Endoscopic treatment of Osthut-Schlatter disease in adults

Osgood-Schlatter disease can present as a painful lump in the area below the kneecap during childhood and adolescence as puberty begins. Osgood-Schlatter disease occurs most often in children who participate in sports, especially sports such as running, jumping, or sports that require rapid changes in movement trajectories, such as football, basketball, figure skating and gymnastics.

And although Osgood-Schlatter disease is more common in boys, the gender gap narrows as girls become more involved in sports. Osgood-Schlatter disease affects more adolescents who play sports (by a ratio of one to five). The age range of incidence has a gender factor, as girls experience puberty earlier than boys. Osgood-Schlatter disease usually occurs in boys between 13 and 14 years of age and in girls between 11 and 12 years of age. The disease usually goes away on its own as bone growth stops.

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”.

Treatment

Previously, it was believed that Osgood-Schlatter disease in children and adolescents went away on its own over the years and did not need to be treated. However, such an attitude towards this pathology can cause complications.

After examining the patient, the doctor will assess the severity of the disease and draw up a treatment plan. In most cases, with Osgood-Schlatter disease, only conservative measures and outpatient treatment are sufficient.

Conservative therapy

During pronounced manifestations of the disease, the patient should completely avoid additional stress on the knee joints, provide them with a gentle regime and stop sports training during the course of treatment. Some patients are recommended to wear a special bandage or fixing bandages that reduce the amplitude of displacement of the proboscis.

To strengthen the structures of the knee joint, special exercises are performed to help develop the hip muscles and reduce tension on the ligaments. Therapeutic exercise is complemented by massage courses with anti-inflammatory and warming creams and ointments. In addition, it is recommended to apply warm compresses. It is permissible to use traditional medicine methods.

The tactics of physiotherapeutic treatment of Osgood-Schlatter disease depend on the results of radiography:

• Group I patients undergo a course of magnetic therapy and UHF;
• Group II patients are prescribed a course of magnetic therapy and electrophoresis with medicinal solutions of lidocaine, calcium chloride and nicotinic acid;
• Group III patients undergo electrophoresis with hyaluronidase or potassium iodide, subsequently a course of magnetic therapy and electrophoresis with calcium chloride and nicotinic acid are prescribed.

Sometimes a course of physiotherapeutic treatment can be supplemented with other procedures:

• paraffin therapy;
• therapeutic mud applications;
• shock wave therapy.

If necessary, conservative treatment is supplemented by taking non-steroidal anti-inflammatory drugs:

• Tylenol;
• Ibuprofen, etc.

In addition, drug therapy can be effectively supplemented by taking calcium supplements, antiplatelet agents, B vitamins and vitamin E.

The course of treatment for this disease takes from 3 months to six months. In most cases, it helps to significantly reduce or completely eliminate pain. After the therapy, the patient should limit the load on the knee joints for some time.

Surgery

In severe forms of Osgood-Schlatter disease, accompanied by the formation of a separate bone growth in the area of ​​the tibial tuberosity, conservative therapy may be ineffective. Indications for surgical treatment in such cases may include the following factors:

• ineffectiveness of all conservative methods;
• prolonged and progressive course of the disease;
• destruction of bone fragments from the underlying apophysis;
• age over 14 years.

The decision on the need to perform an operation is always made taking into account all its likely negative consequences. If it is impossible to refuse such an intervention, the surgeon develops a plan for the upcoming operation - it should be minimally traumatic and maximally effective.

To treat severe manifestations of Osgood-Schlatter disease, the following types of surgical interventions can be performed:

• stimulation of the tuberosity using the Beck or Pease technique;
• implantation of grafts to stimulate osteoreparation;
• movement of the attachment sites of individual parts of the apophysis;
• extended decortication.

The choice of surgical treatment method is selected individually for each patient and depends on his age and clinical picture of the disease.

In the postoperative period, the patient is prescribed a course of drug therapy and physical procedures aimed at accelerating the healing of bone tissue. The patient must wear a pressure bandage or bandage for 1 month.

Already 10-14 days after the intervention, patients notice a decrease in pain. The course of postoperative rehabilitation usually lasts about 4 months, and return to sports becomes possible six months after the operation.

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.

Causes of development of Schlatter's disease

The main factor in the development of Schlatter's disease is damage to the knee joint as a result of intense physical activity. There are a number of reasons that cause such damage and provoke this disease:

• constant overloads;
• frequent microtraumas of the knee;
• regular damage to the knee ligaments;
• direct injuries: fractures of the tibia, patella, dislocations.

