Orthopedics Book

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Osgood SchlatterAka: Osgood-Schlatter, Tibial Apophysitis

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  1. Epidemiology
    1. Common in physically active children near Puberty
      1. Boys (more common): Age 13-14 years old
      2. Girls: Age 10-11 years old
    2. More common in Running and cutting sports
      1. Soccer
      2. Basketball
      3. Gymnastics
      4. Volleyball
  2. Pathophysiology
    1. Cartilage detachment from tibial tuberosity
    2. Acute stress
      1. Recent increase in athletic activity
      2. Recent growth spurt
  3. Symptoms
    1. Waxing and waning anterior Knee Pain for months
    2. Bilateral in up to one third of patients
    3. Knee Pain aggravated by
      1. Running
      2. Jumping or hurdling
      3. Going up and down stairs
      4. Kneeling or squatting
  4. Signs
    1. Localized tenderness and swelling at tibial tuberosity
    2. Provocative maneuvers
      1. Knee extension against resistance
      2. Passive knee hyperflexion
  5. Differential Diagnosis
    1. See anterior Knee Pain
    2. Tibial apophysis avulsion Fracture
    3. Slipped capitalfemoral epiphysis with radiating pain
  6. Management
    1. Reduce Physical Activity
    2. Consider infrapatellar strap
    3. Knee immobilizer splint may occasionally be useful
    4. Quadriceps strengthening
    5. Surgical excision of ossicle may ultimately be needed
    6. Avoid local Corticosteroid Injections
      1. Weakens patellar ligament
      2. Thins and depigments skin
  7. Course
    1. Self limited, resolves over months
    2. Resolves when tibial tubercle fuses to diaphysis
  8. References
    1. Dunn (1990) Am Fam Physician 41:173

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