**OSGOOD SCHLATTER'S DISEASE

ICD 9 732.4

DEFINITION & DISCUSSION

•  DEFINITION? Traction apophysitis of tibial tubercle

•  INCORRECTLY DEFINED AS PARTIAL AVULSION OR OSTEOCHONDRITIS OF THE TIBIAL TUBERCLE

•  ALSO INCLUDED UNDER PFPS petellafemoral pain syndrome

•  MOST COMMON KNEE PROBLEM IN ACTIVE CHILDREN AND YOUNG TEENS

•  3 : 1 MALES : FEMALES

•  BILATERAL? In about 1/3 of cases

ETIOLOGY

•  COMMON AGE OF ONSET

•  10-15 IN MALES & 8-13 IN FEMALES

•  SEVERAL THEORIES REGARDING CAUSE; combo of growth and high impact injuries, staff

•  MOST ACCEPTED CAUSE? Repeative truma

•  SOFT 2NDARY OSSIFICATION CENTER WEAK LINK

•  HIGH TRACTION STRESS ESPECIALLY IN YOUNG ACTIVE PTS

•  WOLFS LAW - BONE PROLIFERATION DUE HIGH STRESS

HISTORY

•  ONSET OF PAIN? Gradual insidious

•  LOCALIZED TO TIBIAL TUBERCLE & LOWER TENDON

•  OFTEN CAUSED AS WELL AS AGGRAVATED BY VIGOROUS ACTIVITY (ie RUNNING, JUMPING, KICKING, HILLS, OR STAIRS)

•  RARELY SINGLE TRAUMA (SIGNIFICANCE? Might be fracture or alvulsion need to take x-rays)

•  MAY PREVENT CONTINUED PARTICIPATION

•  WHAT AGE GROUP? 10-15 (age is a red flag!)

SIGNS & SYMPTOMS

•  SWOLLEN TIBIAL TUBERCLE

•  TENDER TIBIAL TUBERCLE

•  END ROM PAIN (HEEL TO BUTTOCK)

•  SOMETIMES PAIN w/ QUADRICEPS CONTRACTION

•  XRAYS ? not required for definitive DX

OSGOOD SCHLATTER OR AVULSION?

•  RAPID ONSET / SINGLE EVENT =?

•  MORE PAINFUL

•  DISPLACED PATELLA IF COMPLETE

•  XRAYS?

TREATMENT

•  REST FOR 1 2 WEEKS

•  THEN LIMIT ACTIVITY AS NEEDED

•  REDUCE OR AVOID? High impact ballistic activity for a couple of weeks, then self limit for

•  ICE, BROMALAIN, GOOD after exercise; NSAIDS, not so they can play => further injury

•  CALCIUM usefull but not proven, SELENIUM proven helpful, VIT. E & C for CT and bone maintenance avoid coffee

•  TAPE OR BRACE KNEE? Tape below kneecap, Chopat knee brace helpful

•  PROPER SHOES & ORTHOTICS AS NEEDED careful with kids

•  WHEN TO STRETCH/STRENGTHEN QUADS? Not when symptomatic , good when asymptomatic

•  STRETCH HAMS, ITB, GASTROSOLEUS! Very helpfull

•  LONG SLOW WARMUPS

PROGNOSIS

•  USUALLY SELF LIMITTING long term complications is negligible

•  HOW OFTEN DOES IT PROGRESS TO AVULSION? Rarely

•  OFTEN CHRONIC - EBBS & FLOWS DEPENDING ON ACTIVITIES

•  WHAT TO TELL THE PT? Listen to your body, gets worse back off, don't overdue jumping, no hard uphill cycling, cross train, focus on the sports you really want to play

•  WHAT ABOUT SPORTS?

•  PT EDUCATION IS A KEY TO TX!

•  10% OR LESS REQUIRE AGGRESSIVE TX

SINDING, LARSEN, JOHANNSON DISEASE SAME ICD 9 732.4

•  WHAT'S THE DIFFERENCE? Aphopicitis at the inferior pole of the patella, not the tibial tuberocity

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