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Osgood-Schlatter disease is a usually self-limiting disorder causing…
Osgood-Schlatter disease is a usually self-limiting disorder causing anterior knee pain during adolescence.
Aetiology
caused by multiple small avulsion fractures within the ossification centre (apophysis) of the tibial tuberosity at the inferior attachment of the patellar ligament
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develop during the adolescent growth spurt before the tibial tuberosity has completed ossification. At this time, the development of quadriceps strength, particularly in adolescents participating in sports that involve running and jumping, may exceed the ability of the tibial tuberosity to resist these forces
Healing and growth of avulsed fragments produces minimal to marked firm enlargement of the tibial tubercle, depending on the severity and frequency of injury
Bony fragments, known as 'ossicles', may occur in people with more severe Osgood-Schlatter disease. They develop from avulsed fragments that fail to reunite properly with the apophysis despite healing.
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Diagnosis
Knee pain, usually unilateral, starts in adolescence and is localized to the tibial tuberosity. Gradual onset pain, mild and intermittent to severe and continuous
Examination
Tenderness over the tibial tuberosity that is provoked by knee extension against resistance, or by hyperflexing the knee with the person lying prone.
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Abnormalities on hip examination causing referred pain to the knee, which suggests an alternative cause for knee pain.
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Differential
Referred pain from hip-Slipped proximal femoral epiphysis- more common in obese children.Transient synovitis- hip pain in systemically well children under 10yr old, and follows an URTI. Perthes disease- common in boys 4-9yr old with persistant hip pain, limp, and possible referred knee pain.
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Osteochondritis dissecans- presents in adolescents,Examination may reveal localized bony tenderness, an effusion, or evidence of a loose body.
Bone tumours- pain persists at night or at rest, associated with weight loss and general malaise
Patellofemoral pain syndrome-most commonly presents during the adolescent growth spurt with diffuse pain around the patellofemoral joint. Usually both knees are affected, with one side more than the other. It is confirmed by pain or crepitus with the patella grind test.
Management
Advice- continue with sports if tolerated, may require modified to reduce pain
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Pain relief- paracetamol or brufen, ice packs, knee pads
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if symptoms persist to adult hood- advise knee protectors, and consider referral to orthopaedics if affecting quality of life
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