PANCE Blueprint Musculoskeletal (8%)

Osgood-Schlatter disease (ReelDx + Lecture)

REEL-DX-ENHANCED

Osgood-Schlatter disease

A 15-year-old male with knee pain

Patient will present as → a 13-year-old male who comes to the clinic with his parents, complaining of progressive pain just below his right knee that worsens with activity, especially after soccer practice. The pain has been intermittent over the past few months but has recently become more consistent. He denies any trauma or injury. His medical history is unremarkable. On physical examination, there is notable swelling and tenderness over the tibial tuberosity of the right knee. The pain is exacerbated by knee extension against resistance. Radiographs of the knee show no fractures but reveal swelling over the tibial tuberosity with some lifting of the tubercle apophysis consistent with Osgood-Schlatter disease. The patient is advised to limit activities that exacerbate symptoms, apply ice after activity, and consider physical therapy for stretching and strengthening exercises. An over-the-counter pain reliever is recommended for symptom management.

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Classically present with tenderness over the tibial tubercle in a 9-14-year-old male who has undergone a rapid growth spurt and is doing sports that involve running

  • Repetitive traction of the apophysis of the tibial tuberosity results in microtrauma and micro-avulsion - the proximal patellar tendon insertion separates from the tibial tubercle
  • Pain and swelling over the tibial tubercle at the point of insertion of the patellar tendon
  • Pain on resisted knee extension with lump below the knee and prominent tibial tuberosity

Osgood-Schlatter disease is a clinical diagnosis based on history. Additional signs and symptoms include anterior knee pain that increases over time, an enlarged tibial tubercle, and localized edema

  • Diagnostic imaging with a lateral radiograph of the knee
    • For atypical presentation (pain not related to activity, fever, rash, etc.) to exclude other conditions (e.g., osteomyelitis)
    • Soft tissue swelling and loss of sharp margins of the patellar tendon in the acute phase and bone fragmentation at the tibial tuberosity in the late phase
Radiograph of human knee with Osgood–Schlatter disease

Lateral radiograph in Osgood Schlatter disease - note the fragmentation and irregularity of the tibial tubercle

Benign and self-limiting

  • Conservative analgesics, ice, and physical therapy - first-line treatment for Osgood-Schlatter disease
  • Operative - ossicle resection and/or excision of the tibial tuberosity - considered in patients who do not respond to conservative management and after skeletal maturity

osmosis Osmosis
Picmonic
Osgood-Schlatter Disease 

IM_MED_Osgood-SchlatterDisease_V1.6_ASSETS

Osgood-Schlatter disease involves apophysitis of the proximal tibial tubercle often due to overuse. Active, young boys who have experienced a recent growth spurt and partake in running and jumping activities are most at risk for this condition. Osgood-Schlatter disease is a clinical diagnosis based on history; additional signs and symptoms include anterior knee pain that increases over time, an enlarged tibial tubercle, and localized edema. Since this condition is often self-limiting, treatment is conservative and consists of rest, activity restriction, and NSAIDs.

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Question 1
A 13-year-old boy presents with anterior knee pain worsened by kneeling, running, and jumping. Which of the following factors is the most strongly associated with this presentation?
A
Family history of gout
Hint:
Gout is an inflammatory arthritis due to uric acid crystal deposition, unrelated to Osgood-Schlatter.
B
High body mass index (BMI)
Hint:
While being overweight can put extra stress on joints, it's not a specific risk factor for Osgood-Schlatter.
C
Participation in sports requiring repetitive quadriceps loading
D
Recent viral upper respiratory infection
Hint:
Viral infections do not play a role in the development of Osgood-Schlatter.
E
Trauma to the anterior knee
Hint:
A direct injury might cause pain, but not the chronic process of Osgood-Schlatter.
Question 1 Explanation: 
Osgood-Schlatter disease is primarily caused by overuse and repetitive strain on the patellar tendon and its insertion at the tibial tuberosity. This is especially common in young athletes participating in sports involving running, jumping, and sudden changes in direction, all placing significant stress on the quadriceps mechanism.
Question 2
A 15-year-old girl presents with a several-month history of knee pain and a visible prominence below her kneecap. Physical exam reveals localized tenderness at the tibial tubercle. Which of the following is the most appropriate initial step in confirming the diagnosis?
A
Complete blood count (CBC)
Hint:
CBC is for general health assessment; findings are usually normal in Osgood-Schlatter.
B
Erythrocyte sedimentation rate (ESR)
Hint:
ESR is used for inflammation, not routinely needed for Osgood-Schlatter.
C
Knee aspiration and synovial fluid analysis
Hint:
Done for suspected infections or crystal arthropathies.
D
Plain radiograph (X-ray) of the knee
E
Rheumatoid factor (RF)
Hint:
RF is associated with rheumatoid arthritis, not Osgood-Schlatter.
Question 2 Explanation: 
Osgood-Schlatter is primarily a clinical diagnosis, but X-rays can be helpful for confirmation and to rule out other causes of knee pain. Typical findings may include fragmentation of the tibial tubercle, soft tissue swelling, and irregularity of the patellar tendon.
Question 3
A 12-year-old soccer player is diagnosed with Osgood-Schlatter disease. He is in the middle of his competitive season. Which of the following is the most appropriate initial recommendation?
A
Complete cessation of sports
Hint:
While temporary rest from exacerbating activities is needed, complete sports withdrawal can be detrimental.
B
Immediate physical therapy referral
Hint:
PT can be beneficial, but the first step is usually activity modification and pain control.
C
NSAIDs and activity modification
D
Prescription of custom orthotics
Hint:
These can be considered, but not typically the primary intervention.
E
Surgical intervention
Hint:
Surgery is reserved for very rare, severe cases that don't respond to conservative measures.
Question 3 Explanation: 
The most appropriate initial treatment for Osgood-Schlatter disease involves activity modification to reduce strain on the tibial tuberosity and symptomatic relief measures such as ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy exercises to strengthen the quadriceps and hamstrings. This conservative approach is effective in most cases, with symptoms typically resolving over time as the growth plate closes.
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References: Merck Manual · UpToDate

Fractures and dislocations of the knee (ReelDx) (Prev Lesson)
(Next Lesson) Soft tissue injuries of the knee (ReelDx)
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