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Osgood-Schlatter's Disease
Osgood-Schlatter's disease is an overuse injury, whereby repetitive strain leads to chronic avulsion or separation of the attachment of the patellar tendon to the tibial tubercle. As healing occurs, the tibial tubercle may become more pronounced.
Osgood-Schlatters usually affects boys 10-15y/o and girls 8-13y/o, who usually have recently undergone a growth spurt. It is the most common cause of knee pain in children less than 16 years old. Common activities associated with OS include soccer, basketball, ice hockey, and gymnastics. 20-50% of the cases are bilateral.
Clinical Presentation 1. Patient will complain of anterior knee pain that increases gradually over time. Pain starts as an ache and can progress to pain that causes limping or impairs activity. 2. Pain is usually worsened by direct trauma, kneeling, running, jumping, squatting, climbing stairs, and walking uphill. Pain is relieved by rest. 3. Physical examination usually demonstrates very tender prominent tibial tuberosity with no limitation of mobility of the knee. Pain may be reproducible if patient extends knee against resistance, or squats with the knee fully flexed. 4. The diagnosis is clinical and a radiographic examination is not necessary.
Treatment - Complete recovery is expected in 90% of patients. Symptoms can wax and wane for up to 24 mo. Pain usually resolves once the tibial growth plate closes. - Conservative treatment is recommended 1. Rest. 2. NSAIDS. 3. Icing knee after sporting activities. 4. Protective knee padding. 5. Limiting Activities as necessary. Most athletes can play if the pain is mild, and can be controlled with NSAIDs and ice. 6. Physical Therapy – Improves strength and flexibility of surrounding musculature. - Surgical treatment is reserved for patients who have failed conservative treatment. These patients have chronic, unresolved, painful OS. Surgical excision of retained intratendinous ossicles or free cartilaginous tissue may improve symptoms in skeletally mature patients.
SEVER'S DISEASE Sever's disease is an overuse syndrome that involves the apophysis where the Achilles' tendon inserts to the calcaneal bone. Most affected children are between 9-12 years of age. There is often heel pain and tenderness can be elicited if both sides of the insertion area are palpated. Treatment consists of strengthening of the muscle of the leg by doing dorsi and plantar flexion exercises of the foot. Analgesics and icing may help. The placement of a 1/4" heel pad in all shoes may alleviate the pain.
References What is the best treatment for Osgood-Schlatter Disease? J Fam Practice 2004 Feb 53(2):153 Gholve, P et. al. Osgood Schlatter Syndrome. Current Opinion in Pediatrics 2007, 19:44-50 Dyment, Paul. Apophyseal Injuries. Pediatric Annals. January 1997.
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