OsgoodSchlatterDisease:ALiteratureReview

AllisonBaker&MadelineKirton
08066560807473

Abstract
Thisliteraturereviewaimstoexaminepreviousresearchconductedonadolescent
patientswithOsgoodShlatterdisease,inordertomakeaccurateconclusionsinregardsto
treatmentoptions.TheresearchrecordswerecollectedfromthePubMeddatabaseandatotalof
12outof154articleswereusedandreferencedinthisreview.Articleswereexcludedbasedon
theirtitledescription,thetargetofthestudybasedonitsabstract,andthedatethatthestudywas
conducted.Theywerealsoexcludedduetothelackofaccessibilitytothefulltextandifthe
informationthatwasrepetitive,butlessdetailed.Theresultsofthisliteraturereviewestablish
thattherearetwoprimarymethodsfortreatingthesymptomsofOsgoodSchlatterdisease,which
areimplementedbasedonthedevelopmentalstageofthepatient.Themethodusingconservative
measuressuchas;icing,makingadjustmentsinactivityandtheuseofmedications,ispreferred
inyoungathleticadolescentpatients,whoareskeletallyimmatureandrequiredailyparticipation
inphysicalactivity.Thesurgicalmethod,however,ismoreappropriatelyimplementedonadult
patients,whohavesymptomsthathaveprogressedfromchildhoodandwhodonotrespondto
theconservativemeasures.Surgicaltreatmentisriskyintheyoungerpatients,astheyarestill
experiencingbonegrowth;however,thisformoftreatmentissuccessfulinadults,asithas
minimalpostoperativecomplicationsandallowsforimmediatereturntodailyactivities.Overall,
thisliteraturereviewprovidesathoroughunderstandingofOsgoodSchlatterdisease,by
assessingtheprevalence,cause,prognosis,anddiagnosis,aswellasthemostappropriate
treatmentproceduresforthiscondition.

Introduction
Rationale
Involvementincompetitivesportshasbecomeincreasinglycommonamongstadolescent
childrenwhoarebetweentheagesoftenandfifteenandarestillintheapophysealstageofbone
growth.Participatingincuttingandjumpingsports,whilethebonesandligamentsinachilds
kneearephysicallyimmature,makesthemmoresusceptibletoapophysitisofthetibialtubercle,
alsoknownasOsgoodSchlatterdisease(Bellicini&Khoury,2006).OsgoodSchlatterdiseaseis
anoveruseanteriorkneeinjurythatresultsintheinflammationofthepatellarligamentatthesite
ofthetibialtubercle.Thisconditioncanbetreatedwithsimpleconservativemeasures,and
symptomstypicallydissipateasthechildsbonesmature;however,insomecases,symptomsof
OsgoodSchlatterdiseasecanpersistintoadulthoodandcanbecomeseverelydisabling.Proper
understandingandimplicationoftheseconservativemeasuresiscrucialforcontrollingthe
symptomsofthisconditionbeforetheybecomepersistentandmoreaggressivetreatment
options,suchassurgeryneedtobeconsidered.
Prevalence.OsgoodSchlatterdiseaseisprevalentinadolescentathletes,more
commonlyboys(Whitmore,2013)betweentheagesof1015(Cassas&CassettariWayhs,
2006)whoarephysicallyimmatureandareexperiencinggrowthspurts(Foss,Myer,Magnussen,
&Hewett,2014).

Cause.Sportssuchasbasketballandsoccer,thatinvolvejumpingandrunning,require
repetitivecontractionofthequadricepsmusclesandextensionofthekneeagainstresistance
(Whitmore,2013),causingmicrotraumatothetibialtubercle.Thesechildrensjunctionbetween
thepatellarligamentandthetibialtubercleisimmature(Gholve,Scher,Khakharia,Widmann,&
Green,2007)andisunabletowithstandthetensileforcesbeingplacedonthem,leavingtheir
tibialtuberclemoresusceptibletostrain(Bellicini&Khoury,2006).
Diagnosis.OsgoodSchlatterdiseaseiscommonlydiagnosedwithacombinationof
clinicalhistory,physicalexaminationandadvancedimagingtechniques,suchasradiography,
MRIandCT(Gholve,Scher,Khakharia,Widmann,&Green,2007).Aphysicalexaminationcan
successfullydetectOsgoodSchlatterdiseasethroughtheobservationofpain,swelling,resistant
extensionofthekneeandleg,aswellasapredominantfemoralcondyle(Calmbach,&
Hutchens,2003).Initiatingaclienttoparticipateinactivitiessuchaskneeling,squattingand
jumpingislikelytotriggerpainandassistinthediagnosis(Calmbach,&Hutchens,2003).
Radiographicimagingcanalsoassistwithdiagnosis,asitisabletoprovideverydetailedimages
usedtodeterminetheseverityandstageofthecondition.Avulsionfractures(Hirano,
Fukubayashi,Ishii,&Ochiai,2002),swellingofsoftissue(Gholve,Scher,Khakharia,
Widmann,&Green,2007),anununitedossicle(Beyzadeoglu,Inan,Beklet,&Altintas,2008),
orroundregularossificationovertubercle(Falciglia,Giordano,Aulisa,Poggiaroni,&Guzzanti,
2011),areallobservationsthatcanbeseenusingradiographicimaging,assistinginproper
diagnosisofOsgoodSchlatterdisease.Intermsofthestageofthecondition,radiographic
imagingwilldetectslightseparationoftheapophysisfromthetibialtubercleduringearlystages,
andfracturesorcompletedisplacementinthelaterstages(Gholve,Scher,Khakharia,Widmann,
&Green,2007).Advancedimagingtechniques,suchasMRIandCTscans,canprovide

