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Osgood–Schlatter Disease, Emergency Medicine

Basics

Description

- Risk factors: - Age: 10 " пїЅ15 yr of age, associated with growth spurt in puberty - More common in boys - Sports: Activities with running, jumping, swift changes in direction (i.e., soccer, basketball, figure skating)

  • Most frequent cause of knee pain in children aged 10 " пїЅ15 yr
  • Pain and edema of the tibial tuberosity:Tenderness at insertion site for patellar tendon just below the knee joint
  • Extra-articular disease:Pain is worse with activity and improves with restCaused by repetitive stress and is common in children participating in sports
  • Benign, self-limited knee condition

Etiology

  • Etiology is controversial
  • Leading theory: Microfractures caused by traction on the apophysis
  • Pain occurs during activities that stress the patellar tendon insertion onto tibial tubercle.

Diagnosis

Signs and Symptoms

  • Pain and swelling over tibial tuberosity
  • Pain exacerbated by running, jumping
  • Pain relieved by rest

History

  • Risk factors:Age: 10 " пїЅ15 yr of age, associated with growth spurt in pubertyMore common in boysSports: Activities with running, jumping, swift changes in direction (i.e., soccer, basketball, figure skating)
  • Knee pain is worse with activity and improves with rest.
  • Usually unilateral, with 20% occurring bilateral

Physical Exam

  • Prominence and soft tissue swelling over the tibial tuberosity
  • Pain reproduced by extending the knee against resistance
  • Tenderness over tibial tuberosity at patellar tendon insertion site
  • Tight quadriceps and hamstrings compared to unaffected side
  • Erythema of tibial tuberosity may be present.
  • Knee joint exam is normal.

Essential Workup

Diagnosis is clinical: пїЅ пїЅ

  • Pain, swelling, and tenderness localized to the tibial tubercle

Diagnosis Tests & Interpretation

Imaging

Knee x-ray: пїЅ пїЅ

  • Irregular ossification and fragmentation at the tibial tuberosity may be seen.
  • Ultrasound has the advantage of imaging surrounding soft tissues

Differential Diagnosis

  • Patellar stress fracture
  • Patellar or quadriceps tendonitis
  • Prepatellar or infrapatellar bursitis
  • Osteochondritis dissecans
  • Osteomyelitis
  • Patellofemoral pain syndrome
  • Septic joint
  • Inferior patellar pole traction apophysitis (Sinding-Larsen " пїЅJohansson disease)
  • Fat pad impingement (Hoffa disease)
  • Referred pain, especially from the hip

Treatment

Initial Stabilization/Therapy

  • Stabilize lower extremity in position of comfort.
  • Apply ice to affected knee.

Ed Treatment/Procedures

  • Rest from painful activities:Limited activity for 6 " пїЅ8 wkAvoid cutting and jumping sports, such as basketball, soccer, volleyball, etc.
  • Ice affected area.
  • Analgesic medications
  • Stretch the quadriceps and hamstrings.
  • Apply protective padding to knee during activities.
  • Infrapatellar tendon strap may be worn for 6 " пїЅ8 wk.
  • Avoid corticosteroid injections.
  • Reassurance; it is a benign, self-limited condition.

Medication

First Line

Analgesic medications: пїЅ пїЅ

  • Ibuprofen: 10 mg/kg PO q6h
  • Acetaminophen: 15 mg/kg PO q4h

Follow-Up

Disposition

Admission Criteria

No admission is necessary. пїЅ пїЅ

Discharge Criteria

Discharge home. пїЅ пїЅ

Issues for Referral

If patient fails nonoperative therapy, then refer to pediatric orthopedic surgery: пїЅ пїЅ

  • Rarely, surgical excision is required but is delayed until after skeletal maturity.

Followup Recommendations

Rest from painful activities and follow-up with pediatrician in 2 " пїЅ3 wk for repeat exam. пїЅ пїЅ

Pearls and Pitfalls

  • Diagnosis is clinical:Pain, swelling, and tenderness at the tibial tuberosity:Tenderness and pain worse during and after exerciseRisk factors:10 " пїЅ15 yr of ageSports activities with running, jumping
  • Treatment is conservative:Treat with rest, ice, and NSAIDsAvoid sports activities until pain resolves.

Additional Reading

  • Bloom пїЅ пїЅOJ, Mackler пїЅ пїЅL, Barbee пїЅ пїЅJ. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam Pract. 2004;53(2):153 " пїЅ156.
  • Cassas пїЅ пїЅKJ, Cassettari-Wayhs пїЅ пїЅA. Childhood and adolescent sports-related overuse injuries. Am Fam Physician. 2006;73(6):1014 " пїЅ1022.
  • Gholve пїЅ пїЅPA, Scher пїЅ пїЅDM, Khakharia пїЅ пїЅS, et al. Osgood-Schlatter syndrome. Curr Opin Pediatr. 2007;19(1):44 " пїЅ50.
  • Weiss пїЅ пїЅJM, Jordan пїЅ пїЅSS, Andersen пїЅ пїЅJS, et al. Surgical treatment of unresolved Osgood-Schlatter disease: Ossicle resection with tibial tubercleplasty. J Pediatr Orthop. 2007;27(7):844 " пїЅ847.

Codes

ICD9

732.4 Juvenile osteochondrosis of lower extremity, excluding foot пїЅ пїЅ

ICD10

  • M92.50 Juvenile osteochondrosis of tibia and fibula, unsp leg
  • M92.51 Juvenile osteochondrosis of tibia and fibula, right leg
  • M92.52 Juvenile osteochondrosis of tibia and fibula, left leg
  • M92.5 Juvenile osteochondrosis of tibia and fibula

SNOMED

  • 72047008 juvenile osteochondrosis of tibial tubercle (disorder)