SEARCH RESULTS FOR: Osgood-Schlatter-Disease

Osgood Schlatter Disease

Osgood-Schlatter Disease: Pathogenesis and clinical findings Growth-related factors Anatomical variations that may ↑ risk Tibial tubercle develops as a secondary ossification centre, starting with a cartilaginous outgrowth Developing cartilaginous tibial apophysis has ↓ resistance to mechanical stress ↑ Susceptibility to injury prior to tibial apophysis and epiphysis fusion Adolescent growth spurt Longitudinal growth of tibia exceeds ability of quadriceps-patellar tendon unit to stretch ↓ Quadriceps flexibility Repetitive knee extensor mechanism activities during adolescence (eg. jumping, running) Patellar tendon inserts more proximally or broadly on tibia ↓ Patellar tendon moment arm length causes ↑ biomechanical forces on tibial tubercle Patella alta (superior displacement of the patella within the trochlear groove) *temporal relationship uncertain Quadriceps require ↑ forces to achieve full extension Patellar tendon overuse ↑ Patellar tendon tension ↑ Traction stress on the patellar tendon insertion at the cartilaginous tibial tubercle apophysis in one or both knees Osgood-Schlatter Disease Self-limiting osteochondrosis or traction apophysitis (inflammation of the growth plate) of the proximal tibial tubercle at the insertion of the patellar tendon Tibial tubercle apophysis hypertrophies & develops chronic micro-avulsions (tibial apophyseal ossification centers & cartilage is pulled off the tibial metaphysis) ↑ Inflammation at injury site Proximal patellar tendon micro- Repetitive strain/forces on the proximal tibial apophysis Tibial apophysis undergoes partial arrest Asymmetric proximal tibial epiphyseal growth abnormality (posterior > anterior) Genu recurvatum (knee hyperextension) (rare) due to traction apophysitis avulses from the tibial apophysis overcomes bone-tendon attachment strength Activated immune cells release cytokines at injury site Sensitization of nociceptors in periosteum and surrounding tissues Tenderness and Antalgic swelling of gait patellar tendon Proximal tibial apophyseal fragmentation (visible on X-ray) Avulsion fracture of tibial tubercle Calcium is abnormally deposited in the tendon Calcific tendinopathy in patellar tendon (visible on X-ray) Anterior knee pain that worsens with exercise Inflammatory mediators recruit osteoblast precursors to stabilize injury site ↑ Osteoblast activity drives bone remodeling and formation of ossicles (small pieces of bone) Bone remodeling causes united ossicles (ossicle fusion with tibial tuberosity) Ununited ossicle imbedded within patellar tendon (visible on X-ray) Bony prominence of tibial tubercle (visible on X-ray) Residual ununited ossicle remains after apophysis fuses with proximal tibial metaphysis Persistent visible prominence after proximal tibial apophyseal closure Authors: Emily J. Doucette Reviewers: Michelle J. Chan Yan Yu* Gerhard Kiefer* * MD at time of publication Persistent pain & discomfort with ↓ strength & function Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Feb 16, 2025 on www.thecalgaryguide.com