Revista de Medicina Desportiva (English) November 2018 | Page 25

Rev. Medicina Desportiva informa, 2018; 9(6):23-25.
Osgood-Schlatter Syndrome
Dr. Cláudio Espírito Santo 1 , Dra. Joana Rodrigues Maia 2 , Dr. Diogo Lino Moura 3 , Prof. Doutor Fernando
Fonseca 4
1
General Medical Practitioner Specialist USF Rainha Santa Isabel; 2 Resident doctor on General Medical
Practitioner UCSP Cantanhede; 3 Resident doctor on Orthopedics atCentro Hospitalar e Universitário de
Coimbra (CHUC); Medical School of the Universidade de Coimbra (FMUC); Director of the Orthopedic ward at CHUC,
FMUC. Coimbra
RESUMO / ABSTRACT
The Osgood-Schlatter syndrome (OSS) is characterized by partial separation between tibial epi-
physis and the anterior tibial tuberosity ossification center, establishing itself as the most common
origin of morbidity localized to the knee during adolescence. It is characterized by its particular
frequency in males aged between 12 and 15 years and physical exercise practitioners. This condition
is self-limited, with an expected spontaneous recovery in 90% of patients. However, symptoms can
happen at adult stage and surgical intervention can be needed. In this paper we review the scientific
literature about definition, clinic, diagnosis and treatment of SOS.
PALAVRAS-CHAVE / KEYWORDS
Osgood-Schlatter syndrome, knee pain, tibial tuberosity
Definition
The Osgood-Schlatter syndrome
(OSS), also known as osteochon-
drosis or traction apophysis of the
anterior tuberosity of the tibia, is
characterized by partial avulsion of
the anterior tuberosity of the tibia
caused by the continuous traction
exerted by extensor apparatus of
the knee. It was first described in
1903, independently and simultane-
ously by two orthopedic surgeons,
the American Robert Osgood and the
swiss Carl Schlatter. 1-3
and 15 years of age and females is
between 8 and 12 years of age. 5-7
Physiopathology
The secondary ossification center of
the anterior tibial tuberosity arises
between 11 and 14 years of age and it
merges to the superior tibial epiphy-
sis between 14 and 18 years of age.
Before this, both ossification centers
1.
are separated only by cartilage and
that is during this period of fragility
that OSS occurs (apophysis stage of
the Ehrenborg and Lagergren’s Radi-
ological Stages of the tibial tuberos-
ity maturation – Figure 1). 8-12
The strong muscle contraction
and the continuous traction exerted
by the extensor apparatus of the
knee, most evident during intense
sports practice, are bigger than the
distal insertion resistance, the ado-
lescent’s fragile ossification center of
the tibial anterior tuberosity, which
is only separated from the superior
tibial epiphysis only by a non-ossi-
fied cartilage. This disproportiona-
tion between strong tendons and
immatures insertion apophysis, typi-
cal during pediatric period, leads to
inflammation and partial avulsion
of the secondary ossification center
of the tibial anterior tuberosity. The
avulsion can occur either during the
pre-ossification period or after the
ossification of the secondary ossifi-
cation center, occurring exactly in
the weak cartilage that separates the
ossification center of the second-
ary ossification center of the tibial
anterior tuberosity from the superior
tibial epiphysis. This separation of
bone or of cartilage don’t prevents
growth and ossification, but it will
cause a prominent ossification of
the anterior tibial tuberosity or the
2.
Epidemiology
The OSS is the most common cause
of knee morbidity during adoles-
cence. 1 The majority of the cases of
OSS occur on adolescents practicing
physical exercise because there is a
stress over the extensor apparatus of
the knee and, consequently, over its
insertion point: the still immature
anterior tuberosity of tibia. The stud-
ies on osteochondrosis in athletes
indicate that about 20% of the
adolescents practicing sports show
signals of this disease comparing to
the incidence of 4,5% on the non-
practitioner. 4
The OSS is more frequent on the
male subject and generally is
unilateral, but it occurs bilaterally
in about of 20 to 30% of the cases.
Males have symptoms between 12
Figure 1 – Ehrenborg and Lagergren’s
Radiological Stages of the tibial
tuberosity maturation: a) cartilaginous
state (0-11 years of age); b) apophysis
stage (11-14 years); c) epiphysis state,
coalescence of the tibial apophysis and
epiphysis (14-18 years of age); d) osseous
stage, epiphysis closed (>18 years of
age). 8-12
Figure 2 – Pathogeny of Osgood-
Schlatter syndrome: a) appearance of
the secondary ossified center at the
tibial tuberosity; b) fragmentation of
the ossification center; c) fusion and
ossification of the ossification center
of the tibial tuberosity to the superior
tibial epiphysis leading to a prominent
tuberosity; d) a non-united free ossicle. 8
Revista de Medicina Desportiva informa november 2018 · 23