Schlatter's disease of the knee joint treatment. Schlatter's disease - what you need to know and how to treat. You have been struggling with joint pain for many years without success.
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Each tubular bone of a child, located in the arm or leg, has its own growth zones, which actively manifest themselves in the area of the end of the bones, consisting of cartilage.
This tissue is not strong enough like bone, and therefore is much more likely to be damaged and overloaded, which affects the growth zones, which can ultimately lead to swelling and general pain in this area.
During physical activity that involves prolonged running, jumping and bending, such as football, volleyball, basketball or ballet, children's hip muscles strain the tendons.
This puts tension on the quadriceps muscle, which connects the kneecap to the tibia. This is confirmed by reviews of Schlatter's disease of the knee joint in a teenager.
Such frequently repeated loads can lead to small tears of the tendons from the tibia, which will ultimately become a prerequisite for the appearance of swelling and pain, which is directly related to Schlatter’s disease.
In some situations, the child’s body attempts to close the described defect through the growth of bone tissue, which leads to the appearance of a bone lump.
The tibia is a tubular bone, the cartilaginous growth zones of which are located near the heads (epiphyses). In adolescents, these zones, due to the cartilaginous structure, are not as strong as in adults who have already stopped growing (their growth zones have already ossified), therefore they are more vulnerable to any injuries and excessive stress.
It is in this cartilaginous growth area that the tendon of one of the most powerful muscles of the human body, the quadriceps femoris, is attached to the tibia. This muscle contracts during running, jumping, walking, and performing other physical exercises involving the legs.
The main factor in the development of Schlatter's disease is damage to the knee joint as a result of intense physical activity. There are a number of reasons that cause such damage and provoke this disease:
The tibia is tubular and has cartilaginous formations at both ends that ensure the fusion of bone and muscle tissues with each other.
In an adult, in whom the growth process has already been completed, this bone and its components are very strong, and therefore resistant to external influences.
In the growing body of an active child, the knee joint, on the contrary, is still very fragile and is most susceptible to various types of injuries. This is why young athletes between the ages of 10 and 17 are more vulnerable to knee injuries.
This disease also has another name – Osgood-Schlatter disease. The main cause of injury to the knee joint can be dislocations, fractures and even ligament damage.
Approximately 20% of adolescents who have connected their lives with sports may experience Schlatter's disease, and only 5% of adolescent children who do not engage in sports.
It is the passion for sports such as hockey, gymnastics, volleyball, ballet, basketball, football and figure skating that have the greatest risk for developing the disease.
Sports that can cause the development of Schlatter's disease
Further. Schlatter's disease occurs in almost twenty percent of adolescents who take part in sports competitions, while only a small part of them are not involved in active activities at all.
The disease can often manifest itself against the backdrop of hobby activities that require a lot of jumping, running and changing the trajectory of movement, for example:
- football;
- ballet;
- basketball;
- gymnastics;
- volleyball;
- figure skating.
How to relieve pain in the knee joint in a teenager with Schlatter's disease? More on this later.
Symptoms and degrees
The main symptom of Schlatter's disease is a specific neoplasm in the area of the tibial tuberosity in the form of a dense and immobile lump directly under the kneecap.
The skin over the formation is unchanged, there are no signs of inflammation (redness, hyperthermia). In some cases, there may be slight swelling and tenderness when pressed.
Symptoms and degrees
The most common symptoms of this disease include the following disorders:
The main symptoms of Schlatter's disease are as follows:
- Pain and swelling under the kneecap.
- Pain in the knee joint during physical activity.
- Tightness of the thigh muscles, pain along the tendon.
The intensity of pain is different for all children - it all depends on the individual threshold of pain sensitivity and the degree of damage to the cartilage tissue. The described symptoms also persist for varying amounts of time: in some patients for several weeks, in others for several months.
To prevent complications and start treatment on time, you need to know the main symptoms of Osgood-Schlatter disease in order to promptly seek help from specialists. If observed:
Then you definitely need to consult a doctor.
Sometimes Schlatter's disease in adolescents can take a chronic course, but most often there is an undulating course, which is characterized by lulls and periods of exacerbation.
Osgood Schlatter disease can last from one to two years and may go away after a teenager's bone growth has finished, which is around 17 to 19 years of age.
It is worth noting that this disease of the knee joint is not observed in adulthood.
How to diagnose the disease yourself?
First of all, you need to carefully listen to all the teenager’s complaints, and then examine the knee joint. It should be noted that Schlatter's disease usually affects only one leg.
When a child complains, take into account his physical activity and ask about the presence of injury. In addition, find out if there are the same problems before this condition.
If all the symptoms are similar to those listed above, then you should definitely seek help from a doctor who will examine the affected area, evaluate motor activity and order an x-ray of the lower leg, which will help to correctly diagnose and take the necessary measures for treatment.
The image may show a displacement of the ossification nuclei by 2–5 mm. In addition, there may be unclear trabecular structure of the nuclei or uneven contours.
