Osgood schlatter syndrome

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Osgood Schlatter syndrome
Purushottam A. Gholvea, David M. Schera,b, Saurabh Khakhariaa, Roger F Widmanna,b and Daniel W. Greena,b .

Purpose of review Osgood Schlatter syndrome presents in growing children (boys, 12–15 years; girls, 8–12 years) with local pain, swelling and tenderness over the tibial tuberosity. Symptoms are exacerbated with sporting activities that involve jumping(basketball, volleyball, running) and/or on direct contact (e.g. kneeling). With increased participation of adolescent children in sports, we critically looked at the current literature to provide the best diagnostic and treatment guidelines. Recent findings Osgood Schlatter syndrome is a traction apophysitis of the tibial tubercle due to repetitive strain on the secondary ossification center of the tibialtuberosity. Radiographic changes include irregularity of apophysis with separation from the tibial tuberosity in early stages and fragmentation in the later stages. About 90% of patients respond well to nonoperative treatment that includes rest, icing, activity modification and rehabilitation exercises. In rare cases surgical excision of the ossicle and/or free cartilaginous material may give goodresults in skeletally mature patients, who remain symptomatic despite conservative measures. Summary Osgood Schlatter syndrome runs a self-limiting course, and usually complete recovery is expected with closure of the tibial growth plate. Overall prognosis for Osgood Schlatter syndrome is good, except for some discomfort in kneeling and activity restriction in a few cases. Keywords diagnosis,management, Osgood Schlatter syndrome
Curr Opin Pediatr 19:44–50. ß 2007 Lippincott Williams & Wilkins.
a Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, USA and bWeill Medical College of Cornell University, New York, USA

Introduction
In 1903, Osgood [1] and Schlatter [2] separately described a painful condition of the anterior tibial tubercle characterized bypartial separation of the tongue-like epiphysis of the tibial tuberosity, apparently caused by continued strain placed upon it by the patellar tendon. Osgood Schlatter syndrome (OSS) involves the tibial tuberosity in growing children and presents with local pain, swelling and tenderness of the tuberosity. The common age of presentation in boys is between the ages of 12 and 15 years and in girls isbetween the ages of 8 and 12 years [3,4]. The occurrence is reported to be greater in boys than girls [5,6] and it frequently presents bilaterally (20–30%) [7–9].

Etiopathogenesis
Currently it is widely accepted that OSS is a traction apophysitis of the tibial tubercle due to repetitive strain and chronic avulsion of the secondary ossification center of the tibial tuberosity. The repetitivestrain is from the strong pull of the quadriceps muscle produced during sporting activities. The tibial tuberosity avulsion may occur in the preossification phase or the ossified phase of the secondary ossification center. Once the bone or cartilage is pulled away it continues to grow, ossify and enlarge. The intervening area may become fibrous, creating a localized nonunion (separate persistent ossicle),or may show complete bony union with mild enlargement of the tibial tuberosity (Fig. 1). The theory of traction apophysitis and traumatic avulsion of the secondary ossification center of tibial tuberosity is supported by Ehrenborg and Engfeldt [5,10–12] and Ogden and Southwick [13]. Ehrenborg and Lagergren [14] described four radiological stages in the maturation of tibial apophysis (Fig. 2):cartilaginous stage (aged 0– 11 years); apophyseal stage (aged 11–14 years); epiphyseal stage, the tibial apophysis coalesces with tibial epiphysis (aged 14–18 years); and bony stage, the epiphysis is fused (aged > 18 years). On correlating the clinical findings, most OSS cases were seen in the apophyseal stage [5]. With work on cadaveric specimens Ehrenborg [10] suggested that ligamentum patellae...
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