Osgood-Schlatter Disease

Ross Hauser, MD

A conversation with a concerned parent will usually begin like this. “My son/daughter was just diagnosed with Osgood-Schlatter Disease. They are recommended rest and months of physical therapy. He/she is an elite soccer player and he/she cannot afford to miss that much time off the field. Is there anything you can do?”

Osgood-Schlatter Disease (OSD) is a disorder involving painful inflammation of the bone, cartilage, and/or tendon at the top of the shinbone where the tendon from the kneecap attaches to the shin bone. Young athletes will usually go to the doctor because they have severe knee pain.

“No one seems to know how long the recovery will be or even if this is the right diagnosis.”

Another concern that this parent may express is what we have heard from many parents. “No one seems to know how long the recovery will be or even if this is the right diagnosis.”

An accurate means of diagnosing Osgood-Schlatter disease compounds the problem for clinicians who are not experienced in seeing this disorder.

Doctors writing in the journal Archives of Orthopaedic and Trauma Surgery (1) recognized this problem and called for a heightened awareness of risk factors that could predispose children to Osgood-Schlatter disease. They advised doctors to be alerted to growth or height, body weight, body mass index, tightness of the quadriceps femoris and hamstring muscles, muscle strength during knee extension, and flexion.

Osgood-Schlatter Disease is chronic knee pain

At the end of each of the long bones in the child’s arms and legs is a growth plate made of cartilage. Since cartilage isn’t as strong as bone, stress on the cartilage can cause it to become swollen and irritated. Osgood-Schlatter occurs when the tendon from the kneecap (patellar tendon) pulls very forcefully on the growth plate of the large bone (tibia) below the knee.

The child’s body may try to close that gap by creating new bone growth (a bone spur) or calcification of the tendon where it attaches to the tibia or shin bone, resulting in a bony lump in that area. This lump can be very painful, especially when hit or with activities such as kneeling.

Treating Osgood-Schlatter Disease

The chronic knee pain that results from Osgood-Schlatter disease is usually exacerbated by physical activity, especially running and jumping. As a result, the most common treatment physicians recommend for young athletes is simply rest and cessation from playing sports. Needless to say, although this advice has become accepted practice, it is not popular, especially considering that Osgood-Schlatter disease can last until the bones stop growing. That can be a very long time to wait and not participate in a favorite sport.

Some other possible recommendations include:

When the above modalities fail to bring relief and the condition becomes chronic, surgical intervention may be recommended. Surgery often has its complications, and this particular surgery to remove the calcified areas may leave the patient with circulation issues below the knee.

Osgood-Schlatter disease has previously been assumed to be innocuous and to self-resolve with limited intervention. Maybe that is not the case

An August 2021 study from Aalborg University in Denmark, published in the Orthopaedic Journal of Sports Medicine (2) questioned the assumption that all patients with Osgood-Schlatter disease experience quick recovery. Here are the study’s learning points:

Results:

Conclusion: “Over one-third of the study participants had knee pain at 2-year follow-up, which was associated with lower sports-related function and health-related quality of life. This questions the assumption that all patients with Osgood-Schlatter disease experience quick recovery.”

Questioning conservative care treatments – immobilization and avoidance of sports

We are developing a theme here in recent research that questions the prognosis and questions standardized treatment methods. A September 2020 study in the journal International Orthopaedics (3) made these assessments of the standardized conservative care options for Osgood-Shlatter Disease.

According to the researchers, the aim of the study “was to assess the efficacy and safety of the conservative treatment of Osgood-Schlatter disease in young professional soccer players.” What the researchers were looking at was can you treat Osgood-Schlatter disease without immobilization, stopping sport, or ultimately surgery?

Why did these researchers explore this treatment route? Because there are no real consciences in treatment. A May 2021 study in the journal Physical Therapy in Sport (4) from the University Children’s Hospital of Basel, Switzerland suggested this.

“Certain therapeutic approaches, such as stretching, have apparent efficacy, but no randomized control trials comparing specific exercises with sham or usual-care treatment exists. Carefully controlled studies on well-described treatment approaches are needed to establish which conservative treatment options are most effective for patients with Osgood-Schlatter disease.”