Diagnostic methods
To diagnose Osgood-Schlatter disease, it is necessary to take an X-ray of the problem area. X-ray of the knee will help exclude benign and malignant tumors of other origins, sprains, bruises and other joint problems with similar symptoms.
Additional diagnostic methods include palpation of the tumor and the patient's complaints of severe pain when sharply bending the knee.
Without proper treatment, Schlatter's disease leaves serious consequences in the form of bone lumps and growths under the knee.
To avoid consequences and for very pronounced symptoms, use the following treatments for Osgood-Schlatter disease:
- Exercise therapy. A course of physical therapy for those suffering from Osgood-Schlatter disease includes exercises aimed at strengthening the knee joint and developing the hip muscles. A balanced cycle of stretching exercises for the hamstrings and quadriceps muscles will reduce the load on the problem area and will help improve the condition.
- Massage the affected areas with warming and anti-inflammatory ointments. So, troxevasin ointment is ideal.
- Physiotherapy. Tube ultraviolet irradiation is prescribed to patients with the last stage of the disease. If the changes are shallow, electrophoresis with calcium and novocaine, as well as heating, are prescribed.
- Use of warm compresses.
- Taking anti-inflammatory and painkillers. Ibuprofen and acetaminophen are commonly prescribed.
If the disease is detected in a timely manner, all doctor's instructions are carefully followed, and the conservative treatment methods described above are successfully applied, the disease goes away within a few months, and after about a year the patient returns to his normal lifestyle.
But if the disease progresses, and conservative methods are powerless, surgical intervention has to be used, namely mechanical removal of the tumor. If necessary, the entire area of the joint affected by the degenerative process is removed.
The “dead” joint is replaced with a plastic implant. Of course, such an intervention is a fairly serious step, and therefore non-surgical measures are used first.
As part of the diagnosis, the history of the disease is important. Therefore, the doctor may need the following information:
- A thorough description of any symptoms and sensations the patient is experiencing.
- Information about family health and family heredity.
- The presence of a relationship between symptoms and physical activity.
- Information about all medications and nutritional supplements that the child takes.
- Information about the existence of medical ailments in the past, in particular in relation to any previous injuries.
A doctor (orthopedist or traumatologist) can diagnose the disease in question based on data obtained during a conversation with the patient (information about sports activities and complaints) and the results of the examination.
To confirm the diagnosis, additional studies may be required - x-rays of the knee joint and lower leg (allows you to assess the condition of the tibia at the site of attachment of the quadriceps tendon), ultrasound of the knee joint to exclude injuries or inflammatory diseases, blood tests (general clinical and rheumatic tests).
When diagnosing a disease, taking an anamnesis is of great importance. The combination of symptoms, the characteristic localization of pain, the age and gender of the patient allows us to accurately diagnose Schlatter’s disease.
However, the determining factor in making a diagnosis remains X-ray examination in frontal and lateral projection. Sometimes additional ultrasound of the knee joint, MRI and CT of the joint are performed, which must be carried out dynamically for greater information.
Densitometry is also prescribed to analyze the structure of bone tissue. Laboratory tests must be carried out in order to exclude infectious pathology (reactive arthritis).
For this purpose they prescribe:
- general blood analysis;
- blood test for C-reactive protein;
- PCR studies (polymerase chain reaction);
- blood test for rheumatoid factor.
In the initial stage of the disease, radiography demonstrates flattening of the soft cover of the tibia tuberosity. Over time, ossification may shift forward or upward.
The disease must be differentiated from tumor processes, tuberculosis, osteomyelitis, and tibia fractures.
In the case of a typical course of pathology and the presence of characteristic external signs of osteochondropathy, diagnosis is not difficult. To do this, the specialist only needs to examine the patient and find out the characteristic complaints and risk factors for the disease.
X-rays are used to confirm the diagnosis. The photographs reveal an increase in the size of the tibial tuberosity and its heterogeneous structure.
In the case of fragmentation, the images show the separation of a bone fragment with a visible fracture zone. In difficult to diagnose cases, they resort to magnetic resonance and computed tomography.
X-ray of a patient with Osgood-Schlatter disease
To establish an accurate diagnosis, a traumatologist or orthopedist conducts an initial survey and examination of the patient. The tests most often used are radiography of the knee joint (in several projections) and a clinical blood test (to detect inflammation).
Less commonly, if there are difficulties in making a diagnosis, the following diagnostic methods are used: ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI).
The most important thing at the diagnostic stage is to compare the pain, the general appearance of the damaged part of the lower leg and the results of studies with sports activities, as well as find out what injuries the child suffered previously.
Due to the complexity of diagnosis, it is necessary to take a responsible approach to choosing the attending physician.
Surgery
Usually this disease can be cured on its own, and its symptoms disappear immediately after bone growth stops. However, if the symptoms are severe, medication methods, physiotherapy and therapeutic physical education - exercise therapy should be included.
