​Kembara Xtra - Medicine - Osgood Schlatter Disease

​Kembara Xtra - Medicine - Osgood Schlatter Disease  
Osgood-Schlatter disease (OSD) is a syndrome that most frequently affects adolescent boys and girls and is linked to traction apophysitis and patellar tendinosis. Anterior tibial tubercle pain and edema are common in patients.
impacted system(s): musculoskeletal
A similar condition is tibial tubercle apophysitis.


Incidence
Increased engagement in organized childhood athletics has led to a spike in girls' incidence, which is now approximately equal to that of boys in the United States.



Prevalence
Up to 60% of patients will continue to experience symptoms throughout maturity; athletes are more likely than non-athletes to experience this prevalent apophysitis in childhood and adolescence; 10% of all adolescent knee discomfort is caused by OSD.

Pathophysiology and Etiology 

Repetitive stress on the secondary ossification center of the tibial tuberosity, concomitant patellar tendinosis, and rupture of the proximal tibial apophysis leading to tendinosis and apophysitis are the causes of traction apophysitis of the tibial tubercle. Avulsion microfractures may occur near the tibial tuberosity, according to certain evidence.
Basic etiology is complicated and poorly understood, however tendinosis and many microfractures are likely secondary to recurrent microtrauma. Sports involving jumping and rotating put the most strain on the tibial tubercle. The most likely cause of the condition is repetitive trauma.
Possible correlation with tight quadriceps and hip flexors; enhanced quadriceps strength compared to hamstring strength in adolescence
Early sports specialization raises OSD risk by a factor of four.


Risk Elements 
Most frequently affects children and teenagers between the ages of 8 and 18 - Girls 8 to 13 years - Boys 10 to 15 years
Even though boys play more sports than girls, OSD is probably equally prevalent in both sexes.
 Participation in repetitive-jumping sports and sports with heavy quadriceps activity (football, volleyball, basketball, hockey, soccer, skating, gymnastics) Rapid skeletal growth Weak core stabilizer muscles Increased weight/BMI/height Patellofemoral malalignment Overload training volume Quadriceps tightness and/or shortening Ballet (2-fold risk compared with nonathletes)

Basic Prevention 

Avoid activities that place a lot of eccentric or decelerational stress on the quadriceps.
Patients who have little pain may compete.
 Hamstring and quadriceps flexibility should be improved.
Reduce the specialization in sports.
Boost your cross-training.

Accompanying Conditions 

Hamstring tightness Possible association with ADD/ADHD; adolescents with ADD/ADHD are at risk for various musculoskeletal problems. Shortened (tight) rectus femoris seen in 75% of OSD patients.
apophysitis Sinding-Larsen-Johansson

A diagnosis of unilateral or bilateral (30%) discomfort in the tibial tuberosity is made. This pain is made worse by exercise, especially jumping and landing after jumping. This pain is also made worse when one kneels on the affected side(s).

clinical assessment 

Functional testing: Single-leg squat (SLS) and standing broad jump reproduce pain. Knee pain with squatting or crouching. Absence of effusion or condyle tenderness. Tibial tuberosity swelling and tenderness. Pain increased with resisted knee extension or kneeling. Erythema over tibial tuberosity. Hamstring/quadriceps tightness. Weakness in the core muscles.

Differential diagnosis includes patellofemoral stress syndrome, stress fracture of the proximal tibia, pes anserinus bursitis, proximal tibial neoplasm, osteomyelitis of the proximal tibia, tibial plateau fracture, Sinding-Larsen-Johansson syndrome (patellar apophysitis), which causes pain over the inferior patellar tendon, patellar

