Osgood-Schlatter disease ( OSD ), also known as tibia tubercle apophysitis , is an inflammation of the patellar ligament in the tibial tuberosity. It is characterized by a painful bump just below the worse knee with activity and better with rest. Episodes of pain usually last several months. One or both knees may be affected and flares may recur.
Risk factors include overuse, especially sports that involve running or jumping. The underlying mechanism is the recurrent voltage on the upper tibia growth plate. Diagnosis is usually based on symptoms. Ordinary X-rays can be normal or show fragmentation in the attachment area.
Pain usually disappears with time. Applying cold to the affected area, stretching, and strengthening the exercise can help. NSAIDs such as ibuprofen can be used. A little less stressful activity might be recommended.
About 4% of people are affected at some point in time. Men between the ages of 10 and 15 are most commonly affected. After growth slows down, usually 16 years of age in boys and 14 years old in girls, the pain will no longer occur despite any potentially lingering bumps. This condition was named after Robert Bayley Osgood (1873-1956), an American orthopedic surgeon and Carl B. Schlatter, (1864-1934), a Swiss surgeon who described conditions independently in 1903.
Video Osgood-Schlatter disease
Signs and symptoms
Osgood-Schlatter's disease causes pain in the front of the lower part of the knee. This is usually in the ligament-ligament joints of the patellar ligament and tibial tuberosity. The tibial tuberosity is a slight increase in the anterior and proximal bone of the tibia. The patellar tendon attaches the anterior quadriceps muscle to the tibia through the knee lid.
Intense knee pain is usually a symptom that arises during activities such as running, jumping, crouching, and especially up or down stairs and during kneeling. The pain is worse with the effects of an acute knee. The pain can be reproduced by extending the knee against resistance, emphasizing the quads, or attacking the knee. Pain was initially mild and intermittent. In the acute phase, the pain is severe and persistent in nature. The impact of the affected area can be very painful. Bilateral symptoms are observed in 20-30% of people.
Maps Osgood-Schlatter disease
Diagnosis
Diagnosis is based on signs and symptoms.
Ultrasonography
This test can see various warning signs that predict whether OSD might occur. Ultrasonography can detect whether there is swelling in the tissues and cartilage swelling. The ultimate goal of Ultrasonography is to identify the OSD at an early stage rather than later. It has unique features such as increased detection of swelling inside the tibia or cartilage around the area and also can see if any new bone begins to build around the tibial tuberosity.
Type
OSD can cause an avulsion fracture, with tibial tuberosity separating from the tibia (usually staying connected to the tendon or ligament). This injury is rare because there are mechanisms that prevent powerful muscles from doing damage. Fractures in the tibial tuberosity may be complete or incomplete.
Type I: A small proportion shifts proximal and does not require surgery.
Type II: The articular surface of the tibia remains intact and the fracture occurs at the junction where the secondary central hardening and proximal tibialis epiphysis congregate (may or may not require surgery).
Type III: Complete fracture (via articular surface) including most likely meniscus malfunction. This type of fracture usually requires surgery.
Differential diagnosis
Sinding-Larsen and Johansson's syndrome, is an analogous condition involving the patellar tendon and margin under the patellar bone, not the upper margin of the tibia. Sever's disease is an analogous condition that affects the attachment of the Achilles tendon to the heel.
Prevention
One of the main ways to prevent OSD is to check the flexibility of participants in their quads and hamstrings. Lack of flexibility in these muscles can be a direct risk indicator for OSD. Muscles can be shortened, which can cause pain but this is not permanent. Stretching can help reduce muscle shortening. The main stretches for OSD prevention focus on the hamstrings and quads.
Treatment
Treatment is generally conservative with rest, ice, and specific exercises recommended. Simple pain killers can be used if necessary such as acetaminophen (paracetamol) or ibuprofen. Usually the symptoms will disappear when the growth plate closes. Physiotherapy is generally recommended after the initial symptoms improve to prevent recurrence. Surgery may be rarely used in those who have stopped growing but still have symptoms.
Physiotherapy
Recommended efforts include exercises to increase the strength of the quadriceps muscle, hamstring and gastrocnemius.