As part of the medical treatment of Schlatter's disease of the knee in a teenager, ointments and tablets are usually prescribed for painkillers such as acetaminophen, Tylenol and other drugs.
Another medication that may be suitable is ibuprofen. Physiotherapy makes it possible to reduce inflammation and relieve swelling along with pain.
Treatment of Schlatter's disease is carried out quite quickly and successfully. But to increase its effectiveness, the patient must be provided with peace.
Therefore, any physical stress on the legs is completely excluded; sports should remain a thing of the past. If after treatment the patient wants to resume sports activities, these will no longer be such active sports.
As for the treatment itself, it consists of several stages. Initially, drug treatment is carried out - it is aimed at eliminating pain and relieving inflammation.
If we talk about drugs, then medications from the NSAID series are used for these purposes. This is ibuprofen, Tylenol, any other analogues.
For severe symptoms, patients are advised to:
- Peace.
- Drug treatment.
- Exercise therapy (physical therapy).
- Physiotherapy.
Rest is a mandatory component of treatment. If the sore leg continues to be subjected to stress, pathological changes in the tibia will worsen.
Therefore, you should stop training completely for a while; in some cases, doctors even recommend changing your occupation to one that is less traumatic for the musculoskeletal system.
Until the acute symptoms subside, the knee joint must be made inactive by applying a fixing bandage.
Of the medications, the basis for the treatment of Schlatter osteochondropathy is painkillers, anti-inflammatory drugs (for example, ibuprofen). In addition, you can use various ointments, creams, and gels that have an analgesic effect.
Drug therapy must be prescribed by a doctor, since most anti-inflammatory drugs have side effects and numerous contraindications.
The duration of such treatment is determined individually, depending on the characteristics of the disease.
Treatment of Schlatter's disease is carried out by several specialists: traumatologist, orthopedist, surgeon. The disease is highly treatable, and symptoms disappear as the child grows older.
However, if the symptoms are significantly pronounced, then it is necessary to carry out symptomatic therapy that relieves pain and relieves swelling of the knee joint.
In order to relieve pain, it is necessary to completely eliminate physical activity and provide the greatest possible rest to the affected joint.
Treatment of Schlatter's disease is carried out according to the following scheme:
- provide the patient with complete peace and comfort;
- taking medications: painkillers, muscle relaxants and non-steroidal anti-inflammatory drugs;
- physiotherapeutic methods;
- physiotherapy.
The medicines used are:
- painkillers;
- non-steroidal anti-inflammatory drugs (analgin, diclofenac, ibuprofen);
- muscle relaxants (mydocalm);
- calcium supplements and vitamin D.
Medications should be given to a child with caution, only in short courses and in small doses. You can also apply cold compresses to reduce pain.
Physiotherapeutic methods are very effective because they can relieve inflammation and reduce pain. They improve blood circulation and nutrition of the tissues of the diseased joint, help restore bone structure, and reduce inflammation and discomfort.
These methods necessarily complement the treatment program:
- magnetic therapy;
- electrophoresis with various drugs (calcium chloride, potassium iodide, procaine);
- shock wave therapy;
- ultrasound therapy with glucocorticoids (hydrocortisone);
- laser therapy;
- paraffin compresses (with ozokerite, healing mud);
- warming up the knee using infrared rays;
- thalassotherapy (warm baths with sea salt or mineral water).
For each patient, the optimal treatment method is selected, which is determined by the doctor.
Physical therapy includes gentle exercises to stretch the quadriceps femoris muscle and develop the hamstrings. Such exercises reduce the load at the tendon attachment site to prevent tearing and injury.
During treatment, it is necessary to avoid physical activity and limit physical activity, which can increase pain.
In the acute period, intense physical activity should be replaced with more gentle physical therapy exercises, as well as swimming or cycling, but in a reasonable amount.
Surgical treatment is indicated when the disease persistently progresses. The essence of the surgical intervention is to remove lesions that have undergone necrosis, as well as to stitch together an implant that secures the tuberosity of the tibia.
Surgical treatment of Schlatter's disease is advisable in the following cases:
In some cases, Schlatter's disease can be treated at home, but only after an accurate diagnosis and visit to a doctor. These are mainly physical exercises and local therapy:
Treatment of Schlatter's disease is not always necessary. If the pathology is not accompanied by a disturbance in the patient’s quality of life and is asymptomatic, then therapy is not prescribed.
In cases where the disease is accompanied by chronic pain or complications are present, complex treatment is needed. As a rule, it consists of conservative measures.
Surgery is prescribed only if conservative treatment is ineffective or in case of fragmentation of the tibial tuberosity.
Conservative treatment
A prerequisite for successful treatment of the disease is a gentle regimen. During therapy, you must completely exclude all sports.
To ensure maximum rest for the damaged area, experts recommend using special orthopedic bandages and braces that will provide protection and support for the sore knee.
The first and most important step in the treatment of Schlatter's disease of the knee joint in a teenager is to provide rest to the injured knee. To minimize mobility, a special fixing bandage is used; sports are completely excluded during rehabilitation.