Due to significant overloads, frequent injuries to the knee joint and significant tension on the patellar ligaments, which occur during contractions of the quadriceps femoris muscle, blood circulation is impaired in the area of ​​the tibial tuberosity. Minor hemorrhages, rupture of patellar fibers, aseptic inflammation and necrosis are also noted.

The tibia is a tubular bone, its growth zones are located at its head. Since these growth plates have a cartilaginous structure, in adolescents they are not as strong as in adults whose growth has already stopped. That is, these growth zones in adults have already ossified. For this reason, such cartilaginous areas are easily vulnerable to any injury and intense physical activity. In this cartilaginous growth plate, the tendon of the quadriceps femoris muscle, which is the largest muscle in the human body, is attached to the tibia. It is involved during walking, running, jumping and in other cases of physical activity.

If a child is involved in sports professionally and experiences heavy loads on the legs, then it is possible to tear the tendons of the femoral muscle and damage the fragile cartilaginous tissue of the tibia. As a result, inflammatory processes are observed, which are accompanied by swelling of the tendon attachment area. Under constant load, the body tries to compensate for the resulting defect in the bone by filling it with bone tissue, an excessive amount of which leads to the formation of bone formation.

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.

Surgery

Surgical treatment is indicated when the disease persistently progresses. The essence of the surgical intervention is to remove lesions that have undergone necrosis, as well as to stitch together an implant that secures the tuberosity of the tibia.

Surgical treatment of Schlatter's disease is advisable in the following cases:

• with a long course of the disease (more than two years);
• in the presence of complications (bone destruction or rupture of the patellar ligament);
• if you are over 18 years of age at the time of diagnosis.

Surgical intervention is simple, but such interventions are characterized by a long recovery period, on which subsequent motor activity of the leg depends. For quick rehabilitation, you need to follow some rules:

• after the operation, use a fixing bandage on the joint or use a knee brace for a month;
• undergo a course of physiotherapy for rapid restoration of bone tissue (electrophoresis with calcium salts);
• taking dietary supplements based on calcium and vitamin and mineral complexes (for six months);
• avoid massive physical stress on the joint throughout the year.

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.

Schlatter's disease in adolescents

Schlatter's disease in children and adolescents usually appears during a period of intensive growth. The age limit for incidence is 12-14 years for boys and 11-13 for girls. This disease is quite common and is observed in 20% of adolescents who are actively involved in sports. Usually the disease begins for no apparent reason or after a sports injury, sometimes quite minor.

There are three main reasons that contribute to the development of this disease:

1. Age factor. The disease occurs in most cases in children and adolescents. In adults, the disease is practically not observed. The disease is detected extremely rarely, and then only in the case of a residual phenomenon (bone lump).
2. Gender. Medical statistics state that Osgood-Schlatter disease is more often observed in boys, but currently this situation is leveling out, since girls are also actively involved in sports.
3. Physical activity. The disease is more common in children who are actively involved in various sports than in those children who lead a passive lifestyle.

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.

How to treat Schlatter's disease at home

In some cases, Schlatter's disease can be treated at home, but only after an accurate diagnosis and visit to a doctor. These are mainly physical exercises and local therapy:

1. For constant and intense pain in the knee, in conjunction with medications, use compresses at night with non-steroidal topical drugs.
2. The use of folk remedies in the form of a variety of ointments, cold compresses based on chamomile, celandine, wax, honey, St. John's wort, knotweed, and yarrow is encouraged.
3. Massage with non-steroidal anti-inflammatory ointments for external use.
4. Therapeutic exercises alleviate the patient’s condition and prevent relapses of the disease. Do stretching exercises daily
5. The patient must remain calm and ensure a comfortable position of the affected joint;
6. During the rehabilitation period, completely limit physical activity on the sore leg.

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 methods

Osgood-Schlatter disease is curable in 99% of cases. Once this disease is diagnosed, any treatment will only slow down the progression of the pathological process. Recovery occurs on its own without special treatment. Therapy is prescribed only to relieve symptoms.

A complete cure can only be expected by stopping bone growth. This usually occurs between the ages of 17 and 20 years.

Conservative therapy

Conservative methods allow achieving remission in the vast majority of cases.

The first and mandatory stage of therapy is the abolition of intense physical activity (refusal of training and all kinds of rehearsals).

