What Happens If Osgood-Schlatter Disease Doesn’t Go Away & When To Go To Doctor?

Osgood-Schlatter disease pain is felt usually in one knee but in around 20 to 30 percent of the cases, both the knees are affected.(6)

Since the symptoms often worsen due to repeated jumping and running, it often occurs in elementary and junior high school students (12 to 15 years old for boys and 8 to 12 years old for girls) during exercise. There is a tendency for boys to be more common than girls, but the gender ratio has been antagonized because the participation rate of girls in sports has increased recently.1

What Happens If Osgood-Schlatter Disease Doesn’t Go Away?

The chief complaint is sharp local pain in the rough surface of the tibia (anterior to the knee). The pain gradually worsens with repetitive movements such as climbing up and down the stairs, jumping, and running. The tibia may be enlarged.(2)

Symptoms often appear only on one side, but both knees may have the issue. Pain is often not noticeable at rest, but this is not the case if the inflammatory response is strong.

Symptoms such as knee locking and sudden weakness are rare. Symptoms are categorized into three categories depending on the duration of the pain.

The extent of the symptoms of Osgood-Schlatter disease:

  • Grade 1: exacerbation of pain occurs after exercise, but become painless within 24 hours
  • Grade 2: exacerbation of pain occurs during and after exercise or sports activities, lasting for 24 hours or more
  • Grade 3: pain persisting most of the time; hindering exercise and normal daily life.2

When Should You Visit A Doctor For Osgood-Schlatter Disease?

If your child is experiencing the symptoms of Osgood Schlatter, arrange to see a doctor. Early detection is important to prevent the situation from escalating. In rare cases, Osgood Schlatter can affect the bone growth plate and may require surgery. Contact your child’s doctor if the knee pain impairs your child’s ability to perform daily activities. Seek medical help if the knee is swollen and red, or if the knee pain is accompanied by fever or lock or both.2

Cause Of Osgood-Schlatter Disease

In Osgood-Schlatter disease, the repeated traction load on the rough surface of the tibia is the mechanism of onset. The quadriceps tendon is attached to the patella and has a stop on the rough tibia via the patella ligament. Therefore, the repeated flexion and extension of the knee joint causes the quadriceps muscle to expand and contract, and a traction load is applied to the rough surface of the tibia.

The patella ligament extends from the patella apex (lower end of the patella) to the rough tibia. The quadriceps tendon is attached to the base of the patella (top of the patella), and the energy generated by the quadriceps is transmitted to the rough tibia through the patella ligament.

When the patient is in the growth phase, the epiphysis of the rough tibia is not yet closed and structurally weak. As a result, traction is applied to this area, causing an inflammatory response. Excessive loading can also result in epiphyseal fractures.3

Diagnosis For Osgood-Schlatter Disease

Palpation examinations check for inflammatory reactions (hot, swelling, and redness) on the rough tibia. Next, palpate for tenderness at the patella ligament attachment site on the rough tibia.

At that time, palpation is performed at three points on the medial side, superior side, and lateral side of the rough surface of the tibia, and the degree of tenderness at each point is determined (by asking the patient).

  • Palpation of the tibial tuberosity involves touching the proximal surface of the tibial tuberosity and compressing in three directions.
  • Differential diagnosis of Osgood-Schlatter disease and a dislocated fracture of the tibial tuberosity look at the patient’s response in the loading position.
  • Differential diagnoses other than exfoliated fractures include jumper knees, patellofemoral pain syndrome, and subpatellar steatosis.
  • In Osgood-Schlatter disease and patellofemoral pain syndrome, the pain is localized to the rough tibial surface and the patella apex, respectively. On the other hand, in the patellofemoral pain syndrome and subpatellar steatosis, the pain is scattered.
  • In Osgood-Schlatter disease, the pain is localized to the rough tibia, but in the jumper knee, the pain appears at the patella apex.4

Treatment For Osgood-Schlatter Disease

It is not possible to deal manually with the structural problems of the rough tibia. Therefore, it will improve the functional problems of the knee joint. For functional issues, consider the cause of the increased load on the tibial tuberosity.

The first is dyskinesia of the patellofemoral joint. The patella and tibial tuberosity are connected by the patella ligament.

Therefore, any movement impairment in this joint will affect the load on the tibial tuberosity. Also, since the patella is sensitive to the quadriceps, home exercises should have the quads stretched.

The second is a movement disorder of the femoral tibial joint. The external rotation occurs in the tibia in the final range of motion of knee extension.

This is known as a screw home mechanism (in contrast, the tibia rotates inward at the first movement of flexion). The failure of the screw home mechanism changes the load on the patella ligament. Therefore, the presence or absence of internal and external rotation dyskinesias associated with flexion and extension of the femoral tibial joint should be examined, and any abnormalities should be treated. Also, if the external rotation of the tibia is severely restricted, it may be due to rigidity (shortening) of the popliteal muscle.5

References:

  1. Smith JM, Bhimji S. Osgood Schlatter Disease. 2018.
  2. Guldhammer C, Rathleff MS, Jensen HP, Holden S. Long-Term prognosis and impact of Osgood-Schlatter disease 4 years after diagnosis: a retrospective study. Orthopaedic journal of sports medicine. 2019;7(10):2325967119878136.
  3. Arendt EA. Editorial Commentary: Tibial Tubercle Prominence After Osgood-Schlatter Disease: What Causes Pain? : Elsevier; 2017.
  4. Siddiq MAB. Osgood-Schlatter disease unveiled under high-frequency ultrasonogram. Cureus. 2018;10(10).
  5. Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood–Schlatter disease: review of the literature. Musculoskeletal surgery. 2017;101(3):195-200.
  6. https://www.health.harvard.edu/a_to_z/osgood-schlatter-disease-a-to-z

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