significantinformationfordiagnosis;however,theuseofradiographysuchasxraysismore
appropriate,asitislessexpensiveandreadilyavailable(Gholve,Scher,Khakharia,Widmann,&
Green,2007).Overall,thecombinationofaphysicalexaminationandadvancedimaging
techniqueswillprovidethenecessaryinformationforanaccurateanddetaileddiagnosis,
allowingforimplementationofthepropertreatmentplaninordertosuccessfullyreduce
symptoms.
Prognosis.TheoverallprognosisofOsgoodSchlatterdiseaseisgood(Baltaci,Ozer,&
Tunay,2004),andmostpatientsareabletoreturntofullactivitywithin23weeks.Kneebraces
aresuggestedforupto6to8weekswhilegettingbackintonormalactivities(Cassas,&
CassettariWayhs,2006).Completerecoveryisexpectedamongadolescentsassoonasthetibial
growthplateclosesandthekneebecomesmatureandstrongenoughtohandlethestrainbeing
placedonit(Whitmore,2013).Byadulthoodmostpatientsareasymptomatic,butinsomerare
cases,discomfortcontinuestooccurduringkneeling(Gholve,Scher,Khakharia,Widmann,&
Green,2007).
Objective
Thepurposeofthisliteraturereviewistoexaminepreviousresearchconductedon
adolescentpatientswithOsgoodShlatterdisease,inordertomakeaccurateconclusionsin
regardstotreatmentoptions.Comparisonsweremadebasedonadvantagesanddisadvantagesof
twotypesoftreatmentprocedures,conservativeandsurgical.Theresearchersexaminedthe
percentageofpatientswithsuccessfultreatmentofthisdiseasewiththeuseofsimple
conservativeprocedures,aswellasthelackofresponsetothistreatment.Theythendetermined
whenmoreaggressivetreatmentapproachessuchassurgeryarenecessary,andifso,whatisthe

expectedrecoverytimeandwhatarepossiblecomplicationsareassociatedwiththistypeof
treatment.
Methods

ThecollectionofrecordsbeganwithaPubMedsearchusingthekeywordOsgood
SchlatterdiseasewithanEnglishlanguagefilterapplied,whichresultedinatotalof154
articles.Articleswereexaminedandanadditional4recordswereidentifiedthroughthe
referencesof3ofthe154originalarticlesobtainedfromPubMed,computingatotalof158
articles.These158articleswerethenscreenedand127recordswereexcludedafterreviewof
titledescription,targetofstudybasedonabstract,andaccessibility,leavingatotalof31records
tobeassessed.Articleswereexcludediftitlesandabstractsdidnotprovideinformationspecific
totreatmentoptionsforadolescentsoriftheywerenotspecifictoOsgoodSchlatterdiseaseand
iffulltextwasnotaccessible.Afterassessingthe31records,articleswereexcludediftheywere
conductedmorethan10yearspriororhadrepetitiveandlessdetailedinformation.19articles
wereexcludedbasedonthiscriteria,butwererelevantandconsistentwithotherfindings,and

assistedtheresearchersinconfirmingconclusions.Thesearticleswerenotreferencedinthis
literaturereviewbecauseotherarticles,whichprovidedmoredetailedandspecificinformation,
wereused.
Discussion