Laboratory Results 

Initial examinations (lab, imaging)
A clinical diagnostic, typically. Except when additional diagnosis are being considered, no tests are recommended.
● In order to rule out additional pathologies, radiographic imaging of the proximal tibia and knee may reveal heterotopic calcification in the patellar tendon:
X-rays are infrequently diagnostic, however the presence of a distinct fragment at the tibial tuberosity distinguishes patients who may benefit from surgical intervention.
- Fragmentation of the apophysis and calcified thickening of the tibial tuberosity at the tendon insertion on the tibial tubercle


Other/Diagnostic Procedures

Increased uptake in children with apophysitis is common; however, with OSD, there may be more uptake on the side that is affected. This can be seen on a bone scan in the region of the tibial tuberosity.
MRI shows fragmentation of the tibial tubercle and hyperintense T2 signal of the apophysis and patellar tendon insertion in more severe cases. Ultrasound is a great alternative, showing thickening of the distal patellar tendon, occasional infrapatellar bursa effusion, and neovascularity of the patellar tendon insertion.
Interpretation of Tests
Although a biopsy is not required, it would reveal osteolysis and tubercle fragmentation in the tibia.

Management 
Regular applications of ice twice to three times daily for 15 to 20 minutes
No published randomized controlled studies have shown a clear advantage of one treatment over another.
 Rest and activity modification: Steer clear of activities that exacerbate swelling or pain.
Physical therapy aids in the stretching and strengthening of the hamstrings and quadriceps.
Strengthening of the open- and closed-chain eccentric quadriceps
If discomfort is severe, refrain from performing vigorous stretching to lower your chance of tibial tubercle avulsion.
For a tibial tuberosity fracture or full avulsion, consult an orthopedic surgeon.
Patients with significant midfoot pronation may benefit from orthotics. Various bracing and straps have been employed. In cases of more severe disease, a longer period of time away from sports may be advised.


First Line of Medicine
Opioids are not advised as a first line of treatment. Common OTC analgesics may be taken into consideration. NSAIDs may be helpful for pain reduction.
Next Line
Only in the most dire circumstances should stronger analgesics, such opioids, be considered for short-term use.
Injections of corticosteroids are not advised.
Injections of Xylocaine or hypertonic glucose have recently demonstrated to be beneficial.
In one trial, autologous platelet injections (PRP) were beneficial.
• Acupuncture


Referral 

Consider surgical referral if nonsurgical treatment fails and symptoms last into adulthood.

Surgery Débridement of a thickened, cosmetically unattractive tibial tubercle (rare) or removal of movable heterotopic bone Bursoscopy may be used successfully in place of an open operation to remove a painful tibial tubercle.
Recent reports show that percutaneous screw implantation of the tibial tuberosity in OSD successfully eliminates pain (1)[C].
In a short case series, reduction wedge osteotomy was recently reported to be 100 percent effective.


Follow-Up The presence of discomfort does not prevent competition; athletes may resume play if their pain is under control.
patient observation
only when symptoms worsen

Patient education – Limit activities that make you more painful or swollen, such as leaping sports.
 Reassure patients and their loved ones that time and rest will help symptoms and physical findings disappear.
Patients can engage in light physical activity without risk.
Stretching and strengthening the quadriceps are crucial.
Surgery is rarely necessary, but positive outcomes might be anticipated.

Prognosis Usually, this self-limiting condition clears up two years after the full skeletal development. Recent findings, however, indicate that many continue to be affected into adulthood and must cut back on sports and physical activity.
Up to 60% of those with OSD as teenagers may still experience symptoms as adults. Up to 60% of persons with a history of OSD experience sporadic symptoms including knee pain (2).
The majority of OSD sufferers will always have lingering "knots" on their tibial tubercles.

Rarely, a severely damaged and inflamed tibial ossicle will avulse and need to be surgically repaired.
Despite the fact that 90% of cases are said to cure, recent research indicate that persistent pain and decreased activity may persist into adulthood.
Pseudarthrosis of the tibial tubercle, genu recurvatum, patella alta, and ossicle fragmentation perhaps leading to osteoarthritis of the knee are uncommon adult problems.

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