What sports lead to Osgood-Schlatter disease?

Among diseases of the musculoskeletal system in adolescents, dysfunction of the tibia, accompanied by the destruction of bone tissue and cartilage, is often encountered. A unique hallmark of this disease is a growth in the area of ​​the kneecap. This growth is easy to notice visually without fluoroscopy.

The disease was named after the surgeons Schlatter and Osgood who studied it at the beginning of the 20th century. According to the main version, Osgood Schlatter disease develops due to injury to bone tissue during regular exercise. Children who engage in strength sports from an early age are at risk. These include football, volleyball, track and field athletics, and martial arts. Statistics show that a fifth of young athletes suffer from this disease.

The clinical picture consists of the formation of a growth of bone tissue in the joint area, as a reaction of the body to a disruption in the blood supply to the bone area due to damage to the tendon. Moreover, micro-tears can occur not only during force loads, but also when the joint operates with a large amplitude, which is typical for running, jumping, and bending.

General information

Osgood-Schlatter disease is a specific disease of the musculoskeletal system, namely the knee joints, characterized by dystrophic damage to the tibia in the area of ​​its tuberosity.
Such aseptic destruction of bone tissue occurs against the background of permanent or acute trauma and usually affects only young people at the stage of intensive skeletal development. Clinically, the disease is manifested by swelling of the knee joint, the formation of a kind of growth (bump) under it and pain in its lower part, which occurs during normal physical activity (running, squats, etc.) or even without it.

This pathology was first described in 1878 by the French surgeon O. M. Lannelong under the name “Apophysitis of the tibia,” and in 1903, thanks to the work of the American orthopedist R. B. Osgood and similar works of the Swiss surgeon K. Schlatter (Schlatter), it appeared its more detailed nosography. Wikipedia defines this painful condition with the term “Osteochondropathy of the tibial tuberosity,” and the international classification assigned it the ICD-10 code – M92.5 “Juvenile osteochondrosis of the tibia and fibula.” Despite this, in medical practice this disease is still most often referred to as “Osgood-Schlatter disease” or simply “Schlatter disease”.

How to confirm bone necrosis?

The key condition for the formation of the disease is always injury to skeletal matter due to increased physical activity with intensive development of the osseous-ligamentous apparatus in childhood and adolescence.

In the majority of patients who have suffered from this disease, the so-called growth in the knee area does not disappear. In other cases, the prognosis is often positive, pain disappears during therapy.

However, the expression of other insignificant types of aching pain that are associated with changes in weather is likely. They are usually located in the area of ​​the knee joint.

To confirm necrosis of bone matter, the conscript must present an outpatient card during a medical examination, which indicates all visits for this disease, demonstrates the results of the examination and all stages of treatment. In addition, you should provide an extract from a specialist, which will demonstrate the presence of functional changes in the knee or bone tissue of the tibia.

Such an extract can be a guarantee and confirmation of your condition.

Expert opinion

Davydov Dmitry Stanislavovich

Deputy Head of the Military Commissariat

If the draft commission has doubts about the accuracy of the documents provided by the young man, then they can send him for re-examination at institutions that are accredited by the military registration and enlistment office and have connections with them.

If, in the opinion of the conscript, he was given the wrong fitness category and should not serve in the army, then he can file an appeal and challenge the decision of the medical commission through the judiciary.

Pathogenesis

The mechanism of occurrence and further development of Osgood-Schlatter syndrome is directly related to the patient’s age and physical activity. According to statistics, in the vast majority of cases, doctors diagnose Schlatter's disease in children and adolescents in the age group from 10 to 18 years, while young people involved in sports suffer from it 5 times more often than their peers leading a passive lifestyle . The same reason for more intense physical activity explains the fact that this osteochondropathy mainly affects boys.

As is known, two large bones are involved in the formation of the human knee joint - the femur (above the knee) and the tibia (below the knee). In the upper part of the last of them there is a special area (tuberosity), to which the quadriceps femoris muscle is attached by means of a tendon. It is this part of the bone that is responsible for its growth in childhood and adolescence and is therefore particularly susceptible to various injuries and damage. During active physical activity, in some cases, the knee joint is subject to a large load and the quadriceps muscle is overstrained, which leads to stretching or tearing of the tendon and a lack of blood supply in this area. As a result of such a traumatic effect and a decrease in nutrition in the area of ​​the tibial tuberosity, gradual necrotic changes develop in it, up to the death of individual parts of its core.

