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Presentation about Osgood-Schlatter-Disease for Clinical Officers working in a Tanzanian hospital.

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  • De bovengenoemde epifysen zijn met name betrokken bij de lengtegroei en de vorming van gewrichtsoppervlakten waarbij drukkrachten verdeeld worden over het been. Deze klasse van epifysen worden ook wel druk-epifysen genoemd. Daarnaast zijn er ook epifysen die speciaal voor trekkrachten ontwikkeld zijn. Deze tractie-epifysen worden Apofysen genoemd. Pezen zitten dus altijd vast aan tractie-epifysen. Voorbeelden hiervan zijn de trochanter major, tuberositastibia en de apophyse van de calcaneus. Apophysen zijn niet articulair. Histologisch zijn druk- en tractie-epifysen erg vergelijkbaar. Tractie-epifysen hebben wel minder vermenigvuldigend kraakbeen en hebben meer fibrocollageen om de tractiekrachten te kunnen weerstaan. Wanneer de tractiekrachten te hoog zijn zal er vaak eerder een alvulsiefractuur van de apofyse ontstaan dan een ruptuur van de pees
  • Traction forces from the patellar tendon cause micro-alvulsions at the site where the Tuberculum connects with the Tibia
  • Osgood-Schlatter-Syndrome

    1. 1. Osgood-Schlatter SyndromeDr Christian van Rij, 8 July 2010
    2. 2. Case Report• 12 year old boy• Fell on a stone five weeks ago• Still swelling and pain of the right knee• X-ray gave the impression fracture of the ‘lateral condyl’ (POP was incorrectly given)
    3. 3. What is Osgood-Schlatter Syndrome• Described in 1903 by Dr Osgood & Dr Schlatter – Incidence up to 12% in children• Traction Apopohysistis of the Tuberositas Tibia,• Caused by micro-alvulsions on the secondary ossification centre due to excessive strength on the patellar tendon• This leads to excessive growth of the tuberositas and often pain complaints
    4. 4. Patellar Tendon
    5. 5. Bone Ossification Centers• Diaphyse: Primary Center of Ossification• Epiphyse: Secondary Center of Ossification• Apophyse: like SCO but develops on traction spot (therefore sometimes called a traction epiphyses)
    6. 6. Tuberositas Tibia Ossification• Tuberositas ossification starts at 7-9 years• Ossification starts distal and grows first towards the epiphysis• Patellar tendon connects at the tuberositas’ distal end
    7. 7. Etiology• Rapid growth of the bones causes increased traction force on the patellar tendon – Children involved in sport activities like running and jumping have are exposed to even higher traction• The Tuberculum starts to ossify from 7 years onwards but when the traction forces are to excessive, microalvulsions can occur where the bone connects with the epifyis of the tibia
    8. 8. Patellor Tendon Attachment
    9. 9. MRI showing site of the alvulsions
    10. 10. Symptoms Osgood-Schlatter• Tuberositas : local pain & sometimes swelling• Sometimes a higher tension of the quadriceps and hamstrings muscles palpable• Symptoms aggravated by exercises like kneeling, running, jumping• 50% of patient have slow onset of complaints, in the other half there was a luxating injury• About 25% of patients have bilateral complaints
    11. 11. Treatment• Conservative treatment: – Rest, Ice, NSAIDs and stretching exercises – Some patient benefit from a brace• Complaints reoccur frequently in the following year, but 1 year 90% of patients is cured as the ossification centers fuse
    12. 12. Persistent complaints• 10% of patients have persistent complaints even when the skeleton has matured; often due to: – Bursitis above the tuberositas – An incomplete fusion leaving an ossicle• In special cases surgical resection
    13. 13. Differential• Fractures• Jumpers knee: Sinding-Larsen-Johansson syndr.• Osteochondritis dissecans of the knee• Patellar instability• Bursitis• Tendinitis• Referred pain
    14. 14. References1. AK Chang, Osgood-Schlatter Disease, Emedicine.medscape.com, 2005, http://emedicine.medscape.com/article/827380-overview2. PA Gholve, DM Scher, S Khakharia, RF Widmann, DW Green; Osgood Schlatter syndrome; Curr Opin Pediatr. 2007 Feb;19(1):44-503. Kujala UM, Kvist M, Heinonen O. Osgood-Schlatters disease in adolescent athletes. Retrospective study of incidence and duration. Am J Sports Med. Jul-Aug 1985;13(4):236-414. JA Sullivan, Osgood-Schlatter Disease, Emedicine.Medscape.com, 2009, http://emedicine.medscape.com/article/89569-overview5. Engel A, Windhager R (1987), Importance of the ossicle and therapy of Osgood-Schlatter disease, Sportverletz Sportschaden 1 (2): 100–86. Krause BL, Williams JP, Catterall A. Natural history of Osgood- Schlatter disease. J Pediatr Orthop. Jan-Feb 1990;10(1):65-8