To relieve the load on the leg, you may need an orthosis (a fixing pad made of fabric with plastic or metal inserts) or a fixing bandage. If these measures are not enough, the patient is put in plaster for up to several weeks.

Knee brace

The second stage is the prescription of a set of medications that will help eliminate pain and relieve aseptic tissue inflammation:

• For pain relief, local agents are prescribed; Diclofenac-gel, Fastum-gel or Indomethacin give a good effect. Medicines in tablets or injections are used very rarely.
• Electrophoresis with Novocaine helps relieve discomfort (under the influence of a low-strength electric current, the medicine goes directly to its destination)
• Damaged areas of the bone are strengthened using electrophoresis, which saturates the bone with calcium.

Click on photo to enlarge

Electrophoresis procedure
After the severity of symptoms subsides, treatment of Schlatter's disease of the knee joint is continued by prescribing physical therapy. It helps improve metabolism in tissues, speed up their recovery and healing.

The attending physician may prescribe:

• shock wave and magnetic therapy;
• mud applications;
• paraffin therapy;
• UHF (ultra high frequency therapy);
• massage;
• Exercise therapy that involves the thigh muscles.

Conservative therapy lasts at least 3–6 months, rarely up to 3 years. All this time, the leg is provided with rest without strict bed rest.

Examples of possible exercises for Schlatter's disease. Click on photo to enlarge

Surgical treatment

Surgical methods are used for:

• rapid bone destruction;
• persistent pain;
• persistence of symptoms after 20 years.

Usually the operation is performed no earlier than at 14 years of age. The dead area of ​​bone and its fragments are removed, and the defect is restored with a special graft.

After the procedure, a pressure bandage is applied to the leg (for 4 weeks), antibiotics (Doxycycline, Cefazolin, Amoxiclav) and anti-inflammatory drugs (Ibuprofen, Voltaren, Diclofenac), as well as physiotherapy, are prescribed.

It takes up to 3 months to restore the limb after surgery, and at least 6 months for complete recovery. After this period, the leg is allowed to be loaded as before.

Prevention of the disease is a reasonable limitation of physical activity.

Click on photo to enlarge

Osteopathy

Of the alternative methods of treating Schlatter's disease, osteopathy gives good results. This alternative system is based on restoring balance between different parts and structures of the body in order to improve their functions.

Osteopathy is similar to massage and manual therapy.

During the treatment it is possible to:

1. Relax ligaments, tendons and muscles.
2. Restore blood supply to the affected area.
3. Relieve severe symptoms.
4. Launch self-regulation processes and even reverse the development of the disease.

The great advantage of osteopathy is the absence of age restrictions.

ethnoscience

At home, you can be treated with available remedies according to traditional medicine recipes:

• Compress that improves blood circulation. Take a fresh onion. Grind in a blender, add 0.5 tsp. Sahara. Place the mixture on a cloth and apply to the affected area (for 2–4 hours) for a month. Repeat after 2 weeks.
• Warming rub. Take 1 tsp. camphor oil, aloe juice, menthol. Add 0.5 tsp to the mixture. clove and eucalyptus oil. Rub into the affected area 2 times a day (if there is no irritation - a month or until the disturbing symptoms disappear). Repeat the course after 14 days.

On the left is a mixture of onions for a compress, on the right is the preparation of a rub from aloe juice, oils and menthol. Click on photo to enlarge

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.

Treatment methods

If a teenager complains of pain, then if Schlatter's disease of the knee is diagnosed, immediate and active treatment is required.
In the absence of obvious signs of the disease, the doctor observes the clinical picture for a certain time. This is due to the fact that in some cases the signs of the disease disappear on their own as the tubular bones grow. There are no specific treatments for Osgood-Schlatter disease. After a diagnostic examination, the orthopedist gives instructions for each specific case. Treatment of the disease takes a fairly long period: from six months to five years. If the syndrome is detected at an early stage, therapy will be short-lived. In case of surgical treatment, the rehabilitation period can last up to one year.

In order for the treatment to be successful, the patient must limit physical activity and provide complete rest to the leg. In some cases, experts recommend using a plaster cast or knee brace.

Non-steroidal anti-inflammatory drugs and analgesics are used to relieve signs of inflammation and pain. The doctor prescribes medications in short courses and in small dosages.

To strengthen the thigh muscles and strengthen the knee joint, physical therapy exercises are necessary. A set of special exercises helps stretch the hamstring and strengthen the quadriceps muscle.

