Osgood-Schlatter disease

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Classification according to ICD-10
M92.5 Juvenile osteochondrosis of the tibia and fibula
- tibial tuberosity (Osgood-Schlatter disease)
ICD-10 online (WHO version 2019)

Osgood-Schlatter disease ( Osgood Schlatter disease , rugby knee ) is a painful irritation of the insertion (attachment) of the patellar tendon ( kneecap tendon ) on the anterior tibia . Pieces of bone can become detached from the shin and die off ( necrosis ). The disease is therefore counted among the aseptic (ie not infection-related) osteonecrosis .

The American surgeon Robert Bayley Osgood (1873–1956) and the Swiss surgeon Carl Schlatter (1864–1934) published case reports of the disease independently, both in 1903. A similar disease occurring in domestic dogs is better than tibial tuberosity due to some differences -Avulsion to designate.

Occurrence and symptoms

It is believed that exercise-related overload is the cause. Osgood-Schlatter's disease occurs in 20 percent of young people who are active in sports, but only in five percent of non-athletes. The disease is asymmetrical, but occurs on both knees in 25–50 percent. The typical age of the patients is nine to fourteen years, in girls the disease - like the pubertal growth spurt - occurs one to two years earlier. Male adolescents are more often affected, but since sporting activity has increased among female adolescents in recent years, the disease also occurs more often in girls.

Lateral magnetic resonance imaging. Note the detached piece of bone (arrow) on the shin
X-ray showing Osgood-Schlatter's disease

The anterior knee pain occurs under load, when tensing the thigh muscles and with manual pressure on the shin border below the kneecap, during sport in general and when kneeling down.

Diagnosis

In the case of typical clinical symptoms such as ventral knee pain over the tibial tuberosity after exercise or exercise, and possibly also palpable swelling, no further diagnosis is required. However, diagnostic imaging tests are recommended to rule out other injuries.

An imaging arrives at atypical symptoms into consideration, depending on the question and differential diagnosis sonography of the tendon attachment (DD: bursitis , abscess ), an X-ray laterally or rarely a magnetic resonance imaging. Diagnostic criteria are then fragmentation of the tuberosity, swelling of the tendon that attaches it, soft tissue edema and, on MRI, adjacent edema in the tibia.

therapy

The treatment is symptom-oriented (rest, cooling, painkillers, anti-inflammatory preparations, physiotherapy); the prognosis is good with early treatment. The course can drag on for several months or longer. In over 90% of patients, non-surgical treatment methods improve. As the final stage after the growth is complete and thus also after the growth plates have been closed, bone bodies can form within the tendon ( ossicles ) in the diseased area . If there are complaints, these should be surgically removed.

Despite the long course of the disease, the healing prognosis is good, apart from pain when kneeling and in a few cases other activity restrictions. With early diagnosis and consistent therapy, the chances of a complete cure are relatively high.

Occurrence among prominent athletes

Former British professional cyclist Michael Bennett began cycling in rehabilitation for his Osgood-Schlatter disease. The French tennis player Gaël Monfils as well as the English soccer player Jordan Henderson show the disease in adulthood. The Austrian ski racer and Olympic champion Hermann Maier also suffered from this disease before he started his career.

See also

literature

  • Fritz Hefti: Pediatric Orthopedics in Practice. Berlin et al., Springer 1998, ISBN 3-540-61480-X .

Individual evidence

  1. ^ Robert B. Osgood: Lesions of the Tibial Tubercle Occurring during Adolescence. In: Boston Medical and Surgical Journal. Volume 148, 1903, pp. 114-117, doi: 10.1056 / NEJM190301291480502 .
  2. ↑ Carl Schlatter: Injuries to the beak-shaped process of the upper tibial epiphysis. In: Contributions to clinical surgery. Volume 38, 1903, ZDB -ID 125341-4 , pp. 874-887.
  3. ^ Robert J. Nowinski, Charles T. Mehlman: Hyphenated history: Osgood-Schlatter disease. In: The American Journal of Orthopedics. Vol. 27, No. 8, 1998, pp. 584-585, PMID 9732084 .
  4. ↑ Dirsko JF von Pfeil, Charles E. DeCamp, Kelly L. Diegel, Purushottam A. Gholve, Curtis W. Probst, Loic M. Déjardin: Does Osgood-Schlatter Diesease exist in the dogs? Review of human and canine literature and proposed classification system for tibial tuberosity avulsions in the immature dog. In: Veterinary and Comparative Orthopedics and Traumatology. Volume 22, No. 4, 2009, pp. 257-263, doi: 10.3415 / VCOT-08-09-0094 .
  5. ↑ a b c U. M. Kujala, M. Kvist, O. Heinonen: Osgood-Schlatter's disease in adolescent athletes. Retrospective study of incidence and duration . In: The American Journal of Sports Medicine . tape 13 , no. 4 , August 1, 1985, ISSN  0363-5465 , p. 236-241 , doi : 10.1177 / 036354658501300404 , PMID 4025675 .
  6. ↑ BL Krause, JP Williams, A. Catterall: Natural history of Osgood-Schlatter disease . In: Journal of Pediatric Orthopedics . tape 10 , no. 1 , February 1, 1990, ISSN  0271-6798 , p. 65-68 , PMID 2298897 .
  7. ↑ CL Stanitski: Knee overuse disorders in the pediatric and adolescent athlete . In: Instructional Course Lectures . tape 42 , January 1, 1993, ISSN  0065-6895 , p. 483-495 , PMID 8463698 .
  8. ↑ Andrew J Kienstra, Charles G Macias: Osgood-Schlatter disease (tibial tuberosity avulsion). In: uptodate.com. UpToDate, August 4, 2014, accessed on January 11, 2017 (English): "Osgood-Schlatter typically occurs one to two years earlier in girls than in boys, corresponding to the different timing of the pubertal growth spurt."
  9. ^ Zaid AA Duri, Dipak V. Patel, Paul M. Aichroth: The immature athlete . In: Clinics in Sports Medicine . tape 21 , no. 3 , July 1, 2002, ISSN  0278-5919 , p. 461-482, ix , PMID 12365238 .
  10. ↑ Alfred Atanda, Suken A. Shah, Kathleen O'Brien: osteochondrosis: common causes of pain in growing bones . In: American Family Physician . tape 83 , no. 3 , February 1, 2011, ISSN  1532-0650 , p. 285-291 , PMID 21302869 .
  11. ↑ a b c d Purushottam A. Gholve, David M. Scher, Saurabh Khakharia, Roger F. Widmann, Daniel W. Green: Osgood Schlatter syndrome: Current Opinion in Pediatrics . In: Lippincott Williams & Wilkins . tape February 19 , 2007, p. 49 , doi : 10.1097 / MOP.0b013e328013dbea ( researchgate.net [PDF; accessed on January 11, 2017]).
  12. ↑ Osgood-Schlatter knee disease - cause, therapy & consequences. In: med-library.com. March 5, 2013, accessed January 11, 2017 .
  13. ↑ Famous Last Words: Mick Bennett. In: cyclingweekly.co.uk. March 7, 2014, accessed January 11, 2017 .
  14. ^ Gael could miss the French Open. In: skysports.com. April 21, 2009, accessed January 11, 2017 .
  15. ^ Jordan Henderson, Sunderland's bright light to Liverpool's brilliant leader. In: goal.com. November 26, 2016. Retrieved January 11, 2017 .