Osgood Schlatter (OS) is a traction apophysitis of the tibial tuberosity that is seen in children ages 11 to 17. This growing part of the bone is more vulnerable to injury that the surrounding patellar tendon. Insidious onset of pain, which may be unilateral or bilateral, occurs at the tibial tuberosity with running, jumping, or kneeling. Physical examination may reveal an enlarged, tender, swollen tibial tuberosity. Many athletes will have tight hamstrings and feel an anterior knee stretch with full flexion of the knee. Lateral radiographs may show fragmentation of the tibial tuberosity but are not necessary for diagnosis (Fig. 6). Treatment consists of daily physical
therapy to increase flexibility of the hamstring, quadriceps, and hip flexors along with core body strengthening. Icing after activity for 15 to 20 minutes and NSAIDs on an as needed basis after activity can help control pain. A patellar tendon strap (a Velcro strap placed across the patellar tendon to decrease tension on the tibial tuberosity) may also decrease pain. Athletes may continue to participate in sports as long as they are not limping or having a significant increase in pain. The enlarged tibial tuberosity is a permanent feature of OS that lasts into adulthood. Beware of an athlete presenting with "acute OS" as he/she must be evaluated for a Salter Harris type III fracture of the proximal tibia or tibial avulsion. If an athlete can not perform a straight leg raise concern for a more serious injury such as those listed above or a patellar tendon rupture should be addressed. Rarely, if conservative methods fail, casting in extension or surgical excision of ossicles may be recommended.
Sinding-Larsen-Johansson (SLJ) syndrome is a similar traction apophysitis that occurs at the inferior pole of the patella in 9- to 14-year-olds. Fragmentation of the inferior pole of the patella may be seen on lateral radiographs. It causes discomfort with the same activities as OS and is treated similarly. Beware the acute SLJ as one may have a patellar sleeve fracture that requires surgical management. Straight leg raise testing can evaluate this extensor mechanism.
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