A systematic review on conservative treatment options for OSGOOD-Schlatter disease

Self-management including exercise, education and activity modification compared to usual care for adolescents with Osgood-Schlatter (the SOGOOD trial): protocol of a randomized controlled superiority trial

BACKGROUND

Osgood-Schlatter is the most frequent growth-related injury affecting about 10% of physically active adolescents. It can cause long-term pain and limitations in sports and physical activity, with potential sequela well into adulthood. The management of Osgood-Schlatter is very heterogeneous. Recent systematic reviews have found low level evidence for surgical intervention and injection therapies, and an absence of studies on conservative management. Recently, a novel self-management approach with exercise, education, and activity modification, demonstrated favorable outcomes for adolescents with patellofemoral pain and Osgood-Schlatter in prospective cohort studies.

AIM

The aim of this trial is to assess the effectiveness of the novel self-management approach compared to usual care in improving self-reported knee-related function in sport (measured using the KOOS-child 'Sport/play' subscale) after a 5-month period.

METHODS

This trial is a pragmatic, assessor-blinded, randomized controlled trial with a two-group parallel arm design, including participants aged 10-16 years diagnosed with Osgood-Schlatter. Participants will receive 3 months of treatment, consisting of either usual care or the self-management approach including exercise, education, and activity modification, followed by 2 months of self-management. Primary endpoint is the KOOS-child 'Sport/play' score at 5 months. This protocol details the planned methods and procedures.

DISCUSSION

The novel approach has already shown promise in previous cohort studies. This trial will potentially provide much-needed level 1 evidence for the effectiveness of the self-management approach, representing a crucial step towards addressing the long-term pain and limitations associated with Osgood-Schlatter.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT05174182. Prospectively registered December 30th 2021. Date of first recruitment: January 3rd 2022. Target sample size: 130 participants.

Role of Physiotherapy in Osgood-Schlatter's Disease in Adolescent Volleyball Smasher: A Case Report

A 14-year-old female presented to the sports physiotherapy with a diagnosis of Osgood-Schlatter's disease (OSD), a condition particularly prevalent in adolescents engaged in sports with repetitive knee motions, such as volleyball. This ailment commonly manifests at the tibia, directly beneath the patella, eliciting discomfort and inflammation. The chronic overuse injuries involve repetitive activities inducing fatigue in specific anatomical structures. Adequate recovery mechanisms allow for tissue adaptation, mitigating the risk of injury. In the absence of proper recovery, microtrauma ensues, instigating inflammation mediated by substances like histamines. The release of inflammatory cells and enzymes inflicts damage on local tissue, and prolonged stress contributes to degenerative changes, resulting in weakness, diminished flexibility, and chronic pain. These manifestations are intimately associated with OSD in chronic or recurrent instances. The primary symptom of OSD is knee pain, often of sufficient severity to induce limping. Patients report discomfort during activities such as kneeling, descending stairs, prolonged stationary positions, prolonged episodes of sitting with the knee rendered immobile, and engagement in sporting activities. This case study specifically underscores the efficacy of tailored physiotherapy in the management of OSD among adolescent volleyball players. The study's findings indicate that the patient successfully alleviated symptoms, facilitating recovery with improved outcomes. Furthermore, the physiotherapy regimen appears instrumental in enhancing the patient's functional mobility, as evidenced by the study's outcomes.

The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease

The mainstay in the treatment of Osgood-Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and systematic reviews informed the initial leaflet. Twelve children with OSD and four clinical experts provided feedback through semi-structured interviews. After incorporating stakeholder input, the leaflet 'Osgood-Schlatter-Information and guidance' was developed. This provides a resource to assist the provision of information and translation of the current evidence.

Acute traumatic patellar tendon rupture and simultaneous fracture of the tibial tubercle avulsion in a premature soccer player

Bone-tendon junctions are prone for acute trauma due to its structural weakness, especially in premature males. For the lower limb, the most eminent area is the tibial tubercle apophysis. Osgood Schlatter disease (OSD) due to repetitive trauma or epiphyseal fractures due to one trauma is well described in literature and known in pediatric practice. Traumatic distal patella tendon ruptures on the other hand are a typical injury of the knee extensor mechanism of mature patients in the fourth decade. Here, the very rare condition of fracture of the tibial tubercle apophysis with simultaneous rupture of the distal patellar tendon of a 15 year old soccer player with previous history of OSD is presented including a review of the recent literature.