The buffer or use of an orthopedic cast to enforce joint immobilization is seldom necessary and does not necessarily encourage faster resolution. However, strengthening can provide comfort and help reduce pain as it reduces tension in the tibial tubercle.
Surgery
Surgical excision is rarely required in a skeletally ripe patient. In chronic cases that are refractory to conservative treatment, surgical intervention produces good results, especially for patients with bone ossicles or cartilage. This ossicular excision results in resolution of symptoms and returns to activity within a few weeks. After surgery, it is common because of the lack of blood flow down the knee and into the legs. This can cause a loss of circulation to the area, but will return to normal again in a short time. High pain can come and go occasionally, due to lack of blood flow. If this happens, sitting down will help reduce the pain. The removal of all loose intratendinous ossicles associated with prominent tibial tubercles is the procedure of choice, both from a functional and cosmetic point of view.
Rehabilitation
Rehabilitation focuses on muscle strengthening, gait training, and pain control to restore knee function. Non-surgical treatments for less severe symptoms include: strength training, stretching for increasing movements, ice packs, knee lining, knee support, anti-inflammatory agents, and electrical stimulation to control inflammation and pain. The quadriceps and hamstring exercises prescribed by rehabilitation experts restore muscle flexibility and strength.
Education and knowledge about stretching and exercising are important. Exercise should be less pain and increase gradually with intensity. Patients are given strict guidance on how to do home exercises to avoid more injuries. Exercises can include leg lifting, squats, and wall stretching to improve the strength of quads and hamstrings. It helps to avoid pain, stress, and tight muscles that cause further injuries that are opposed to healing. Knee orthotics such as patella straps and knee cells help reduce attraction and prevent painful tibia contacts by restricting unnecessary movement, providing support, and also adding compression to the pain area.
Prognosis
This condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle in the front of the thigh to the tibial tuberosity. After a juvenile growth spurt, recurrent stress from quadriceps contractions is transmitted through the patellar tendon to untreated tibial tuberosity. This may cause some subacute avaction fractures along with tendon inflammation, leading to excessive bone growth in the tuberosity and producing visible bumps that can be very painful, especially when hit. Activities such as kneeling can also cause irritation to the tendon.
This syndrome can develop without trauma or other real causes; However, some studies report up to 50% of patients linking a history of trauma to the originator. Several authors have attempted to identify the underlying etiology and underlying risk factors that influence Osgood-Schlatter's disease and postulate theories. However, it is now widely accepted that Osgood-Schlatter's disease is the tractional aphisis of the proximal tibial tubercle in the patellar tendon insertion caused by recurrent micro-trauma. In other words, Osgood-Schlatter's disease is an excessive injury and is closely related to the child's physical activity. It shows that children who are actively participating in sports are affected more often than non-participants. In a retrospective study of adolescents, older athletes who actively participated in sports showed a 21% frequency of reported syndrome compared with only 4.5% of age-matched nonatletic controls.
Symptoms usually resolve with treatment but may recur for 12-24 months before complete resolution of bone maturity, when the tibia fuse fuses. In some cases, the symptoms do not go away until the patient is fully grown. About 10% of symptomatic patients continue into adulthood, despite all conservative measures.
Long-term implications
OSD occurs from the combined effects of infertile tibial and thigh infestation tuberosities. There is the possibility of ossicle migration or fragmentation in Osgood-Schlatter patients. OSD implications and hardening of the tubercle can cause functional and painful limitations for the patient to adulthood.
Of the people treated with OSD, about half were children between 1 and 17 years of age. In addition, by 2014, a case study of 261 patients was observed for 12 to 24 months. 237 of these individuals responded well to exercise restrictions and non-steroidal anti-inflammatory agents, which resulted in recovery for normal athletic activity.
Epidemiology
Osgood-Schlatter disease generally occurs in boys and girls aged 9-16 years coinciding with the growth period. This is more common in boys than girls, with reports of male-to-female ratios ranging from 3: 1 to 7: 1. It has been argued that the difference is related to greater participation by boys in sporting activities and risks than by girls.
References
External links
Source of the article : Wikipedia
0 Comments