Osgood-Schlatter disease
Synonyms
Medical: Osteochondrosis deformans juvenilis of the tibial tuberosity, apophysitis tibialis adolescentium, juvenile Osteochondrosis the tibia and fibula, rugby knee
English: Osgood Schlatter disease, Osgood-Schlatter disease
Frequent writing variant: M. Osgood Schlatter
definition
Osgood-Schlatter's disease is a painful irritation of the insertion of the kneecap tendon (patellar tendon) on the anterior tibia.
In Osgood-Schlatter's disease, pieces of bone from the shin bone can become detached and dying off (necrosis). A dead bone area is created (Osteonecrosis). Since this osteonecrosis is not infectious (not caused by bacteria, viruses or any other), it belongs to the group of aseptic osteonecrosis.
Osgood-Schlatter's disease can occur unilaterally or bilaterally. Mainly affected are Young people between the ages of 10 and 14. Boys are affected more often than girls in a ratio of 4: 1.
Read more about this under Osteonecrosis in the knee
history
In 1903, the American orthopedist Robert Bayley Osgood (1873-1956) and the Swiss surgeon Carl Schlatter (1864-1934) independently published case reports on the disease, which was later named after them.
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Summary
Of the Osgood-Schlatter disease is a non-infectious (aseptic) Withering away from bone (Osteonecrosis) at the Shin namely at the point where the kneecap ligament (Patellar tendon) below the Kneecap starts (Tibial apophysis).
Osgood-Schlatter's disease are mainly athletically active boys between 10 and 14 years. The cause is unclear, but there are various theories of origin, e.g. Overload, Obesity and local Circulatory disorders.
With the Osgood-Schlatter muscle, the adolescents mostly feel movement-dependent pain, which improves when they are at rest. However, there are also asymptomatic courses, which means that the disease is discovered by chance, but there are no symptoms.
As a therapy, rest and anti-inflammatory measures are usually sufficient.
Osgood-Schlatter's disease only needs to be operated on in exceptional cases. The heals at the latest with the completion of growth Osgood-Schlatter disease mostly without consequences.
root cause
The real cause of the Osgood-Schlatter disease is unknown.
It is assumed that, for example, through sporting activities, Obesity and / or a reduced resilience of the Shin during the hormonal change in the puberty an imbalance in the load im knee or increased tension on the kneecap ligament (Ligamentum patellae) arises.
Another assumption is that overload or training-related micro-injuries are the cause, since overweight or particularly active adolescents often suffer from this disease during puberty.
The M. Osgood-Schlatter may also be caused by local Circulatory disorders evoked.
Symptoms
Various courses of Osgood-Schlatter's disease are observed.
Patients often complain of movement-dependent pain when tensing the Thigh muscles, with manual pressure below the Kneecap on the edge of the shin, when bending and stretching from Knee joint.
This pain can be accompanied by swelling of the upper shin. They improve in peace, but usually do not go away completely.
This resting pain permanently irritates the knee. It decreases over time, but there is a risk that the knee can no longer be fully loaded. The result is weakness and the knee "kinks away'.
However, there are also completely asymptomatic courses in which Osgood-Schlatter's disease is only an incidental finding in the X-ray image represents.
Pain in Osgood Schlatter's disease
The Pain in Osgood-Schlatter disease kick in the front knee area (please refer: anterior knee pain), usually just below the kneecap.
In this area, a protruding bone can usually be felt, which is particularly painful when pressed. However, they can also expand after exercise.
The pain generally increases after exercise or other stress. Since the disease itself usually heals on its own, the therapy of the pain is the essential part of the treatment.
The self-cooling of the knee also helps, but also a professional one Cryotherapy.
Also the so-called TENS A method and targeted strengthening of the muscles can help reduce pain. Exercise after which the pain has increased should be avoided.
Painkillers are also used, mainly from the group of NSAIDs, how Ibuprofen or Diclofenacwhich, in addition to reducing pain, also inhibit the inflammatory response.
You can try out whether externally applied pain gels and ointments help. Other complementary treatments, such as a massage and stretching of the thigh muscles or acupuncture can help reduce the pain.
diagnosis
The diagnosis of Osgood-Schlatter disease is made by:
- Ultrasound examination (Sonography) and
- X-ray of the knee joint in 2 planes (from the front and from the side)
posed.
If the findings are unclear, the following can also be used:
- an MRI scan of the knee (Magnetic resonance imaging, MRI)
- or a scintigraphy, with which a statement about the metabolic function can be made, may be necessary.
X-ray and MRI
The diagnosis of Osgood-Schlatter's disease can usually be made very easily by a simple X-ray in connection with the typical symptoms.
This usually shows a typical growth plate, as well as free so-called ossicles (Bone particles) and loosening in the affected area. However, nowadays one often foregoes an X-ray and uses one instead MRI.
Above all, this has the advantage that the very young person affected can be spared the radiation of an X-ray image.
Another benefit of the MRI examination of the knee consists in the fact that the initial stage of the disease can usually be captured well in the MRI, which is often easy to overlook on the X-ray.
The MRI also offers the possibility of better assessing the exact extent of the disease and also showing the surrounding inflammation, if present.
In principle, the disease can also be represented by means of an ultrasound, but whether this is used depends very much on the preferences and experience of the respective examiner. In principle, the disease can be well represented and diagnosed with all possibilities.
Therapy / treatment
Freedom from pain is the predominant treatment goal for Osgood-Schlatter's disease.
Most often, reducing or stopping exercise is accompanied by additional anti-inflammatory (anti-inflammatory) Medication sufficient.
