Osgood-Schlatter DiseaseDz

Synonyms: Tibial apophysitis.

ICD-9 Code: 732.4.
ICD-10 Code: M92.5

Definition: Osgood-Schlatter disease is a traction apophysitis of the distal patellar tendons insertion at the tibial tuberosity. Larsen-Johansson disease is a similar to Osgood-Schlatter disease but involves the insertion of the patellar tendon on to patella.

Pathogenesis: Repetitive traction on the secondary ossification center of the tibial tuberosity.

Demographics: Osgood-Schlatter disease is a common sporting injury that occurs in 4% of adolescents. It typically affects athletic adolescents; boys more frequently than girls. Onset age is younger in girls (10–11 years) than boys (13–14 years).

Cardinal Findings: Pain over the tibial tubercle worsened with exercise or extension against resistance. Symptoms may be worse with squatting, jumping, or using stairs. Localized pain, with or without swelling, may be found over the tubercle. Bony hypertrophy may persist after pain subsides. Rarely tibial tubercle avulsion fractures occur. The prognosis is favorable for most.

Imaging: If symptoms are chronic, imaging is indicated and often shows soft tissue swelling or hypertrophy and fragmentation of the tubercle (which is normally irregular in contour in young people). Chronic symptoms may be further imaged by CT or MRI.

Differential Diagnosis: Patellar subluxation, patellar tendonitis, Larsen- Johansson disease.

Therapy: Rest, activity avoidance or ice after activity, and quadriceps strengthening exercises are all helpful. Splinting or casting is discouraged. Pain management with simple analgesics or NSAIDs may be useful. Surgery may be indicated if symptoms persist into adulthood.

BIBLIOGRAPHY

Bloom OJ. What is the best treatment for Osgood-Schlatter disease? J Fam Pract 2004; 53:153–156.PMID:14764303

Hogan KA. Overuse injuries in pediatric athletes. Orthop Clin North Am 2003;34:405–415.PMID:12974490