An adolescent brings a physician’s note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?
A. The condition was caused by the student’s competitive swimming schedule.
B. The student will most likely require surgical intervention.
C. The student experiences pain in the inferior aspect of the knee.
D. The student is trying to avoid participation in physical education.
Correct Answer: C. The student experiences pain in the inferior aspect of the knee.
Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps, including track and soccer.
Option A: Swimming is not a likely cause. Osgood Schlatter disease is an overuse injury that occurs in active adolescent patients. It occurs secondary to repetitive strain and microtrauma from the force applied by the strong patellar tendon at its insertion into the relatively soft apophysis of the tibial tubercle. This force results in irritation and severe cases partial avulsion of the tibial tubercle apophysis.
Option B: The condition is usually self-limited, responding to ice, rest, and analgesics. The condition is self-limited and occurs secondary to repetitive extensor mechanism stress activities such as jumping and sprinting. Ultimately, the condition is self-limiting but may persist for up to 2 years until the apophysis fuses. Treatment includes relative rest and activity modification from the offending activity as guided by the level of pain.
Option D: Continued participation will worsen the condition and the symptoms. Force is increased with higher levels of activity and especially after periods of rapid growth. Rarely trauma may lead to a full avulsion fracture. Predisposing factors include poor flexibility of quadriceps and hamstrings or other evidence of extensor mechanism malalignment.