Painkillers and anti-inflammatory drugs may be indicated as medical therapy if necessary. Taking vitamin E and group B, as well as calcium, has a beneficial effect on the healing process.
When the pain syndrome goes away completely, a course of therapeutic physical education (PT) is prescribed. For patients, a special course of physical exercises is selected that ensures pumping and stretching of precisely those muscle groups that will subsequently ensure the stability of the knee joint and prevent further development of the disease or its relapse.
When the inflammation of the joint is completely stopped, you can begin physiotherapeutic treatment methods, such as:
- ultra-high frequency therapy (UHF);
- shock wave therapy (SWT);
- ultrasound therapy;
- mud treatment;
- electrophoresis using calcium preparations;
- paraffin therapy;
- magnetic therapy;
- electrical stimulation.
Experts' opinions on the effectiveness of the listed methods of physiotherapy still differ, but patient reviews are usually positive. Even if these procedures do not give a positive result, in any case they do not cause a negative one.
In cases where conservative treatment does not have the expected positive result (the protrusion of the lump remains, associated with pain), surgical treatment is performed.
However, these cases are extremely rare in practice. If surgery is unavoidable, necrotic tissue lesions are eliminated and the tuberosity of the bone is fixed.
After surgery, rest and wearing a fixing bandage, followed by a course of exercise therapy, are also indicated. Return to physical activity is possible no earlier than 6 months after surgery.
Home methods for treating the disease are based on compresses, lotions and paraffin baths. An oil compress throughout the night helps the most.
To do this, you need cotton fabric or gauze, which must be folded several times. The fabric should be heated strongly with an iron and then soaked in unrefined sunflower oil.
This fabric should be applied to the sore joint, covered with polyethylene and wrapped with a warm scarf around the leg so that the compress does not slip off. This compress should be done every night for one month.
If the disease is severe, the course of treatment is extended to three months.
Possible complications
In severe cases of the disease, after completing the course of treatment, a bone growth remains in the form of a lump under the kneecap.
With incomplete treatment, pain and aching pain remain, which can regularly appear after intense physical exertion.
Osgood-Schlatter disease means not only the need for treatment, but also dramatic changes in lifestyle.
During the period of treatment and rehabilitation, you should exclude sports, adhere to a certain diet, do not forget about therapeutic exercises, and avoid overloading the joint.
Osgood-Schlatter disease is completely curable, but its treatment must be approached responsibly.
Timely diagnosis and adequate treatment of Schlatter's disease does not cause serious complications or severe consequences. However, it is impossible to predict the outcome of the disease, so prevention of the disease is necessary.
megan92 2 weeks ago
Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!
Daria 2 weeks ago
I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are
Schlatter's disease (ICD code - 10: M92.5) is a lesion of the musculoskeletal system, in which certain areas of the long bones are affected. It is classified as osteochondropathy, a group of pathologies that often appear in children and adolescents. To date, the true causes of the disease have not been established. Nevertheless, the opinion of experts is that Schlatter’s disease of the knee joint in a teenager develops as a result of an imbalance in bone development and disruption of the functioning of blood vessels. All this occurs against the backdrop of serious physical exertion.
The disease is accompanied by pain
Age category of disease exposure
Osgood Schlatter disease is an age-related disease and is mainly experienced by adolescents and children aged 10 to 18 years. It is during this period that they begin to grow rapidly. However, there are some differences between girls and boys. Since puberty begins earlier in girls, the risk of developing pathology begins at the age of 11-12 years. For boys it is 13-14 years old.
The disease is very common. According to statistics, it is diagnosed in 11% of all children. This is especially true for those who are actively involved in sports. The disease begins to develop against the background of an injury, even a minor one.
So, the main risk factors include:
- Age. Often, the pathology develops in children and adolescents under 18 years of age. In adulthood, the risk is minimal. The main symptom is a lump under the knee.
- Floor. Schlatter syndrome of the tibial tuberosity is often observed in boys, as they are most interested in various sports. As a result, their risk of injury is very high.
- Kind of sport. Children who play active sports such as football, basketball, hockey and others are at risk. Sometimes the disease occurs against the background of concomitant diseases, such as flat feet. As you know, the military registration and enlistment office notes the presence of such an illness in the conscript card.
To prevent complications from occurring, it is necessary to promptly seek help from a specialist, but to do this you need to know the main symptoms of the disease.
The disease often affects children and adolescents
Nature of pain
The disease is accompanied by various symptoms. One of the main symptoms is pain in the knee joint. Their character directly depends on the individual characteristics of the organism. For example, some children experience minor pain when performing certain movements and exercises, such as jumping or running. Others suffer from debilitating and constant pain not only in the leg, but also in the back.
As a rule, the pathology affects only one limb, but there are exceptions. If both legs are affected, the teenager feels characteristic pain and discomfort. Symptoms will continue until the period of bone growth ends. In the acute form, qualified treatment will be required, including surgery.