Prolotherapy in our experience gets the athlete back many weeks even months before standard physical therapy

We have been using Prolotherapy in the treatment of Osgood-Schlatter for more than 29 years. In the research below you will see studies including a double-blind study that showed that dextrose Prolotherapy significantly reduced the amount of pain Osgood-Schlatter suffered with.

Prolotherapy’s injection technique causes a mild inflammatory response that stimulates the body’s immune system. This boosts blood flow to the damaged areas and causes an influx of reparative cells to come in to heal the weakened tendon attachment and cartilage. It even stimulates the body to lay down collagen, which is what the tendon and cartilage are made of. This new collagen causes a strengthening of the tendon, the tendon attachment, the cartilage, and the weakened soft tissue in the treated area. In short, Prolotherapy gives the body the resources it needs to repair.

Reviewed studies

In our research overview, A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain was published in the journal Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders. We highlighted several studies in patients with athletic injury resulting in tendinopathy unresponsive to conservative treatment.

That study which appeared in the medical journal Pediatrics also suggests:

After three injections, at the 6-month and 12-month follow-up visits, significant improvement

This study was published in the medical journal Journal of Foot and Ankle research by doctors at the School of Surgery, University of Western Australia. This research goes on to say:

“The analysis also suggests Prolotherapy injections provide equal or superior short, intermediate, and long-term results to alternative treatment modalities, including eccentric loading exercises for Achilles tendinopathy, Platelet-rich plasma for plantar fasciopathy and usual care or lidocaine injections for Osgood-Schlatter disease.”(7)

An October 2021 study in the journal Archives of Orthopaedic and Trauma Surgery (8) examined the use of hyperosmolar dextrose (Prolotherapy) injection in patients with Osgood-Schlatter disease.

Results:

Conclusion: “After three injections, at the 6-month and 12-month follow-up visits, the VISA-Patella (degree of symptoms, functional ability, and the ability to play sports) scores of the two groups were significantly improved; the dextrose group score was better than the saline group score, and there were significant differences between the two groups.

Would you like to ask a question about Osgood-Schlatter Disease?
Get help and information from our Caring Medical staff.

References

1 Nakase J, Goshima K, Numata H, Oshima T, Takata Y, Tsuchiya H. Precise risk factors for Osgood-Schlatter disease. Arch Orthop Trauma Surg. 2015 Sep;135(9):1277-81. doi: 10.1007/s00402-015-2270-2. Epub 2015 Jul 2. [Google Scholar]
2 Holden S, Olesen JL, Winiarski LM, Krommes K, Thorborg K, Hölmich P, Rathleff MS. Is the Prognosis of Osgood-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up. Orthopaedic Journal of Sports Medicine. 2021 Aug 18;9(8):23259671211022239.  [Google Scholar]
3 Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016 Jan;9:CMAMD-S39160. [Google Scholar]
4 Bezuglov EN, Tikhonova АА, Chubarovskiy PV, Repetyuk АD, Khaitin VY, Lazarev AM, Usmanova EM. Conservative treatment of Osgood-Schlatter disease among young professional soccer players. International orthopaedics. 2020 Sep;44(9):1737-43. [Google Scholar]
5 Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh H. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter Disease. Pediatrics. 2011;128(5):e1121–e1128. doi: 10.1542/peds.2010-1931. [Google Scholar]
6 Sanderson LM, Bryant A. Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review. Journal of Foot and Ankle Research. 2015;8:57. doi:10.1186/s13047-015-0114-5. [Google Scholar]
7 Wu Z, Tu X, Tu Z. Hyperosmolar dextrose injection for Osgood–Schlatter disease: a double-blind, randomized controlled trial. Archives of Orthopaedic and Trauma Surgery. 2021 Oct 21:1-7.  [Google Scholar]
8 Neuhaus C, Appenzeller-Herzog C, Faude O. A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Physical Therapy in Sport. 2021 Mar 9.  [Google Scholar]

This article was updated October 30, 2021

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