Physiotherapeutic treatment has a positive effect on the affected joint. Paraffin therapy, electrophoresis, and heating will help slow down degenerative processes. Physiotherapeutic procedures help reduce swelling and eliminate pain. The choice of treatment method is made by an orthopedist, taking into account the severity of the condition and the age of the child.

To relieve discomfort, therapeutic massage sessions are performed using anti-inflammatory and analgesic ointments and gels. Medicines should be selected by the attending physician.

If conservative treatment does not give a positive result, the patient may be recommended to undergo surgery to remove the resulting growth. In more severe cases, part of the damaged knee joint may be removed. Surgical treatment of Osgood-Schlatter disease in adolescents is extremely rare.

At home, traditional medicine can be used for therapy. To relieve pain in the knee joint, the use of oil compresses is recommended. To prepare them, heat olive or sunflower oil in a water bath, soak a cloth with it and apply it to the sore spot. Place a plastic bag and a warming bandage on top.

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.

The mechanism of development of the disease

Schlatter's disease in children and adolescents involves a tuberous lesion of the tibia. Part of this bone is located below the knee, its main function is to attach the patellar ligament. This is precisely the reason for the development of the disease.

The thing is that the bone process near the apophysis has its own blood vessels that supply the growth zone with the necessary substances. When a child is actively growing, these vessels simply do not have time to “grow” compared to the increase in bone mass, which naturally leads to a lack of nutrients. As a result, this area becomes very fragile and vulnerable to injury. If at this time the child experiences constant physical activity on the lower extremities, then microtraumas of the patellar ligaments occur and, as a result, Schlatter’s disease.

You should know that the resulting bone tissue is very fragile and fragile. And with regular physical activity, sequestration of the bone (severation of a piece) and the patellar ligament can occur. Such consequences are common and require surgical intervention.

This disease causes a lot of controversy among scientists. Some experts believe that Schlatter's disease of the knee is genetic. They suggest that the disease is transmitted in an autosomal dominant manner. This suggests that the tendency to the disease can be transmitted from parents to children. But this point of view cannot be fully accepted, since the factor of inheritance is not always identified. The main reason that triggers the pathology is still mechanical trauma.

Schlatter's disease can also occur in adults, but is extremely rare. In this case, it manifests itself as arthrosis, which causes swelling of the tissues under the knee. When pressing on this place, the patient feels unpleasant pain, and during an exacerbation the local temperature rises. When complications occur, bone growth develops on the front surface of the leg.

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.

Nature of pain

The duration of pain in the initial stages of the disease is short or may not be noticeable at all. Over time, the duration increases.

It always appears after exercise. In the beginning, full training time is enough for pain to appear. In the last stages, pain appears already during warm-up.

The location is always limited to the tuberosity zone. Pain does not spread to the hip or ankle joint.

The intensity of pain depends on the extent and severity of the process. Mild pain is observed in the early stages and does not create any particular inconvenience. Severe pain is noted at a late stage. With severe pain, it is sometimes difficult for a person to even step on the sore leg.

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.

How to treat Schlatter's disease

Treatment of Schlatter's disease is carried out by several specialists: traumatologist, orthopedist, surgeon. The disease is highly treatable, and symptoms disappear as the child grows older. However, if the symptoms are significantly pronounced, then it is necessary to carry out symptomatic therapy that relieves pain and relieves swelling of the knee joint. In order to relieve pain, it is necessary to completely eliminate physical activity and provide the greatest possible rest to the affected joint.

Treatment of Schlatter's disease is carried out according to the following scheme:

• provide the patient with complete peace and comfort;
• taking medications: painkillers, muscle relaxants and non-steroidal anti-inflammatory drugs;
• physiotherapeutic methods;
• physiotherapy.

The medicines used are:

• painkillers;
• non-steroidal anti-inflammatory drugs (analgin, diclofenac, ibuprofen);
• muscle relaxants (mydocalm);
• calcium supplements and vitamin D.

Medications should be given to a child with caution, only in short courses and in small doses. You can also apply cold compresses to reduce pain.

Physiotherapeutic methods are very effective because they can relieve inflammation and reduce pain. They improve blood circulation and nutrition of the tissues of the diseased joint, help restore bone structure, and reduce inflammation and discomfort.