Causes of the disease
The reasons for the development of the disease lie not only in physical activity, but also in the structural features of the musculoskeletal system. All tubular bones located in the limbs have certain growth zones. They are located at their ends and are presented in the form of cartilage tissue, which is less durable than bones.
As a result of insufficient strength and exposure to physical stress, growth zones are damaged. This manifests itself in their swelling and pain. In addition, physical activity can stretch tendons. Against this background, the quadriceps muscle, which connects the tibia and the cap, becomes tense. In addition, with active growth, the nutrition of the apophysis is disrupted.
Under the influence of such factors, inflammation begins to develop, which leads to ossification of the bone that is not fully formed. In this case, abnormal growth of bone tissue in the area of the apophysis is observed. Thus, a tubercle forms under the knee, which is the main symptom of Schlatter syndrome.
Physical activity is associated with the development of Schlatter syndrome
Possible complications
Complications and negative consequences of the disease are very rare. Often the disease has a benign course. Self-regression occurs after a person stops growing. This means that in any case, at the age of 23-25 years, the disease stops progressing. This is due to the fact that after reaching this limit, the growth zones of the bones close. As a result, the main causes of the occurrence and development of the disease disappear.
In some cases, especially at an advanced stage, a person is left with an external defect. It is presented in the form of a tubercle, which is located under the knee. Despite the presence of such a formation, it does not affect the functioning of the knee joint and the limb itself, although there are exceptions.
In rare cases, under the influence of various factors, the disease occurs with complications. First of all, this concerns the fragmentation of the tuberosity. In other words, the ligament is torn off and the sequester is disconnected from the tibia. Fragmentation is accompanied by impaired functioning of the joint and limb. The only solution is surgery, during which the integrity of the ligament is restored.
Diagnosis of the disease
Diagnosing Schlatter's disease is not difficult for a qualified doctor. To do this, just follow a few simple procedures:
- Examination of the patient and collection of necessary information. As a result of palpation, a specialist can determine the presence of an inflammatory process, which indicates pathology. In addition, he needs all the information about the inherent symptoms. A description of past or concomitant diseases, as well as current medications taken, is also taken into account.
- X-ray examination (X-ray). It is carried out in order to confirm the diagnosis. In this case, the joint is examined in a lateral projection. The x-ray shows osteochondropathy of the tibial tuberosity and its fragmentation, if any.
If, as a result of such studies, the doctor doubts the diagnosis, then the patient is prescribed CT, ultrasound and MRI. As for laboratory tests, there is no need for them, since blood and urine tests will be within normal limits.
X-ray examination is often used in diagnosis
Surgery
Often, the disease does not require treatment at the initial stage, since it regresses on its own over a certain period of time. To do this, you just need to adhere to certain conditions. The main task is to prevent stress and damage to the limb. But if the disease reduces the quality of life, impairs the functioning of the legs and causes pain, then the patient is prescribed complex therapy.
In most cases, as indicated by information from the forums, the disease can be dealt with through conservative treatment at home, which includes taking medications and physical therapy. You need to get rid of the disease by taking certain medications and following the doctor's instructions. Do not forget about the regime, diet, taping, use of orthopedic insoles and exclusion from sports. All these methods are aimed at preventing the development of the disease and its complete elimination.
Conservative treatment includes massage and other physical therapy methods
To eliminate symptoms, therapeutic massage, gymnastics and exercise therapy, electrophoresis, ointments and even essential oils are used. Developing the limb will speed up recovery.
Unfortunately, there are cases when conservative treatment does not give the desired result. In this case, doctors recommend an operation aimed at eliminating symptoms and restoring normal function of the limb. Indications for the procedure are as follows:
- the disease develops over 2 years or more;
- conservative treatment, which was carried out for 9 months, did not give the desired result;
- the degree of damage is very high - the presence of bone fragmentation and ligament separation;
- At the time of diagnosis of the disease, the patient was already 18 years old.
When performing an operation, specialists adhere to the basic principle: to achieve high results with minimal damage. In this way, the surgeon eliminates the necrotic focus and sutures the fixing tuberosity of the bone graft. After this, the traumatologist applies a pressure bandage on the left or right leg. The patient must wear such a knee brace for one month. However, it is not recommended to exercise.
After the operation, the patient undergoes a rehabilitation period, during which special exercises and medications are prescribed. This allows for faster pain relief and recovery of the limb after the intervention.
Schlatter's disease of the knee joints in adolescents
Schlatter's disease of the knee joint in a teenager is an aseptic destruction of the core and tuberosity of the tibia, which is a consequence of constant trauma to this focus due to increased skeletal growth. This disease, as a rule, manifests itself with intense pain in the kneecap (when flexing, extending the joint), swelling in the area of the tibial tuberosity.
Why does the problem occur?
The true reasons why this disease develops in adolescents have not been established to date. Most experts agree that problems arise against the background of increased physical activity due to an imbalance between the growth rate of bones and the vessels associated with them. Schlatter's disease is a peculiar form of osteochondropathy, the appearance and development of which is associated with a failure in the natural processes of ossification.
