IS Case 318: Sequela of Osgood-Schlatter disease

Richard Gong, MD

Imaging Sciences URMC 2009
Publication Date: 2009-09-14

History

Patient is a 27-year-old woman with knee pain.

Findings

ateral radiograph, proton density and T2-weight MRI images show ossific fragments at the tibial tubercle.

Diagnosis

Sequela of Osgood-Schlatter disease

Discussion

Osgood-Schlatter disease (OSD) is a painful inflammation of the growth plate at the tibial tubercle. It is commonly encountered in children during their growth periods while participating in cutting and jumping sports such as basketball, gymnastics and volleyball. Although the exact cause is unknown, it is thought to be repetitive microtrauma or a traction apophysitis of the tibial tuberosity.

The presentation is usually anterior knee pain and swelling. The majority of patients have unilateral symptoms, but this condition can occur bilaterally in 20 to 30% of patients. Physical examination shows tenderness and swelling at the tibial tubercle.

Imaging is usually not needed for the diagnosis. Radiographs show fragmentation and irregular ossification at the tibial tubercle. MRI will show similar findings at later staging of the disease, but is more useful in revealing the early lesions of OSD when the clinical symptoms are minimal and the radiographs normal. These early findings include low T1 signal at the secondary ossification center and the adjacent tibia and high T2 signal within the secondary ossification center.

Most patients respond to conservative treatment consisting of suspension of sporting activities, ice and analgesics for pain. The disease is usually self-limiting. Some potential complications include discomfort while kneeling, residual osseous deformity and painful ossicles in the distal patellar tendon. Most patients are able to return to normal activities in two to three weeks.

References

  1. Cassas KJ, Cassettari-Wayhs A. Childhood and adolescent sports-related overuse injuries. Am Fam Physician. 2006 Mar 15;73(6):1014-22. PMID: 16570735
  2. Hirano A, Fukubayashi T, Ishii T, Ochiai N. Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease. Skeletal Radiol. 2002 Jun;31(6):334-42. PMID: 12073117

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