur during transformation processes on the bone and subsequently rub against ligaments and tendons or even restrict the joint’s ability to move.

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Bandages and Braces for Osgood-Schlatter disease

So-called “Jumper Knee Straps” are used as a bandage for Osgood-Schlatter disease. These adjustable straps are designed to improve patella guidance by applying light pressure to the tendon below the kneecap. The tubular insert provides even pressure and helps relieve pain. Also, there are anatomically shaped knitted bandages that provide local pressure relief to the tibial tuberosity to support therapy. These include the patellar tendon support, which helps to relieve pressure on the affected area.

Operation

The typical complaints below the patella, as well as pressure pain in the same area, usually signal the diagnosis. An X-ray or CT is then taken to confirm the diagnosis. The therapy aims to make the patient pain-free. Surgery is not the treatment of first choice. First, conservative measures are taken, such as cooling, fewer sports activities, protection of the knee, or bandages.

As drug therapy, NSAIDs such as paracetamol, ibuprofen, and similar drugs are mainly used. An operation is only necessary if the remodeling processes cause free bone parts or bone pulls, which lead to persistent complaints of the young people. Then surgical removal of the exostosis (the bony prominence) is necessary. Besides, the completion of growth is awaited, if this is possible.

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General risks of an operation:

The attending physician must mention the risks of the operation before every surgical procedure. During the operation, the surrounding tissue, as well as muscles, nerves, and blood vessels, could be injured. This can cause permanent damage, although this is rarely possible. In the course of the operation, bleeding or post-operative bleeding may occur, which in rare cases, may require another operation to stop the bleeding. If too much blood is lost, a blood transfusion may be necessary, which carries the risk of an intolerance reaction or infection with hepatitis or HIV.

Infection with viruses or bacteria may occur, the risk is about 0-10%. After the operation, one usually has a slightly more extended period of hospitalization, so that there is the possibility of a leg vein thrombosis, which in the worst case leads to a pulmonary embolism and can be fatal. Blood-thinning agents are administered, and compression stockings are recommended as a preventive measure. It should also be remembered that every anesthetic has its risks. Osgood-Schlatter disease often affects young people without any other illnesses, so the general risk of the operation is generally low.

Homeopathy for Osgood-Schlatter

The homeopathic treatment of Osgood-Schlatter disease also focuses on the use of remedies that are believed to have analgesic or anti-inflammatory effects.

These include, for example, Rhus Toxicodendron, Calcium Phosphoricum, Guaiacum, or Arnica. These remedies are supposed to achieve in a homeopathic way almost the same effect as the painkillers would otherwise achieve.

Hekla Lava is also said to help improve the symptoms and even reduce the formation of the ossicles. Whether this is possible, however, is questionable. Also, in homeopathy, it is recommended to supplement the treatment with cooling and physiotherapeutic concepts.

Injections with homeopathic and naturopathic substances, such as belladonna or devil’s claw, are also sometimes offered. However, as the disease cannot be treated causally, the benefit is somewhat questionable, as each injection into an inflamed area also carries additional risks.

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Prognosis

The disease almost always heals without consequences, at the latest when growth is complete.

Osgood-Schlatter disease occurs very frequently in children and adolescents. In this group, in turn, an unusually large number of children are affected who play football often and extensively.

The particular strain on the knee during football and soccer, especially the frequent braking and accelerating during ball contact, therefore has a negative influence on the disease.

However, it is not necessary to prohibit all sports for the course and later healing, regardless of the disadvantages, this would have for further development and health. Even with Osgood-Schlatter disease, it is, in principle, possible to continue to do sports and possibly also play football. However, it must be clearly stated that other sports with less abrupt changes in direction would be better.

In this respect, however, one should try to reduce the level of stress in any case. Also, the consequent application of painkillers and other treatments for Osgood-Schlatter disease and possibly also the wearing of a bandage during particularly stressful training sessions usually make it possible to continue with the sport.

However, if severe pain occurs during each training session and the clinical picture deteriorates overall as a result of the training, one should consider switching to another sport that is less stressful for the joints, such as swimming.

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