Factors predisposing to the development of pathology are:
- Age. Mostly children and adolescents suffer; in adults, Schlatter's disease is almost never diagnosed.
- Floor. The disease mainly occurs in boys and young men.
- Sports activities. According to medical statistics, pathological processes are 5 times more common in adolescents who prefer strength and (or) team sports.
The risk group for this knee disease primarily includes teenagers from 10 to 15 years old who play various sports. As a rule, the defeat is unilateral.
The “triggers” of the pathological process can be direct injuries to the knee (dislocations, sprains, rupture of ligaments), as well as regular microdamage to the joint during sports. Thus, constant overloads, frequent microtraumas, strong tension of the patellar ligament lead to disruption of the “healthy” blood supply to the tibial tuberosity.
The pathology under study does not have any classical manifestations as such. Visually, it can be “suspected” by the characteristic lumpiness and swelling in the lower part of the knee joint, as well as severe pain (under load). There may be minor hemorrhages, rupture of patellar ligament fibers, an inflammatory process in the area of the affected joint capsule, as well as necrotic processes in the tibia.
The pathology has a benign course (in most clinical cases) and regresses on its own. Sometimes Schlatter's disease results in a number of complications - separation of the patellar tendon, fragmentation of the tibial tubercle. The chronic form of the disease is characterized by sequential alternation of periods of necrosis and tissue regeneration. As a result, specific lumps are found under the knee.
The list of typical signs of Schlatter's disease includes:
- pain syndrome localized at the junction of the knee joint with the tibia;
- swelling, severe pain in the lower leg and the kneecap itself;
- severe pain in the knee after running or jumping, which goes away fairly quickly as soon as the joint comes to a resting state;
- constant tension in the quadriceps of the “affected” leg;
- as a rule, Schlatter's disease affects the joint of only one lower limb;
- bone growth is accompanied by severe pain.
Diagnostics
An objective examination of a teenager suspected of having this pathology reveals the following manifestations:
- swelling, pain on palpation of the lesion located just below the patella;
- severe pain when trying to straighten or bend the leg at the knee;
- no motor dysfunction of the joint is observed;
- there is no joint effusion;
- there are no signs of meniscus damage;
- the skin in the affected area may be hyperemic;
- in rare cases, partial atrophy of the quadriceps femoris muscle of the “affected” limb.
To confirm the diagnosis, the orthopedic doctor refers the patient to an x-ray of the knee joint in the lateral position. The images clearly show osteochondropathy, as well as bone fragmentation (if any). If indicated, CT, MRI, and ultrasound of the knee may be additionally performed. There are no pathological changes in the blood count.
Sometimes pathological changes in the structure of the tibia in children are associated with spinal osteochondropathy. The onset of the disease is asymptomatic; patients rarely attribute the appearance of knee pain to a previous injury. The disease clearly “makes itself known” when bending and extending the leg at the knee, during squats, going down and up the stairs. Subsequently, while maintaining intense physical activity on the joint, the symptoms of the pathological process worsen significantly.
Solution
Treatment of Schlatter's disease of the knee joint in adolescents is determined by an orthopedic surgeon. As a rule, the disease is easily amenable to appropriate therapy, and the unpleasant symptoms disappear as therapeutic measures are implemented and bones grow. Schlatter's disease must be treated with medication, physiotherapeutic procedures, and exercise therapy techniques.
Drug therapy for the disease involves taking NSAIDs and painkillers. As a rule, the doctor prescribes Tylenol, Ibuprofen and their analogues. Take tablets in minimal dosage in short courses. Physiotherapeutic measures are selected based on the severity of the disease and the presence of specific symptoms. Their action is aimed at eliminating swelling, inflammation and relieving pain.
The most common methods:
- Magnetic and shock wave therapy;
- massage;
- paraffin treatment.
Exercise therapy for Schlatter's disease is designed to stretch the quadriceps femoris muscle and develop the hamstring muscle. Exercises are performed for preventive purposes to prevent ligament tears and other joint injuries. Lifestyle correction is an important component of complex treatment of Schlatter's disease. Thus, during an exacerbation of pain syndrome, adolescents should relieve the affected joint as much as possible and wear a knee brace during training.
For joint injuries, apply a cold compress to the damaged area. If you suspect Schlatter's disease, you should contact a traumatologist, orthopedist, or surgeon for medical help. As a rule, such patients undergo outpatient conservative treatment. To prevent further development of the pathological process, adolescents who are actively involved in sports should wear a fixing bandage on their knee during training.
Severe destruction of bone tissue in the area of the head of the tibia is an indication for surgical intervention. The essence of the procedure is to remove areas of necrosis and suturing a graft that will fix the bone tuberosity. Symptomatic treatment of the disease at home may include (carried out only after consultation with the doctor):
- compresses with Dimexide for severe pain;
- warming ointments based on propolis, honey, nettle, yarrow;
- daily gymnastics to develop the joint and thigh muscles.
