OSGOOD-SCHLATTER DISEASE This common condition affecting children's knees got its peculiar name from the two doctors who first described it in 1903: an American, R. B. Osgood and a German, Carl Schlatter. The name has stuck because no one can agree to a more accurate or more descriptive one.
A child with Osgood-Schlatter disease complains of pain in the front of the knee over that bump at the top of the shin bone (the tibia) a couple of inches below the knee cap (the patella). The pain may be aggravated by running, jumping and using steps. Kneeling can also be painful.
That bony prominence at the top of the tibia, the tibial tuberosity, becomes tender and swollen. Pushing on the knee in that area causes the pain. The rest of the exam is normal in a child with Osgood-Schlatter disease.
The only test needed to help finalize the diagnosis is an x-ray of the knee. It will also eliminate the possibility of other disorders of the knee and perhaps indicate how severe the case is.
The knee is a rather complicated hinge which can bend back and straighten out. The motion of straightening out (extending) the knee is performed by the quadriceps muscle - the bulky muscle on the front of the thigh. The quadriceps muscle pulls on the patella (knee cap) which in turn pulls on the patellar tendon, a strong band stretching between the patella and tibial tuberosity. Thus, with every contraction, all the power of the strong quadriceps, the largest muscle in the body, is concentrated on the tibial tuberosity. In children the tuberosity forms as a separate bone from the main shaft of the tibia and seems to be an area of relative weakness. The pull of the patellar tendon can cause inflammation and sometimes an actual change in the bone.
The inflammation causes pain and swelling. The persistent tension may actually pull off flakes of bone. On x-ray the tuberosity may appear broken into two or more fragments. Even if the tuberosity is not fragmented, as it is in two-thirds of the cases, the x-ray may show soft tissue swelling.
Boys are affected two or three times as frequently as girls. Symptoms appear around age 13 (range 10-15) in boys and 11 (range 8-13) in girls. Presumably because an 11-year-old girl has already achieved the skeletal maturity of a 13 year old boy, girls develop symptoms at a younger age. Two or three of every 10 patients will have both knees affected.
Diagnosis is usually easy, but treatment is more difficult. The first line of treatment is reassurance; both child and parent need to be told that Osgood-Schlatter disease is a benign condition. In at least three quarters of the cases the symptoms will eventually resolve. The pain is usually gone within a year, although it may last until the tibial tuberosity fuses with the shaft of the tibia at about age 18.
If the pain is severe the child may have to forego activities which cause the pain for three to six months. Medicines such as aspirin, which reduce pain and inflammation, may help. Warm moist compresses are soothing.
Fore more significant or persistent symptoms, a strap (like a tennis elbow strap below the knee) or knee brace may help. For more severe cases, a cylinder cast which reaches from thigh to ankle is often needed for three to six weeks, although such treatment does not affect the final outcome. Sometimes an injection of cortocosteroid and local anesthetic ("A cortisone shot") is useful, although it may have to be repeated once or twice.
About one child in 10 will need a surgical operation if disabling symptoms persist after several months of non-operative treatment. A variety of operations have been performed. Removal of the loose fragment (which can be cartilage - gristle - and thus not visible on the x-ray) has been very successful in relieving symptoms. Sometimes just drilling the abnormal area of bone may help. If the tuberosity is very prominent it can be thineed down.
In trying to predict the future for any Osgood-Schlatter lesion, the x-ray may be helpful. Recent studies have suggested that if no separate ossicles (bony pieces) can be seen, the outlook is excellent. The pain goes away and the knee regains its full function although in about 10% the bump remains tender and kneeling is still painful. On the other hand if an ossicle does develop, persistent symptoms are much more likely and surgery may be needed.
COPYRIGHT 1990 Pediatrics for Parents, Inc.
COPYRIGHT 2004 Gale Group
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