These methods necessarily complement the treatment program:

• ultra-high frequency therapy (UHF);
• magnetic therapy;
• electrophoresis with various drugs (calcium chloride, potassium iodide, procaine);
• shock-wave therapy;
• ultrasound therapy with glucocorticoids (hydrocortisone);
• laser therapy;
• paraffin compresses (with ozokerite, healing mud);
• warming up the knee using infrared rays;
• thalassotherapy (warm baths with sea salt or mineral water).

For each patient, the optimal treatment method is selected, which is determined by the doctor.

Physical therapy includes gentle exercises to stretch the quadriceps femoris muscle and develop the hamstrings. Such exercises reduce the load at the tendon attachment site to prevent tearing and injury.

During treatment, it is necessary to avoid physical activity and limit physical activity, which can increase pain.

In the acute period, intense physical activity should be replaced with more gentle physical therapy exercises, as well as swimming or cycling, but in a reasonable amount.

Each teenager is prescribed dietary nutrition and a vitamin and mineral complex. It is also recommended to wear a special bandage and orthopedic devices that have a protective effect, reduce the load and fix the knee ligaments.

Conservative treatment is carried out for a long time. As a rule, it lasts from 2 to 5 years. The bone lump remains forever, but does not increase in size and does not hurt. Over time, patients may experience aching pain in the knee joint, which is a reaction to changing weather.

After the course of treatment, you should not immediately begin active physical activity; this is fraught with serious complications such as osteoarthritis, displacement of the patella, and deformation of the bones of the knee joint.

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.

Diagnostics

If your child complains of knee pain, you can try doing the following diagnostic tests yourself:

• ask him to sit down several times: the pain should intensify;
• feel the area under the knee: make sure there is a lump there (in the early stages this is not necessary);
• apply sharp pressure to this area: movement causes pain;
• ask the child about the nature of the pain: when it appears and when it disappears.

However, relying on the results of “home” testing, diagnosing yourself and starting treatment is unacceptable. The teenager needs to be shown to an orthopedist or surgeon as soon as possible so that they can conduct a full examination.

X-ray

Radiography remains the most popular type of examination. The doctor prescribes it after a survey and visual examination of the patient. It is used both for diagnosis and to track the results of further treatment. As a rule, the picture is taken in 2 projections - front and side.

In the later stages of the disease, compaction in the area of ​​the greater tuberosity is clearly visible. With early diagnosis, the image may show only some changes in nearby tissues inherent in Schlatter's disease, but it is impossible to diagnose the extent of bone damage from them.

Radioisotope study (scintigraphy)

This type of diagnostics will allow:

• identify the disease in the early stages;
• examine the structure of bone tissue in detail;
• assess the degree of its destruction.

A marker substance with low radioactivity that is not dangerous to the human body is orally injected into the patient’s body.

The examination is carried out after 2 days, when most of the marker has been deposited in the bone. Using a device sensitive to radioactive radiation, it will be possible to obtain a clear picture of the problem area.

Scintigraphy has no contraindications or limitations. However, it may not give results if shortly before the patient underwent radiography using a contrast agent. The barium contained in it will distort the picture.

Densitometry

A method that allows you to determine bone mineral density and the percentage of calcium it contains.

The procedure is safe and painless: the patient is placed on a special table, after which a sensor is placed over the desired area of ​​the body, displaying data on the screen.

Other types of research

Schlatter's disease of the knee joint in a teenager sometimes requires additional research.

It is necessary to:

• clarify the diagnosis;
• track the dynamics of the disease;
• choose the optimal treatment method;
• exclude possible pathologies with similar symptoms.

The following types of diagnostics can be prescribed:

Shock wave therapy: mechanisms of therapeutic action

A shock wave is essentially a sound pulse emitted by a generator located outside the human body, that is, extracorporeally, which is why the technique is called extracorporeal shock wave therapy (ESWT).

In a short period of time (about 1 microsecond), the wave has a powerful effect (up to 20 MPa) on tissues, due to which mechanisms are triggered in them that have a positive therapeutic effect:

• a new vascular network is formed at the site of exposure (neoangiogenesis);
• in the zone of action of shock waves, blood circulation improves, the outflow of decay products is restored;
• the permeability of cell membranes to drugs increases;
• the sound impulse irritates the nerve endings, which causes a local analgesic effect;
• endorphins are released, which is also accompanied by an analgesic effect;
• bone growths are loosened, fibrous and scar tissues are softened.

Thus, the use of shockwave therapy for Schlatter's disease leads to pain relief and improved mobility in the knee joint.