Osgood-Schlatter disease
General information
Osgood-Schlatter disease is a specific disease of the musculoskeletal system, namely the knee joints, characterized by dystrophic damage to the tibia in the area of its tuberosity. Such aseptic destruction of bone tissue occurs against the background of permanent or acute trauma and usually affects only young people at the stage of intensive skeletal development.
Clinically, the disease is manifested by swelling of the knee joint, the formation of a kind of growth (bump) under it and pain in its lower part, which occurs during normal physical activity (running, squats, etc.) or even without it.
This pathology was first described in 1878 by the French surgeon O. M. Lannelong under the name “Apophysitis of the tibia,” and in 1903, thanks to the work of the American orthopedist R. B. Osgood and similar works of the Swiss surgeon K. Schlatter (Schlatter), it appeared its more detailed nosography. Wikipedia defines this painful condition with the term “Osteochondropathy of the tibial tuberosity,” and the international classification assigned it the ICD-10 code – M92.5 “Juvenile osteochondrosis of the tibia and fibula.” Despite this, in medical practice this disease is still most often referred to as “Osgood-Schlatter disease” or simply “Schlatter disease”.
The mechanism of occurrence and further development of Osgood-Schlatter syndrome is directly related to the patient’s age and physical activity. According to statistics, in the vast majority of cases, doctors diagnose Schlatter's disease in children and adolescents in the age group from 10 to 18 years, while young people involved in sports suffer from it 5 times more often than their peers leading a passive lifestyle . The same reason for more intense physical activity explains the fact that this osteochondropathy mainly affects boys.
As is known, two large bones are involved in the formation of the human knee joint - the femur (above the knee) and the tibia (below the knee). In the upper part of the last of them there is a special area (tuberosity), to which the quadriceps femoris muscle is attached by means of a tendon. It is this part of the bone that is responsible for its growth in childhood and adolescence and is therefore particularly susceptible to various injuries and damage. During active physical activity, in some cases, the knee joint is subject to a large load and the quadriceps muscle is overstrained, which leads to stretching or tearing of the tendon and a lack of blood supply in this area. As a result of such a traumatic effect and a decrease in nutrition in the area of the tibial tuberosity, gradual necrotic changes develop in it, up to the death of individual parts of its core.
In addition, any injury to the knee joint or constant impact on its musculoskeletal structure (for example, jumping) can cause cracks and microfractures of the tibial tuberosity, which the growing body tries to quickly compensate for by the growth of new connective tissue. As a result of this, a person develops a bone growth (bump), typical of Osgood-Schlatter osteochondropathy, that forms just below the knee. Such a pathological process usually involves one leg, but bilateral involvement of the lower extremities is also possible.
Classification
In the orthopedic environment, this pathology is usually classified according to the degree of its severity and the severity of the observed external and internal symptoms. Regarding this, there are three degrees of Schlatter’s disease, namely:
- initial – visual manifestations in the form of a lump-like growth under the knee are absent or minimal, pain in the area of the knee joint is episodic, mild and occurs mainly at the time of physical activity on the leg;
- an increase in symptoms - swelling of the soft tissues around the affected knee appears, a lump becomes visually visible directly below it, pain syndrome manifests itself during the period of loads on the leg and for a certain period of time after them;
- chronic - a lump-like formation is clearly visible under the knee, which is most often surrounded by swelling, discomfort and pain in the joint is persistent and is observed even at rest.
There are two main physical activity-related underlying causes of Osgood-Schlatter disease in adolescents and children:
- direct injuries to the tissues of the knee joint (subluxations and dislocations, sprains, bruises, fractures);
- systematic microtraumas (external and internal) of the knee joint that occur as a result of intense sports or other activities associated with excessive physical stress on the lower extremities.
The greatest risk factors for Schlatter's disease in adolescents and children are:
- football, basketball, handball, hockey, volleyball, tennis;
- track and field athletics, acrobatics, gymnastics;
- judo, kickboxing, sambo;
- skiing, sports tourism, figure skating, cycling;
- ballet, sports and ballroom dancing.
Symptoms of Osgood-Schlatter disease
The severity of the negative manifestations of this pathology in different patients may differ depending on the nature of the injuries received, the degree of physical activity and the personal characteristics of the body.
At the beginning of the development of the disease, the patient begins to experience vague pain in the knee area, which usually appears after or during physical activity on the affected limb. As a rule, such pain is not yet associated with an internal pathological process and therefore there are quite few visits to the doctor during this period.
Over time, pain symptoms begin to increase, are localized in one place and can appear not only during physical activity, but also at rest. At the same time, swelling caused by edema appears around the affected knee, and a lump-like growth appears just below it. During this period of illness, it becomes increasingly difficult for the patient (especially the athlete) to perform his usual exercises, and sometimes even natural leg movements. The greatest intensity of pain is observed in the body position - kneeling.