The Falcon Test: An Observer Agreement Study in Subjects With and Without Anterior Knee Pain

Introduction

A shortened rectus femoris muscle has been associated with many different musculoskeletal problems. Assessing rectus femoris muscle length is commonly performed using the Modified Thomas Test. However, this test position is often difficult to assume and there are difficulties with reliably measuring rectus femoris length. A method that that uses an easier position to assume and could be more reliable would be beneficial to therapists. The purpose of this study was to determine observer agreement using a new test for assessment of rectus femoris length. A second purpose was to determine if those with anterior knee pain have different rectus femoris muscle length than those without anterior knee pain.

Method

Fifty-three participants with and without anterior knee pain were enrolled. Rectus femoris muscle length was measured lying prone with the leg measured on the table while the non-measured leg was off the table in a position of 90° hip flexion. Rectus femoris muscle was lengthened by passively bending the knee until a firm end-feel. The angle of knee flexion was then measured. The process was then repeated after a brief rest period.

Results

Observer agreement assessing rectus femoris length using this method showed "almost perfect" reliability for both intra- and inter-rater testing: intra-rater: ICC = .99, [CI95: .98-.99], inter-rater: ICC = .96, [CI95: .92- .98]. Agreement for the sub-sample of those with anterior knee pain (N=16) showed "almost perfect" reliability for intra-rater (ICC 1,1 = .98); [CI95: 0.94-.99] and inter-rater reliability (ICC 2,1 = 0.88); [CI95: 0.70 -.95]. No differences were noted in rectus femoris length between those without and those with anterior knee pain (t= 0.82, p> 0.01); [CI95: -7.8 -3.33]; (SEM = 1.3°; MDC=3.6°).

Conclusion

This new method of assessing rectus femoris length is reliable between and within raters. No differences were noted in rectus femoris length between those with anterior knee pain and those without.

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be "imprinted" in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.

Periostin Contributes to Fibrocartilage Layer Growth of the Patella Tendon Tibial Insertion in Mice

Background and Objectives: The influence of periostin on the growth of the patella tendon (PT) tibial insertion is unknown. The research described here aimed to reveal the contribution of periostin to the growth of fibrocartilage layers of the PT tibial insertion using periostin knockout mice. Materials and Methods: In both the wild-type (WD; C57BL/6N, periostin +/+; n = 54) and periostin knockout (KO; periostin −/−; n = 54) groups, six mice were euthanized on day 1 and at 1, 2, 3, 4, 6, 8, 10, and 12 weeks of age. Chondrocyte proliferation and apoptosis, number of chondrocytes, safranin O-stained glycosaminoglycan (GAG) area, staining area of type II collagen, and length of the tidemark were investigated. Results: Chondrocyte proliferation and apoptosis in KO were lower than those in WD on day 1 and at 1, 4, and 8 weeks and on day 1 and at 4, 6, and 12 weeks, respectively. Although the number of chondrocytes in both groups gradually decreased, it was lower in KO than in WD on day 1 and at 8 and 12 weeks. In the extracellular matrix, the GAG-stained area in KO was smaller than that in WD on day 1 and at 1, 4, 8, 10, and 12 weeks. The staining area of type II collagen in KO was smaller than that in WD at 8 weeks. The length of the tidemark in KO was shorter than that in WD at 4 and 6 weeks. Conclusion: Loss of periostin led to decreased chondrocyte proliferation, chondrocyte apoptosis, and the number of chondrocytes in the growth process of the PT tibial insertion. Moreover, periostin decreased and delayed GAG and type II collagen production and delayed tidemark formation in the growth process of the PT tibial insertion. Periostin can, therefore, contribute to the growth of fibrocartilage layers in the PT tibial insertion. Periostin deficiency may result in incomplete growth of the PT tibial insertion.

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.