Osgood-Schlatter Disease: A Review of Current Diagnosis and Management

Kartini Ciatawi, MD, MPH; I. Wayan Suryanto Dusak, MD

Curr Orthop Pract. 2022;33(3):294-298.

Abstract and Introduction

Abstract

Osgood-Schlatter disease is a common cause of knee pain in children and adolescents, particularly in those who participate in sports. Repetitive force during athletic activities, along with changes that happen during a growth spurt, result in the development of traction apophysitis. Because of its typical presentation, the diagnosis is usually made clinically. The disorder generally resolves with skeletal maturity, and most patients respond to conservative therapy. Surgery can be considered in recalcitrant cases. Several approaches of surgical intervention have been proposed; each approach has its advantages and disadvantages.

Introduction

Osgood-Schlatter disease (OSD), also known as apophysitis of tibial tubercle or partial avulsion of tibial tubercle, is a traction apophysitis of the tibial tuberosity particularly near the insertion of patellar tendon.^[1,2] The disorder was named after the first two persons who individually described it in 1903, Robert Osgood and Carl Schlatter.^[3,4] OSD is a common cause of anterior knee pain in children and adolescents, especially in those who are active in sports, and is frequent in 8- to 15-year-olds. Since it is considered a self-limiting disease, the treatment is usually conservative.^[5,6]

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Table 1. Czyrny & Greenspan classification of Osgood-Schlatter disease based on ultrasonographic findings ³⁹
Type 1	Type 2	Type 3
• Delamination of the internal ossification center, giving an "igloo" appearance	• Delamination tear/fracture of the epiphyseal part of the tibial tuberosity	• Delamination tear of the ossification center causing irregular deformation of the tuberosity, cartilage fracture
	• Cartilage fracture overlying ossification center and significant anterior displacement of the patellar ligament on the proximal attachment	• Focal scarring and possible ectopic calcium or bone formation
• Deep infrapatellar bursitis and/or fibrosis	• Deep infrapatellar bursitis and/or fibrosis	• Deep infrapatellar bursitis and/or fibrosis
• Disseminated inflammation/fibrosis of the patellar ligament	• Disseminated inflammation/fibrosis of the patellar ligament	• Disseminated inflammation/fibrosis of the patellar ligament
• Superficial infrapatellar bursitis	• Superficial infrapatellar bursitis	• Superficial infrapatellar bursitis
• Very favorable prognosis	• Moderately favorable prognosis	• Unfavorable prognosis

Table 2. Classification of Osgood-Schlatter disease according to MRI ⁴⁰
Stage	Findings
Normal	Subjective symptoms with normal MRI findings
Early	Inflammation around the secondary ossification center of tibial tuberosity without avulsion
Progressive	Partial cartilaginous avulsion from the secondary ossification center
Terminal	Presence of separated ossicles
Healing	Osseous healing of the tibial tuberosity with no separated ossicles

Table 3. Summary of proposed advantages and disadvantages of surgical approaches ^{28,44,47–49,52–55}
	Open procedures	Arthroscopy	Bursoscopy
Advantages	Provides better exposure, therefore allows extensive debridement and is better in cases with: Large ossicle Bulging prominence Revision scenario	Less invasive Able to perform diagnostic test at the same time Does not injure patellar tendon Shorter postoperative recovery Small surgical scar away from bony prominence: Less pain Better cosmetics	Less invasive Good results were reported in selective young, active patients with unresolved symptoms Does not involve anterior interval release Minimal damage on the infrapatellar fat pad Less painful scar
Disadvantages	Longer period of recovery Painful surgical scar especially when kneeling	Requires special skills In a condition where the ossicle is located lower, an additional portal is needed Cause damage in the infrapatellar fat pad May damage the anterior horn of the meniscus or intermeniscal ligament, and patellar tendon	Requires special skills Limited working space An additional portal is needed for diagnostics Ineffective to reduce prominence on the tuberosity