Osgood Schlatter's disease: causes, symptoms. Methods of treatment

This ailment (Osgood Schlatter's disease ), Called osteochondropathy of the tubercle of the tibia, is most common in people between the ages of ten to fifteen or eighteen. The disease is characterized by a violation of ossification of the apophysis. The teenagers, who are constantly engaged in sports, are most susceptible to this disease. The chance to undergo the disease is the same for both women and men.

Manifestation of Osgood Schlatter's disease

The disease is accompanied by the appearance of pain in the tuberculate zone of the tibia. It increases during frequent extension under load, during jumping, when running on a rough bumpy road, at the time of lifting or descending the stairs. Pain can be overtaken even without an external reason at the time of strong extension.

The general condition is stable, inflammations of a local nature are practically or completely absent. Often after the defeat of one knee, another is struck with the same objective deviations to the shin. Painful manifestations can last for more than a month, then, intensifying because of mechanical strokes, then poaching, throughout the year, sometimes longer.

Diagnosis of the disease

In situ, deforming the contours of the front cover in the upper region of the metaphysis of the shin is determined. The disease is characterized by an increase in the size of tuberculation. In the case of a unilateral process, such signs are most pronounced.

During palpation, pain occurs: often during a load on the upper part of the apophysis, less often at the base of tuberculation. In addition, pain manifestations can occur with a strong pressure on their patellar ligament, and therefore, the traction of the ligament increases over the proboscis process (it can be imaged on an X-ray image, as a separate formation from the base of tuberosity, by means of a growth plate). Sometimes an inflammatory process is detected in the bag under its nasal ligament, which causes even greater pain.


Laboratory and instrumental study

The main way that makes it possible to determine Osgood Schlatter's disease is an x-ray study. Patients who have the same clinical picture, based on their age and radiographic findings, are divided into three main groups:

  • having an x-ray picture of the ossification of the apophysis, depending on their age;

  • with the inhibited rate of ossification of the apophysis;

  • those that have an independent fragment of bone in the projection of the anterior outer part of the proboscis process.

  • D. Shoylev (1986) identified four consecutive phases of the development of the process: ischemic-necrotic, revascularization, regeneration phase and bone apopysis occlusion phase.

    According to roentgenology, the characteristic changes of each stage of osteochondropathy are determined:

  • ischemically necrotic stage - decrease of mineral concentration of apophysis, local radiographic increase in bone density, characteristic of osteonecrosis;

  • revascularization stage - radiologically expressed fragmentation of the proboscis process;

  • regeneration stage - restoration of bone structure, replacement of necrotic parts with zones of correct bone structure.

  • Of the available methods for diagnosing Osgood Schlatter's disease, it is worth mentioning CT, which determines the stage of the course of the disease.


    Regardless of the detailed radiographic findings, sonography is used to determine the presence of fragments unfrozen by roentgenologically in the apophyses. This method makes it possible to expand the picture of progression and the structure of the cartilaginous model of the proboscis spine.

    The therapy of Osgood Schlatter's disease

    Prediction is quite positive. Treatment of this disease without surgery implies the implementation of measures to eliminate pain: neutralization of inflammatory processes at the junction of the knee ligament, restoration of ossification of the apophysis of the tibia.

    Patients who have been diagnosed with the disease are assigned a regime with minimal physical exertion. For those involved in sports, a complete suspension of activity in this direction on the course of the whole cycle of medical procedures will be mandatory. It will be appropriate to strengthen the tuberosity with a bandage with a pad. You can also use a tight bandage to reduce the deflection in the displacement of the proboscis process, which is carried out by its strong nasal ligament during movement.

    It will not hurt to use bioavailable types of calcium preparations, doses up to 1500 mg per day, calcitriol - up to 4000 units per day, vitamin E, group B vitamins, antiplatelet agents.

    Treatment of Osgood Schlatter's disease with the help of physiotherapy is used based on the picture of x-ray in such cases:

  • First X-ray group - therapy of the disease is carried out by means of a course of exposure to the body of a large electromagnetic field (UHF method) and magnetotherapy.

  • 2 nd group - therapy of the disease is carried out using electrophoresis of a 2% solution of procaine to the tibial bone zone and to the L3-L4 zone in combination with a course of calcium chloride electrophoresis with nicotinic acid and magnetotherapy.

  • 3rd group - treatment is carried out with the help of aminophilin electrophoresis, a course of potassium iodide electrophoresis or hyaluronidase in a complex with a course of calcium chloride electrophoresis with nicotinic acid and magnetotherapy. At the end of the course of non-surgical treatment most often there comes an improvement: pain in a state of rest and under stress passes partially or completely. There are cases when the pain syndrome does not pass and is felt at the time of a strong palpation of the apophys apex zone, but it is not so significant. The lateral parts of tuberosity are often deprived of pain. The period of therapy lasts from 3 months to 6 months.

  • It is worth emphasizing that the course of therapy in the presence of an isolated fragment of bone in the tuberosity zone most often does not bring effectiveness. The non-surgical treatment of Osgood Schlatter's disease, devoid of obvious signs of improvement, is the reason to resort to surgery.

    Treatment of the disease by surgical method

    Symptoms that indicate the need for an operative intervention:

  • a long period of illness;

  • no positive effect of conventional therapy;

  • absolute demarcation of fragments of bones from the underlying apophysis;

  • patient, at least 14 years old.

  • Surgical intervention implies:

  • minimizing the possible consequences of the operation;

  • getting the most out of the surgical method of treatment.

  • At the present time, the disease is treatable in such operational ways:

  • Stimulation of apophysis ossification by Beck method. The method involves the formation of channels from the zone of tuberosity to the bone fragment to achieve its fusion with the desired bone.

  • Stimulation of tuberosity by the method of Pease - the formation of incisions on it.

  • Implantation of autografts to stimulate osteoreparation (for example, from the wing of the ilium).

  • Transfer of the attachment zones of individual apophysial lobes.

  • Enhanced decortication - the method of Shoylev D.

  • The effectiveness of revascularization osteoperforation is observed under such approaches:

  • The creation of channels from the proboscis spine to the growth plate under X-ray observation (concerns the patients of the 2nd and, in part, the 3rd radiological groups) stimulates the faster formation of the cartilaginous model without the early arrest of the growth zone. Recurrent deformation of the tibia during growth is not observed.

  • Creation of channels from the proboscis process, with movement through the growth plate, directly into the tibia (concerns patients of the 3rd radiologic group, having a free fragment of bone in the zone of the proboscis process or fragmentation of the proboscis spine against the synostosis of the casual zone of the latter with the tibia). Angular deformation of the tibia during growth is also not observed.

  • A more extensive process of removal of the outer layer is carried out in patients who have reached the age of 20 years, who have discovered the phenomena of protracted bursitis in the tibial bumpy zone. In the case of such an intervention, not only a separate fragment of the bone is excised, but also the mucous bag in which it caused the inflammatory process.

    Upon completion of the operation, to eliminate the disease Osgood Schlatter should be a course of therapeutic therapy trophoregenerator method. Also it is necessary to carry out physiotherapy procedures to speed up the rate of osteoreparation of the proboscis spine.