In addition, any injury to the knee joint or constant impact on its musculoskeletal structure (for example, jumping) can cause cracks and microfractures of the tibial tuberosity, which the growing body tries to quickly compensate for by the growth of new connective tissue. As a result of this, a person develops a bone growth (bump), typical of Osgood-Schlatter osteochondropathy, that forms just below the knee. Such a pathological process usually involves one leg, but bilateral involvement of the lower extremities is also possible.

Is it possible to get exemption from the army?

You can rest assured that this disease is mentioned in the main Schedule approved at the government level. However, this does not mean that the patient will be given release. The explanation clearly states the answer to the question of whether a conscript who has been diagnosed with Schlatter's disease is accepted into the army. It all depends on the individual flow pattern.

If the main functions of the joint were not impaired, then they will definitely take you into the army. If the date of the commission meeting coincides with the time of relapse of the disease, the conscript will be given a deferment for treatment in a medical institution. After rehabilitation, the army awaits him.

The advanced stage of the disease, even after all the procedures performed, will not allow the joint to function normally. Changes in bone tissue are recorded by a doctor. At the military commission, the conscript provides an outpatient card in which all stages of treatment are prescribed, as well as a separate extract from the doctor, which will indicate the presence of functional changes in the knee joint or bone tissue of the tibia. Such an extract is a guarantee that you will not have to join the army.

Find out: Are conscripts with flat feet allowed to serve in the army?

Knowing your rights will help you comply with the law when selecting conscripts for military service. It is no secret that the degree of popularization of military craft has increased significantly in recent years and there are more people wishing to join the ranks of the Armed Forces. But if the conscript really suffers from a serious illness, then every effort must be made to ensure that he remains in the conditions prescribed by the doctor.

The fact that he ends up in the army by the verdict of an incompetent commission will not benefit anyone. The ranks of the armed forces will include a soldier with disabilities who may experience exacerbations. Therefore, a qualified approach and conscientious treatment will preserve health and replenish the army with a suitable contingent.

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Author of the article

Filatova Oksana

General practitioner. Current member of the VVK.

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Classification

In the orthopedic environment, this pathology is usually classified according to the degree of its severity and the severity of the observed external and internal symptoms. Regarding this, there are three degrees of Schlatter’s disease, namely:

• initial – visual manifestations in the form of a lump-like growth under the knee are absent or minimal, pain in the area of ​​the knee joint is episodic, mild and occurs mainly at the time of physical activity on the leg;
• an increase in symptoms - swelling of the soft tissues around the affected knee appears, a lump becomes visually visible directly below it, pain syndrome manifests itself during the period of loads on the leg and for a certain period of time after them;
• chronic - a lump-like formation is clearly visible under the knee, which is most often surrounded by swelling, discomfort and pain in the joint is persistent and is observed even at rest.

What are the symptoms of the disease?

The beginning of the formation of this disease, as a rule, goes unnoticed, since certain characteristic signs are not visible. Over time, with prolonged stress, the young man will feel pain in the joint.

With rest, the pain subsides. But even in this case, the alarm is not sounded, since not everyone knows about such a disease, and only when painful spasms no longer stop even at rest do young people think about making an appointment with a specialist.

In order to consult a doctor in time and not miss the time when a change in the joint may occur, you need to pay attention to such signs of the disease as:

• Placement of pain in the knee area. Pain is felt when doing physical exercises;
• Formation of build-up;
• When performing strength exercises and for a certain period after performing them, pain is felt;
• Temporary absence of symptoms followed by return;
• Pain when walking, running and climbing stairs;
• Swelling forms in the area of ​​the knee joint. Pressing on the joint provokes pain.

Therapy for Schlatter's disease does not involve surgical intervention. The main component is reducing the load on the joint. It is often necessary to immobilize the knee joint with a cast. Among the medications, doctors prescribe anti-inflammatory drugs. The doctor prescribes exercise therapy for the patient.

