Revista de Medicina Desportiva (English) November 2018 - Page 27

in about 5 to 10% of the situations the symptoms persist, and surgery might be needed. 16-20 There are several surgical tech- niques for the treatment of this pathology, with diverse results, and there is no particular procedure more effective than the others (Fig- ure 5). 5,16,20,23-25 Mital et al presented the results of surgical procedures on 15 knees with OSS. In all there was a free separated ossicle, pain e tenderness, with symptoms for an average period of 3,8 years without improvement with the conservative treatment. According to the authors, all patients felt better after surgi- cal excision of the ossicle and the underneath synovial bursa. 20 Flowers and Bhadreswar performed a technical modification of the classical Ferciot and Thomson’s technique of excision of the tibial tuberosity prominence, adding the removal of any osseocartilagi- nous material. There was a relieve of the pain in about 95% of the patients and an improvement of the prominence in about 86% of the patients. 16,23,24 Complications It is described that in about 10% of the cases of OSS there might be some complications. The pseudoar- throsis and the persistence and migration of the free ossicle inside the patellar tendon can promote a premature closure of the anterior area of the superior tibial epiphysis, leading to a recurvatum knee. Also as a complication, it might result on a patella alta and changes on the biomechanical on the patelofemoral joint, which could result on patellar instability and gonarthrosis. There Figure 5 – Exeresis of the ossicle at the anterior tibial tuberosity. are some reports about the fragility on the insertion of the patellar ten- don on the anterior tibial tuberosity that can result on avulsions of the tendon. 8,26 Conclusion The OSS is in most cases a self- limited disease, which diagnosis must be known because it affects the physical and the sports perfor- mance. Its physiopathology explains why most of the cases occurs during adolescence and its typical presen- tation allows a diagnosis supported by the symptoms. The X-ray can confirm the diagnosis and help with the differential diagnosis. The initial the treatment with nom-steroids anti-inflammatory drugs and partial limitation of physical activity are o paramount importance for the fast return to sports practice of the young athlete. These measures are effective in the majority of the cases but in about 5 to 10% of the patients the symptomatology will persist until adulthood, and the surgical treatment might be needed. The authors declare the absence of any conflict of interests Correspondence: Dr. Cláudio Espírito Santo USF Rainha Santa Isabel, Coimbra Bibliography 1. Osgood RB. Lesions of the tibial tubercle occur- ring during adoloscence. Boston Med Surg J 1903; 148:114–117. 2. Schlatter C. Verletzungen des schnabelformi- gen Fortsatzes der oberen Tibiaepiphyse. Beitr Klin Chir 1903; 38:874–887. 3. Kujala, U. M., Kvist, M., and Osterman, K., Knee injuries in athletes. Review of exertion injuries and retrospective study of outpatient sports clinic material. Sports Med. 1986; 3(6):447-60. 4. Kujala, U. M., Kvist, M., and Heinonen, O., Osgood-Schlatter’s disease in adolescent athle- tes. Retrospective study of incidence and dura- tion. Am J Sports Med. 1985; 13(4):236-41. 5. 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