TheresearchconductedonthetreatmentproceduresforsymptomsofOsgoodSchlatter

diseaseinyoungathletes,agreethatthisconditioncanbetreatedwithsimpleconservative
methods.Yetinsomecircumstances,wherethereisalackofresponsetothesemethods,more
aggressivetreatmentoptionsareavailableintheformofsurgery.
Treatments
Conservativetreatment.AfteraproperdiagnosisofOsgoodSchlatterdisease,itcanbe
effectivelyselfmanagedthroughconservativemeasuresincluding;reductioninactivity
intensity,durationandtypethatcausespain(Weller,Ingram,&Wolman,2011),icingthetibial
tuberosity,aswellasanalgesicandantiinflammatorymedications(Cassas,&CassettariWayhs,
2006).Oncesymptomsarecontrolled,physiotherapyinvolvingassistedstretchingofthe
quadricepscanbehelpfulinreducingthetensionofthepatellarligament,ultimatelyreducingthe
strainplacedonthetibialtubercle(Weller,Ingram,&Wolman,2011).Kneebracesorpadscan
provideadditionalsupportandcomforttopatientsastheyreturntoactivity(Falciglia,Giordano,
Aulisa,Poggiaroni,&Guzzanti,2011).90%ofpatientswillrespondwelltononoperative,
conservativetreatments,andtheother10%willneedtoconsidermoreaggressivetreatment
options,astheydonotrespondwelltoconservativemethods.Thiscausestheirsymptomsto
persistintoadulthood(Weller,Ingram,&Wolman,2011).

Surgicaltreatment.Moreaggressivetreatmentistypicallyintheformofsurgery,but
canonlybesuccessfullyperformedonskeletallymaturepatients(Weiss,Jordan,Anderson,Jee,
&Kocher,2007).PatientswithprolongedOsgoodSchlatterdiseaseexperiencethegrowthof
smallbonyformations,alsoknownasossicles,whichfailtounitewiththetibialtubercle,and
arethesourceofanteriorkneepain(Falciglia,Giordano,Aulisa,Poggiaroni,&Guzzanti,2011).
Thepurposeofsurgeryistoremovethesesymptomaticossiclesand,orfreecartilaginous
material(Weiss,Jordan,Anderson,Lee,&Kocher,2007)inordertorelievepainand
discomfort.Surgeryisconsideredtobeverysuccessful,asitrelievespainwhileavoiding
postoperativecomplications.Althoughthesurgicalprocedureisinvasiveandrequiresanincision
tothepatellartendon,immobilizationisnotrequiredandpatientsareencouragedtoresumeto
activitiesofdailylivingimmediatelyandlevelsofphysicalactivitywithintwelveweeks
(Falciglia,Giordano,Aulisa,Poggiaroni,&Guzzanti,2011).
Limitations
Researcherswerebiaswhenbeginningtheprocessofthisliteraturereview,andbasedon
previousknowledgeofthisdisease,thefocuswasprimarilyontheeffectthisdiseasehadon
children.Thisbiasresultedinalimitationofthetypesofstudiesthatwerereviewed,avoiding
thosefocusingonadultpopulations.Theresearchthatwascollectedforthisliteraturereviewon
OsgoodSchlatterdiseasewasfromstudiesthatprimarilyinvolvedadolescentboys.Thelackof
availableresearchthatassessedpopulationsincludedadultsandfemales,restrictedthe
researchersfromacquiringknowledgeandevidenceintermsoftheprevalenceofdevelopment
ofthisdiseaseinadultsandwellasanyinformationregardingadolescentfemales.The
researchersbelievethatboysweretargetedbasedontheassumptionthatmalesparticipatein
moreorganizedsports,andarethereforemoresusceptibletothisdisease.Researchersonly

assessedstudiesthatwereconductedwithinthelast10years,attemptingtouseonlythemost
currentinformationtomaketheirconclusions.Researchersalsoonlycollectedtheirrecords
fromthePubMeddatabase,restrictingtheuseofotherdatabases,whichmayconsistofstudies
withadditionalsignificantandrelevantinformation.Acombinationoftheresearchersbias,the
exclusionofcertainparticipantsintheavailableresearch,andtherestrictiontostudiesonly
foundfromPudMed,conductedwithinthelast10years,limitedtheconclusionsthatthe
researcherswereabletomakeforthisliteraturereview.
Conclusion
TheoverallinterpretationoftheseresultshasledtoafinalconclusionthatOsgood
Schlatterdiseaseisprevalentinadolescentathletesandcanbetreatedwiththeuseof
conservativemethodssuchas,activitymodification,icingproceduresandsupervisedand
assistedstretchingofthequadricepsmuscles.Mostpatientsbecomeasymptoticwhentheyhave
finishedgrowingandhavecompletefusionofthetibialgrowthplate(Whitmore,2013).
However,somepatientslackresponsetotheconservativemethodsandsymptomspersistinto
adulthood.Intheserarecircumstancesthereareother,moreaggressivetreatmentoptionsinthe
formofsurgery,whichareshowntobesuccessfulandhaveminimalpostoperative
complications.FutureresearchissuggestedintermsofpreventionofOsgoodSchlatterdisease.
Kneebracesorspecificstretchingandtrainingmethodsmaybeassessedandprescribedto
reducequadricepsstrainonimmaturebonesandtendons.PreventingOsgoodSchlatterdisease
willreducethenumberofchildrenthatareforcedtoreduceactivitylevelsduetodiscomfortand
pain,andwillcontributetoanimprovedphysicalaspectoflifefortheseadolescentathletes
worldwide.