This is important to know: Who is not subject to military registration

Causes

There are two main physical activity-related underlying causes of Osgood-Schlatter disease in adolescents and children:

• direct injuries to the tissues of the knee joint (subluxations and dislocations, sprains, bruises, fractures);
• systematic microtraumas (external and internal) of the knee joint that occur as a result of intense sports or other activities associated with excessive physical stress on the lower extremities.

The greatest risk factors for Schlatter's disease in adolescents and children are:

• football, basketball, handball, hockey, volleyball, tennis;
• track and field athletics, acrobatics, gymnastics;
• judo, kickboxing, sambo;
• skiing, sports tourism, figure skating, cycling;
• ballet, sports and ballroom dancing.

Symptoms of Osgood-Schlatter disease

The severity of the negative manifestations of this pathology in different patients may differ depending on the nature of the injuries received, the degree of physical activity and the personal characteristics of the body.

At the beginning of the development of the disease, the patient begins to experience vague pain in the knee area, which usually appears after or during physical activity on the affected limb. As a rule, such pain is not yet associated with an internal pathological process and therefore there are quite few visits to the doctor during this period.

Over time, pain symptoms begin to increase, are localized in one place and can appear not only during physical activity, but also at rest. At the same time, swelling caused by edema appears around the affected knee, and a lump-like growth appears just below it. During this period of illness, it becomes increasingly difficult for the patient (especially the athlete) to perform his usual exercises, and sometimes even natural leg movements. The greatest intensity of pain is observed in the body position - kneeling.

Photo of a “bump” in Osgood-Schlatter disease

In addition, the patient may experience other negative symptoms:

• tension in the leg muscles (mainly the thigh muscles);
• limited mobility of the knee joint;
• outbreaks of sharp “shooting” pain in the knee area, arising when it is overstrained;
• severe morning swelling in the upper or lower part of the knee, which forms the day after physical activity.

When you independently palpate the affected knee, points of pain are felt, as well as smoothness of the contours of the tibia. The texture of the knee joint is felt as densely elastic, and a hard lump-like formation is felt under the swollen soft tissues. The general well-being of the patient, despite the accompanying pain and pathological processes in the knee, does not change significantly. The skin over the affected joint does not turn red, temperature indicators remain normal.

In most clinical cases, this disease occurs in a measured chronic form, but sometimes its wave-like course can be observed with periods of sudden exacerbation and relative calm. Without medical intervention and with continued physical activity, negative symptoms can persist for many months and worsen against the background of further mechanical damage to the knee joint. However, the manifestations of the disease gradually disappear on their own over 1-2 years, and by the time the period of bone tissue growth ends (approximately 17-19 years) they usually eliminate themselves. Before treating Osgood-Schlatter, the need for such therapy should be comprehensively and individually assessed, since in some cases it may be inappropriate.

Schlatter's disease contraindications

The formation of the disease is evidenced by the gradually increasing nature of pain, especially when bending a limb, when a young person performs squats or simply exercises. From this we can immediately conclude that in case of Schlatter’s disease it is contraindicated to perform physical activity on the injured limbs.

As a rule, the signs of the disease increase directly in direct proportion to the load that was placed on the joints and tibia. The patient may notice pain after an overly active workout.

This mode can be observed during preparation for competitions. In this case, many young men decide to continue training in order to take care of their own well-being only after the competition.

If you have Schlatter's disease, this is contraindicated. You will need to cancel your trip to the competition.

If this is not done, then the symptoms will worsen, the condition will rapidly deteriorate, since the disease can develop into a more severe degree.

The disease is immediately classified as chronic, it has almost no acute expressions, the knee joint regularly remains in one state, but it causes suffering to a person. For this reason, it is contraindicated to leave it in this form.

Of course, any physical activity is considered a direct contraindication for illness. Therefore, during illness they should be reduced to zero.

Tests and diagnostics

In general, the doctor can suspect the development of Schlatter’s disease due to the complexity of the patient’s clinical manifestations and the localization of the pathological process typical for this disease. The gender and age of the patient also play an important role in correct diagnosis, since adults, as a rule, are not exposed to this type of damage. Even through a simple visual examination and the usual collection of anamnesis regarding previous injuries or overloads of the knee joint, an experienced orthopedic traumatologist is able to make the correct diagnosis, but it would be useful to confirm it using some hardware diagnostic methods.

