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