References
Baltaci,G.,&Ozer,H.,&Tunay,V.B.(2004).Rehabilitationofavulsionfractureof
thetibialtuberosityfollowingOsgoodshlatterdisease.KneeSurgery,Sports
Traumatology,Arthroscopy:OfficialJournalofESSKA,12(2),1158.Retrievedfrom
http://www.ncbi.nlm.nih.gov/pubmed/12910334
Bellicini,C.,&Khoury,J.G.(2006).Correctionofgenurecurvatumsecondaryto
Osgoodshlatterdisease:acasereport.TheIowaOrthopaedicJournal,26,1303.
Retrievedfromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1888600/
Beyzadeoglu,T.,&Inan,M.,&Beklet,H.,&Altintas,F.(2008).Arthroscopic
excisionofanununitedossicleduetoOsgoodshlatterdisease.Arthroscopy:TheJournal
ofArthroscopic&RelatedSurgery,24(9),10813.doi:10.1016/j.arthro.2007.03.010.
Calmbach,W.L.,&Hutchens,M.(2003).Evaluationofpatientspresentingwithknee
pain:partII.differentialdiagnosis.AmericanFamilyPhysician,68(5),91722.Retrieved
fromhttp://www.aafp.org/afp/2003/0901/p917.html
Cassas,K.J.,&CassettariWayhs,A.(2006).Childhoodandadolescentsports
relatedoveruseinjuries.AmericanFamilyPhysician,73(6),101422.Retrievedfrom
http://www.aafp.org/afp/2006/0315/p1014.html
Falciglia,F.,&Giordano,M.,&Aulisa,A.G.,&Poggiaroni,A.,&Guzzanti,V.
(2011).OsgoodShlatterlesion:histologicalfeaturesofslippedanteriortibialtubercle.
InternationalJournalofImmunopathologyandPharmacology,24(1),258.Retrieved
fromhttp://www.ncbi.nlm.nih.gov/pubmed/21669134
Foss,F.D.,&Myer,G.D.,&Magnussen,R.A.,&Hewett,T.E.(2014).Diagnostic

differencesforanteriorkneepainbetweensexesinadolescentbasketballplayers.Journal
ofAthleticEnhancement,3(1).Retrievedfrom
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214064/
Gholve,P.A.,&Scher,D.M.,&Khakharia,S.,&Widmann,R.F.,&Green,D.W.
(2007).Osgoodshlattersyndrome.CurrentOpinioninPediatric,19(1),4450.
Retrievedfromhttp://www.ncbi.nlm.nih.gov/pubmed/17224661
Hirano,A.,&Fukubayashi,T.,&Ishii,T.,&Ochiai,N.(2002).Magneticresonance
imagingofOsgoodschlatterdisease:thecourseofthedisease.SkeletalRadiology,31(6),
33442.Retrievedfromhttp://www.ncbi.nlm.nih.gov/pubmed/12073117
Weiss,J.M.,&Jordan,S.S.,&Anderson,J.S.,Lee,B.M.,&Kocher,M.(2007).
SurgicaltreatmentofunresolvedOsgoodshlatterdisease:ossicleresectionwithtibail
tubercleplasty.JournalofPediaticOrthopedics,27(7),8447.Retrievedfrom
http://www.ncbi.nlm.nih.gov/pubmed/17878797
Weller,R.,&Ingram,M.,&Wolman,R.(2011).10minuteconsultation.Osgood
shlatterdisease.BMI(clinicalresearched.)343(10).doi;
10/1091/01.JAA.0000435006.47717.41.
Whitmore,A.(2013).OsgoodShlatterdisease.JAAPA:officialjournalofthe
AmericanAcademyofPhysicianStudents,26(10),512.
doi:10.1097/01.JAA.0000435006.47717.41.