The decisive factor in making an unambiguous diagnosis of Osgood-Schlatter disease in children and adolescents was and remains radiography , which, in order to increase the information content of the pathology, is best carried out over time. To exclude other orthopedic diseases, such an examination of the affected knee joint must be carried out in two projections, namely lateral and direct.

In the initial phase of the development of the disease, X-ray images show a flattening of the tibial tuberosity in its soft part and a rise in the lower edge of the clearing, corresponding to the adipose tissue located in the anterior lobe of the knee joint. The last discrepancy with the norm is caused by an increase in the size of the infrapatellar bursa, which occurs as a result of its aseptic inflammation. There are most often no visible changes in the ossification nucleus itself at this stage of Schlatter’s disease.

X-ray of the knee joint in Osgood-Schlatter disease

As the pathology progresses, the x-ray picture changes for the worse. The photographs show a shift of the ossification nucleus by 2-5 mm upward and forward relative to the standard location of the tuberosity or its fragmentation. In some cases, there may be unevenness of the natural contours and unclear structure of the ossification nucleus, as well as signs of gradual resorption of its parts, but most often it fuses with the main body of the bone with the formation of a bone conglomerate in the form of a spiky protrusion. This “bump”, characteristic of Schlatter’s disease, in the later stages of the disease is especially clearly visible on a lateral radiograph and is clearly palpable during palpation in the area of ​​the tuberosity.

In some atypical cases, it may be necessary to prescribe an MRI , CT and/or ultrasound of the problem knee and adjacent tissues to clarify the expected diagnosis. It is also possible to use a technique such as densitometry , which will provide comprehensive data on the structural state of the bones being studied. Other laboratory diagnostic methods, including PCR studies and blood tests for rheumatoid factor and C-reactive protein, are carried out in order to exclude the possible infectious nature of problems with the knee joint (mainly nonspecific and specific arthritis ).

Differential diagnosis of Osgood-Schlatter syndrome must be carried out with any fractures in the knee joint, bone tuberculosis , patellar tendinitis osteomyelitis , infrapatellar bursitis , Sinding-Larsen-Johanson disease and tumor neoplasms.

Treatment with folk remedies

With the permission of the attending physician and in addition to traditional methods of treating Schlatter's disease, the use of folk remedies is allowed, which mainly boil down to the use of various compresses and rubbing that relieve pain and inflammation. The following recipes have proven themselves well in this direction.

Honey compress

To make such a product, natural fresh honey should be mixed in equal proportions with medical alcohol and heated in a water bath until the honey is completely liquefied. Immediately after this, you need to moisten a clean piece of gauze in this mixture, apply it to the problem joint and wrap it first with cellophane and then with a warm cloth (preferably wool). Such procedures can be carried out twice a day for a month, keeping the compress on the knee for approximately 2 hours.

St. John's wort and yarrow

A kind of ointment is prepared from a crushed mixture of these herbs (in equal proportions), for which they are mixed with rendered pork fat, and then heated over low heat for 15 minutes. After cooling, the ointment is considered ready for use and can be rubbed into the skin around the injured knee 2-3 times a day.

Garlic

Two medium heads of garlic are peeled, passed through a garlic press and mixed with 400 ml of regular apple cider vinegar. Before use, this drug should be infused for a week in a dark glass container, where it can then be stored for six months. The method of application is to rub a small volume of this tincture into the damaged knee area 2-3 times a day.

Burdock

Finely chop a few fresh burdock leaves, place them on clean gauze and wrap it around the painful part of the leg for 3 hours. This dry compress is placed at night and applied once every 24 hours for one month (instead of burdock, you can take cabbage or plantain leaves).

Onion

Grate two small peeled onions on a fine grater and mix them with 1 tsp. granulated sugar. The resulting mixture is used for night compresses for about a month.

Healing oils

Camphor, clove, eucalyptus, menthol oil and aloe juice should be carefully mixed in equal proportions. This mixture should be rubbed into the skin over the damaged area several times a day, and then wrapped with a warm cloth.

