Introduction:
Osgood-Schlatter disease is a common condition affecting the knee joint, characterized by knee pain. The condition was named after two physicians, Dr. Robert Osgood and Dr. Carl Schlatter. They were the ones who described the disease in 1903. Osgood-Schlatter disease is the most common cause of knee pain in children and young adults. The condition mainly occurs during the rapid growth phase combined with high sporting or physical activity. It is more common in boys between 10 to 15 years of age. The condition is called rugby knee or football knee since it is prevalent among rugby or football players.
What Is Osgood-Schlatter Disease?
The knee is one of the largest and most complex joints in the body and acts as a hinge for the movement of the legs. The four bones, the femur (thigh bone), tibia (shin bone), fibula (calf bone), and patella (kneecap), along with the extensive network of ligaments and muscles, constitute the knee joint. The knee cap is attached to the shin bone by a patellar ligament.
Osgood-Schlatter disease is an inflammation of the patellar ligament at the spot where the ligament is connected to the shinbone. As a result, a bump appears below the knee joint, which causes pain, especially with activity.
What Are the Causes of Osgood-Schlatter Disease?
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Osgood-Schlatter disease is caused by repetitive stress or injury applied to the knee joint. During the growth phase, new bones often form at the end of the existing bone. These active areas are called the growth plate of the bone. The growth plate is cartilage that transforms into bone once the growth phase is over. Hence, in adolescent age, overuse of the knee joint during sports involves pulling traction from the ligament to the growth plate, which cannot withstand the stress and causes swelling and pain.
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Previous injury or trauma may be considered a risk factor predisposing to Osgood-Schlatter disease.
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Falling in the knee bend position may cause a sudden involuntary strain on the ligament.
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This condition runs in families.
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Some research also suggests that children with ADHD (attention deficit hyperactivity disorder) are at risk of developing Osgood-Schlatter disease.
What Are the Symptoms of Osgood-Schlatter Disease?
Osgood-Schlatter disease is nothing but inflammation. The typical features of inflammation are pain, tenderness, swelling, redness, and heat. Other symptoms are joint stiffness, tight muscles, and difficulty in walking. Tightness may be felt in the thigh and hip region also. The pain may get aggravated during activity and alleviated while resting.
How to Diagnose Osgood-Schlatter Disease?
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History Evaluation: Patient should explain their symptoms, which helps the physician understand how to proceed with the treatment.
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Physical Examination: The area around the knee is examined and palpated (touch and feel with hands) to check for swelling and tenderness. The patient may be asked to walk, run, or climb stairs to see if the pain increases.
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X-ray: Thickening of the ligament and soft tissue swelling can be demonstrated in X-rays, and they also help to rule out other conditions associated with knee pain.
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Ultrasonography: The early stage of Osgood-Schaller disease can be identified in ultrasound since it can detect even a mild increase in swelling and new bone growth.
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MRI (Magnetic Resonance Imaging): It is a highly sensitive technique to evaluate the soft tissue changes and patellar ligament abnormalities associated with Osgood-Schlatter disease.
How to Treat Osgood-Schlatter Disease?
The treatment for Osgood-Schlatter's disease aims to reduce swelling and pain. Generally, a conservative treatment protocol is recommended. They include,
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Rest: Resting without activity relaxes the ligament, releases the stress from the growth plate, and allows it to heal.
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Medication: Painkillers and anti-inflammatory drugs (NSAIDs - non-steroidal anti-inflammatory drugs) are prescribed based on the symptoms.
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Physical Therapy: A physiotherapist will perform stretches and manipulation in the knee joint to relieve the strain.
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Exercises: Stretching and muscle-strengthening exercises are recommended to reduce pain and prevent the disease from recurring.
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Ice Pack: Placing cold packs on the inflamed area reduces swelling and pain.
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Heat Fomentation: Applying heat promotes blood flow and reduces muscle stiffness.
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Supporting Devices: An orthopedic brace (a unique medically designed holding device) or an orthopedic cast (a shell made up of plaster of Paris or fiberglass for stabilization) can reinforce immobilization for a quicker recovery.
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Steroid Injection: If the symptoms are severe, cortisone shots may be given to reduce swelling and pain.
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Surgery: Osgood-Schlatter disease rarely requires surgery. It may be the last resort recommended to remove any bony fragments irritating the ligament. The surgery is typically done only in adults after the growth phase.
Can Kids With Osgood-Schlatter Disease Do Sports?
Children with Osgood-Schlatter disease can continue participating in sports but need modifications to manage the symptoms.
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Encourage participation in low-impact exercises.
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Proper warm-up and stretching improve flexibility.
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Limit high-impact activities.
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Consider using knee pads and braces.
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Allow adequate time for rest and recovery.
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Monitor symptoms like changes in pain levels during physical activity.
How to Prevent Osgood-Schlatter Disease?
Children and young adults who are very active in sports are the ones at risk of developing Osgood-Schlatter disease.
Some of the general advice to prevent Osgood-Schlatter disease while playing sports is:
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Wear shock-absorbing insoles in shoes to prevent injuries.
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Apply heat 15 minutes before the sport to increase muscle flexibility.
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Place an ice pack 15 minutes after sport to reduce muscle spasms.
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Wear a protective kneecap or knee guard to protect the knee from the risk of further damage.
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Regular stretching and strengthening exercises increase the muscles' flexibility, durability, and balance.
Conclusion:
Osgood-Schlatter disease is a periodic condition that does not last for a long time. The condition is self-limiting. Most of the symptoms will completely disappear after puberty. However, the bulge under the knee joint may persist forever without any pain. Children and teenagers can become depressed over Osgood-Schlatter disease during sports activities. Therefore, proper awareness and reassurance should be given to children and their parents regarding the condition, as it is only a temporary disability.