In the case of overweight children, weight reduction should also be sought.
In the inflammatory phase with reddening, swelling and pain in the knee, systemic anti-inflammatory drugs are prescribed and local cryotherapy is carried out using a cool pack and quark compresses. Local gel applications, for example: with Dolobene Gel, have a pain-relieving effect. During this time, sport should also be restricted. What does it mean exactly? A general ban on sports is not required. Only the duration and the maximum load should be reduced. However, parents should prevent indoor sports that involve extreme braking. The temporary relief should only be short-term. Bandages are also used to treat Osgood Schlatter's disease. A plaster cast should definitely not be done as it has not shown good results in the past.
Read more about this topic under Bandage for Osgood-Schlatter's Disease
As soon as the inflammatory phase is over, a build-up program should be started. They are exercises that train and strengthen the thigh muscles and hip muscles. Low-extensive endurance training using bicycles is often suggested, as it is intended to improve the blood circulation in the damaged area, which is intended to accelerate regeneration. In the case of transformation processes that cause bone pulling and cause discomfort despite existing pain therapy, surgical removal of the exostoses is necessary. If possible, the growth will be completed.
An operation is only necessary in the rarest of cases, namely when free bone parts (sequester, jointed mouse) or bone extensions arise during remodeling processes on the bone and then rub against ligaments and tendons or even restrict the mobility of the joint.
Read more on the topic: Treatment of Osgood-Schlatter disease
The bandage for the therapy of Osgood-Schlatter's disease
So-called "jumper knee straps" in English "springer knee straps" are used as a bandage in Osgood-Schlatter's disease.
These adjustable straps are designed to improve patellar guidance by applying light pressure on the tendon below the kneecap. The tubular insert provides even pressure and helps relieve pain.
In addition, there are anatomically knitted bandages that relieve pressure locally on the tibial tuberosity and thus support the therapy.
This includes the patellar tendon bandage, which helps relieve pressure on the affected area.
Read more on this topic under Osgood-Schlatter's disease bandage
surgery
The typical symptoms below the patella as well as the tenderness in the same area usually signal the diagnosis. An X-ray or CT is then made to confirm. The aim of the therapy is pain-free for those affected. The operation is not the treatment of choice. First, conservative measures are carried out, such as cooling, less sporting activities, protection of the knee or bandages.
NSAIDs such as paracetamol, ibuprofen and similar drugs are mainly used as drug therapy. An operation is only necessary if the remodeling processes cause free bone or bone pulling, which leads to persistent discomfort in the adolescents. Then there is surgical removal of the exostosis (the protruding bone). In addition, the completion of the growth is awaited if this is possible.
General risks of an operation:
The attending physician must mention the risks of the operation before any surgical procedure. The surrounding tissue, muscles, nerves and blood vessels could be injured during the procedure. This results in permanent damage, albeit rarely possible. In the course of the operation, bleeding or secondary bleeding may occur, which in rare cases require another operation to stop the bleeding. If too much blood is lost, a blood transfusion may be necessary, which carries the risk of an intolerance reaction or infection with hepatitis or HIV.
An infection with viruses or bacteria can occur, the risk is around 0-10%. After the operation you usually have to lie in bed for a little longer, so there is the possibility of a leg vein thrombosis, which in the worst case leads to a pulmonary embolism and can be fatal. As a preventive measure, blood thinners are administered and compression stockings are recommended. It should also be remembered that each anesthetic has its own risks. Osgood-Schlatter's disease often affects young people without any other illnesses, so that, on the whole, the general risk of the operation is usually low.
Read more on the topic: Surgery for Osgood-Schlatter's disease
Homeopathy for Schlatter's disease
Also with the homeopathic treatment of Osgood-Schlatter's disease the focus is on the use of agents that are thought to have a pain reliever or anti-inflammatory effect.
These include, for example Rhus Toxicodendron, Calcium Phosphoricum, Guaiacum or Arnica. In a homeopathic way, these remedies are supposed to achieve almost exactly the effect that you would otherwise achieve with painkillers.
Also Hekla lava is said to help improve symptoms and even reduce the formation of the ossicles. However, it is questionable whether this is possible. In homeopathy, too, it is recommended to supplement the treatment with cooling and physiotherapeutic concepts.
Also injections with homeopathic and naturopathic substances such as Deadly nightshade or Devil's claw are partially offered. However, since the cause of the disease cannot be treated, the benefit is rather questionable, since every injection into an inflamed area also carries additional risks.
forecast
The disease almost always heals without any consequences, at the latest when growth has finished.
Osgood-Schlatter disease and football
Osgood-Schlatter disease occurs very often in children and adolescents. In this group, in turn, a particularly large number of children are affected, who often play football extensively.
The particular strain on the knee in soccer, especially the frequent braking and accelerating when contacting the ball, has a negative influence on the disease.
However, it is not necessary to forbid every sport for the course and the later healing, regardless of the disadvantages that would have for further development and health.
Also with Osgood-Schlatter disease So, in principle, sports can continue to be practiced and, under certain circumstances, football can also be played, whereby it must be clearly stated that other sports with less abrupt changes of direction would be better.
In this respect, however, you should definitely try to reduce the level of exposure. Also the consistent implementation of pain relievers and others Treatment of Osgood Schlatter's disease and possibly also wearing a bandage during particularly stressful training sessions usually make it possible to continue doing sports.
However, if severe pain occurs with every training session and the clinical picture worsens overall due to the training, you should think about switching to another, joint-friendly sport such as swimming.
