this is assignment prepared on immature skeleton injury of knee in athletes known as osd. made for MPT sports.

1. © Andrew Leipus 2005
Knee - Osgood Schlatters.doc
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Knee – Osgood Schlatter Disease
(& Sinding-Larson-Johanson Disease)
Area of Sx’s - Pain felt quite localised to the front of the knee, either
at the base of the kneecap (SLJ) or where the tendon
inserts into the tibial tuberosity (OS)
Characteristics of Sx’s - Sharp pain on activity
- Latent ache
- Usually localised region of thickening or swelling
Activity capability/restriction - Unable to forcefully load the quadriceps muscle
Participation capability/restriction - Not able to run, kick, jump therefore sports generally
ruled out
Patient’s perspective on their
experience
- Young children affected and having to stop them from
playing sport will create issues – particularly
adherence to rehabilitation program
- Can be a very traumatic problem for elite young
athletes/sportspeople
- Need to educate the parents as well since this will
effect them too indirectly
Sx Behaviour – 24 hour pattern - Tends to follow an inflammatory pattern of behaviour
Aggravating - Forceful/dynamic extension/loading of the knee
Easing - Rest, avoidance of loading the patellar tendon
- Icing
- Taping
History - Caused by overuse of the patellar tendon either at its
origin on the patella (S-L-J) or its insertion into the
tibial tuberosity (O-S)
- Sports/activities such as volleyball, basketball,
sprinting, kicking usually common

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Diagnostic imaging - X-rays usually requested to exclude any epiphysiolysis
or tumors but MRI and PET also possible
- Chronic cases present with bony prominence of
variable shape at the tibial tuberosity
- May reveal small avulsions/ossicles/calcification within
the substance of the patella (esp in SLJ syndrome)
Medication - NSAIDS may take away some of the aching but
probably not affect the acute pain on activity
Pathobiological mechanisms - Peripheral nociceptive
Proposed pathology - Traction apophysitis - excessive traction of the patella
tendon on the developing soft bony epiphysis of the
tibia (prior to the secondary ossification centre closing
in adolescents)
- Often coincides with a rapid growth period for the
adolescent
- Actual pathology is minor avulsion with repetitive
healing and bone deposition.
- Note that OS can also occur from repeated impact to
the tibial tuberosity – eg surfers knee
- Growth on its own can be a factor – decreased
flexibility of the muscle-tendon unit during growth
spurts
- SLJ – traction osteochondritis of the patellar tendon on
the inferior pole of the patella
Physical impairments and associated
structure/tissue sources
- Localised tenderness and swelling/thickening/bony
growth at the tibial tuberosity and/or the inferior pole of
the patella
- Possible quadriceps atrophy in longstanding problems
- +/- Extension/quads lag in severe pain
- General tightness of the quads, hams, calves, ITB
- Resisted knee extension reproduces pain, whereas
resisted SLR is normally pain free
Contributing factors - Age – only occurs in pre-adolescents or adolescents
- Predominantly boys
- SLJ commonly occurs more in girls at an earlier age
reflecting their earlier skeletal maturity
Precautions/CI’s to P/E and Rx - Growth still occurring therefore there may be radical
changes in the behaviour of the injury
Prognosis - Everyone recovers eventually
- Worst case scenario is that the problem only
disappears when the growth plates stop growing,
ossification and fusion occur
- May be some minor ‘fragmentation’ of bone (tibial
tuberosity) in a few patients which require excision in a
few patients
Mx/Rx selection (PT, surgical, med
n
etc)
- Activity patterns must be reduced for a period of at
least 6 weeks
- May need to avoid jumping and sprinting sports for up
to 6 months
- Taping and offloading techniques used for treating
patellofemoral injuries may be beneficial
- Correction of LL biomechanical alignment, muscle
balances, flexibility issues and proprioception must be
considered
- Use of orthotics should also be considered where

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applicable to change/improve foot posture as well as
possibly trying increased shock absorption in the
shoes
- Using these methods may allow the child to continue
to participate in modified sport
- Other modalities should be freely used such as ice
therapy, ultrasound, IFT, TNS
- Knee pads should be used if kneeling activites are
aggravating
- Rarely is complete immobilisation in a cast required
- Surgical Treatment involves excision of ossicles,
debridement of degenerative tendon
References
Engelbretsen L & Bahr R (2004) Knee Pain. In: Bahr, R. & Mæhlum, S. (editors) Clinical Guide to Sports Injuries – An Illustrated
Guide to the Management of Injuries in Physical Activity. Human Kinetics. pp351-352.
Brukner, P. & Khan, B. (1993) Clinical Sports Medicine. McGraw Hill. pg390.
Trepman E, Micheli LJ & Backe LM (2003) Children and Adolescents. In: Kolt GS & Snyder-Mackler, L (editors) Physical Therapies
in Sports and Exercise: Churchill Livingstone, pp467-468.
Rodeo SA & Izawa K (2000) Diagnosis and Treatment of Knee Tendon Injury. In: Garrett WE, Speer KP, Kirkendall DT (editors)
Principals and Practice of Orthopaedic Sports Medicine. Lippincott, Williams & Wilkins. pp705-706
Gerrard B (1995) The Patellofemoral Complex. In: Zuluaga M, Briggs C, Carlisle J, McDonald V, McMeeken J, Nickson W, Oddy P &
Wilson D (editors) Sports Physiotherapy – Applied Science and Practice: Churchill Livingstone. pg596.