Prevention

Prevention of the first occurrence or re-development of Schlatter's disease in general consists of controlling the intensity of physical activity performed by a child or adolescent on the lower extremities, especially if he is actively involved in sports, dancing, etc. This largely depends on the parents, since young people are rarely aware of the adequacy of their own training and can constantly overexert themselves. Also, an important role in the preservation of joints and the entire skeletal system during the period of its growth is played by nutritious nutrition, which should include the entire complex of minerals and vitamins . In addition, it is imperative to undergo full professional treatment for any injuries sustained by children, even if at first glance they seem insignificant.

Reviews

Dear readers, you can leave your feedback on whether Schlatter’s disease and military service are compatible in the comments; your opinion will be useful to other users of the site!

Fedor:

It has long been established that people with Schlatter's disease are drafted into the army. Only if at the time of the conscription campaign the conscript just had a relapse of the disease. In this case, only a delay of six months for treatment and recovery and then to the army.

Ivan:

My son was drafted into the army with Schlatter's disease. As a child, he was involved in a sports section, which is why this disease appeared. When the draft board started talking about this disease, they immediately told us that it was a conscription disease.

Osgood-Schlatter disease in adults

The age group at increased risk of developing Schlatter's disease includes only children and adolescents, whose tibia in the area of ​​their tuberosity are in the process of intensive growth. As it stops and the body naturally matures, the tuberosity zone becomes stronger and eventually completely ossifies, which in itself excludes the development of this disease in adults. The only thing that can connect adults with this osteochondropathy is its residual changes in the form of small tubercles under the knees.

Consequences

Contrary to popular belief, this disease does not go away on its own. Its therapy is long-term (can last several years), but with timely treatment and persistence in treatment, the outcome for patients is positive.

Many patients are cured of Schlatter's disease after the growth process is complete. In certain situations, after recovery, bumps in the knee area may persist.

In addition, one of the consequences of the disease can be expressions of meteosensitivity.

Complications and consequences of Osgood-Schlatter

Most often, Osgood-Schlatter disease does not lead to any serious complications in the damaged knee joint and goes away over time with virtually no consequences. Sometimes, at first after treatment, local swelling or minor pain persists in the knee area, which usually occurs after excessive physical exertion.

Also, quite often, in the area of ​​​​the previously affected lower leg, a formed bone growth remains noticeable, which, as a rule, does not affect the mobility of the knee joint and does not cause a feeling of discomfort both in everyday life and during sports. In rare cases, with severe cases and/or improper treatment of Schlatter's disease, such a bone growth can provoke deformation and displacement of the patella. osteoarthritis as adults and may experience pain when kneeling, as well as aching pain when weather conditions change.

What does the medical board's decision depend on?

The violation itself, as noted above, does not exempt the citizen from service. The Regulations on Military Medical Examination states that illness without pathologies of joint functionality does not interfere with military service. As a rule, in such a situation, a young person is assigned fitness category “B”.

Of course, a conscript can insist that he is not subject to conscription. In particularly severe cases of the disease, the young man may not be accepted into the army and given the appropriate fitness category. But this does not happen so often, since, usually, a deferment is issued for the treatment of this disease.

Conscripts diagnosed with Osgood Schlatter disease in the army can be found in any branch of the military.

The exceptions are:

• Special Forces;
• Airborne assault troops;
• Marines;
• Airborne troops.

In order for a young man not to be recruited, he will need to prove the presence of functional pathologies that are caused by this disease. In such a situation, the examination is carried out according to Article 65 of the Schedule of Diseases. It is possible to issue a military document if the violation is accompanied by pain and limited joint mobility.

List of sources

• Abalmasova E.A. Osteochondropathies // Orthopedics and traumatology of childhood. - M., 1983. - P. 385-393.
• Gorodnik A.G., Lantsov V.P. The problem of Osgood Schlatter's disease // Vestn. X-ray Radiol. — 1963.- No. 38.-С14-17.
• Pozharsky V.F., Osteochondropathy of the tibial tuberosity (Osgood Schlatter disease) // Medical assistant Obstetrics.- 1982.- No. 47(9).- P.53.
• Pudovnikov S.P., Tarabykin A.N. “Method of surgical intervention for Osgood-Schlatter disease” // Military Medical Journal 1987. - No. 7. - P. 62.
• Esedov E.M. “Osgood-Schlatter syndrome” in the practice of a therapist // “Clinical Medicine”. - 1990, - No. 1. - P. 109-111.