Hyperosmolar dextrose injection for Osgood-Schlatter disease: a double-blind, randomized controlled trial

The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease

Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.

The posterior tibial slope and Insall-Salvati index in operative and nonoperative adolescent athletes with Osgood-Schlatter disease

INTRODUCTION

Osgood-Schlatter disease (OSD) is a common cause of anterior knee pain in adolescent athletes due to repetitive stress on the tibial tubercle. The posterior tibial slope angle (PTSA) and the Insall-Salvati Index (ISI) play a role in knee biomechanics. However, to our knowledge, the posterior tibial slope and patellar height have not been compared in operated versus nonoperative OSD patients. The purpose of the current study is to compare the differences in the PTSA and the ISI between operative and nonoperative patients with OSD.

MATERIALS AND METHODS

The study was approved by the College of Medicine's Institutional Review Board. A retrospective review was performed on 75 adolescent athletes with OSD between 2008 and 2019. The data extracted included: age, sex, body mass index (BMI), sporting activity and type, mechanism of injury (MOI), chronicity of symptoms, PTSA, and the ISI. Descriptive and quantitative statistics were used.

RESULTS

Seventy-five patients (88 knees) with OSD were studied (28 boys, 47 girls). The average age was 12.2 years and the average BMI was 22.3. The mechanism of injury (MOI) included repetitive stress (77%) and trauma (23%). The duration of knee pain averaged 10.3 months. Sixty-six patients were included in the nonoperative cohort. Nine patients were included in the operative cohort and underwent surgery due to persistent symptoms after skeletal maturity with tubercleplasty and/or ossicle excision. The average PTSA was 12.1° ± 1.7° and average ISI was 1.05 ± 0.15. Comparing the operative and nonoperative patients, we found no significant difference in PTSA (11.2° ± 0.73° versus 12.8° ± 1.8°, p < 0.064). However, we did find that patients treated operatively had a lower ISI (0.95 ± 0.18 versus 1.14 ± 0.13, p < 0.001).

CONCLUSION

In patients with OSD, operative and nonoperative patients demonstrated a similar PTSA. On the other hand, the ISI was higher in nonoperative patients. In the current paper, a decreased ISI was helpful in predicting the need for operative intervention in symptomatic patients after skeletal maturity.

Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review

Osgood-Schlatter disease is the most common osteochondritis of the lower limb in sport-practicing children and adolescents. Its manifestation usually coincides with the appearance of the secondary ossification center of the tibia and is linked to the practice of sports with an explosive component. In the present study, a review of the factors related to its appearance, diagnosis and treatment was carried out. Its appearance seems to be multifactorial and related to multiple morphological, functional, mechanical and environmental factors. Given all the above, risk factor reduction and prevention seem the most logical strategies to effectively prevent the appearance of the condition. In addition, it is essential to create prevention programs that can be objectively assessed and would allow to stop the progress of the pathology, particularly in those sports where high forces are generated on the insertion zone of the patellar tendon at sensitive ages. More studies are needed to clarify which type of treatment is the most appropriate—specific exercises or the usual care treatment.