Photo of a “bump” in Osgood-Schlatter disease
In addition, the patient may experience other negative symptoms:
- tension in the leg muscles (mainly the thigh muscles);
- limited mobility of the knee joint;
- outbreaks of sharp “shooting” pain in the knee area, arising when it is overstrained;
- severe morning swelling in the upper or lower part of the knee, which forms the day after physical activity.
When you independently palpate the affected knee, points of pain are felt, as well as smoothness of the contours of the tibia. The texture of the knee joint is felt as densely elastic, and a hard lump-like formation is felt under the swollen soft tissues. The general well-being of the patient, despite the accompanying pain and pathological processes in the knee, does not change significantly. The skin over the affected joint does not turn red, temperature indicators remain normal.
In most clinical cases, this disease occurs in a measured chronic form, but sometimes its wave-like course can be observed with periods of sudden exacerbation and relative calm. Without medical intervention and with continued physical activity, negative symptoms can persist for many months and worsen against the background of further mechanical damage to the knee joint. However, the manifestations of the disease gradually disappear on their own over 1-2 years, and by the time the period of bone tissue growth ends (approximately 17-19 years) they usually eliminate themselves. Before treating Osgood-Schlatter, the need for such therapy should be comprehensively and individually assessed, since in some cases it may be inappropriate.
Tests and diagnostics
In general, the doctor can suspect the development of Schlatter’s disease due to the complexity of the patient’s clinical manifestations and the localization of the pathological process typical for this disease. The gender and age of the patient also play an important role in correct diagnosis, since adults, as a rule, are not exposed to this type of damage. Even through a simple visual examination and the usual collection of anamnesis regarding previous injuries or overloads of the knee joint, an experienced orthopedic traumatologist is able to make the correct diagnosis, but it would be useful to confirm it using some hardware diagnostic methods.
The decisive factor in making a definitive diagnosis of Osgood-Schlatter disease in children and adolescents has been and remains radiography , which, in order to increase the information content of the pathology course, is best carried out dynamically. To exclude other orthopedic diseases, such an examination of the affected knee joint must be carried out in two projections, namely lateral and direct.
In the initial phase of the development of the disease, X-ray images show a flattening of the tibial tuberosity in its soft part and a rise in the lower edge of the clearing, corresponding to the adipose tissue located in the anterior lobe of the knee joint. The last discrepancy with the norm is caused by an increase in the size of the infrapatellar bursa, which occurs as a result of its aseptic inflammation. There are most often no visible changes in the ossification nucleus itself at this stage of Schlatter’s disease.
X-ray of the knee joint in Osgood-Schlatter disease
As the pathology progresses, the x-ray picture changes for the worse. The photographs show a shift of the ossification nucleus by 2-5 mm upward and forward relative to the standard location of the tuberosity or its fragmentation. In some cases, there may be unevenness of the natural contours and unclear structure of the ossification nucleus, as well as signs of gradual resorption of its parts, but most often it fuses with the main body of the bone with the formation of a bone conglomerate in the form of a spiky protrusion. This “bump”, characteristic of Schlatter’s disease, in the later stages of the disease is especially clearly visible on a lateral radiograph and is clearly palpable during palpation in the area of the tuberosity.
In some atypical cases, an appointment may be necessary MRI , CT and/or Ultrasound problem knee and adjacent tissues, allowing you to clarify the expected diagnosis. It is also possible to use a technique such as densitometry , which will provide comprehensive data on the structural state of the bones being studied. Other laboratory diagnostic methods, including PCR studies and blood tests for rheumatoid factor and C-reactive protein, are carried out in order to exclude the possible infectious nature of problems with the knee joint (mainly nonspecific and specific arthritis ).
Differential diagnosis of Osgood-Schlatter syndrome must be carried out with any fractures in the knee joint, tuberculosis of the bones , tendonitis patella, osteomyelitis , infrapatellar bursitis , Sinding-Larsen-Johanson disease and tumor neoplasms.
Treatment of Schlatter's disease
During the natural maturation of the body and the cessation of bone growth, the pathological process in the knee joint disappears on its own, and therefore the advisability of treating Osgood-Schlatter disease in adolescents and children should be considered by a doctor on an individual basis, especially with regard to drug therapy and surgical intervention. In the vast majority of cases, this type of osteochondropathy can be treated conservatively on an outpatient basis using standard physiotherapeutic procedures and a minimum amount of medications.
First of all, treatment of Schlatter's disease of the knee joint in adolescents and children requires the patients themselves and their parents to fulfill the following mandatory conditions:
- completely abandon physical activity on the lower extremities that preceded the onset of the disease (sports, dancing, etc.);
- provide the injured leg (or two) with a gentle regimen that limits the mobility of the affected knee joint (move less unless absolutely necessary);
- follow all other instructions of the attending physician (wearing a knee brace, applying compresses, following a diet, etc.).
With a mild course of the disease, treatment of Osgood-Schlatter can be limited only to local anti-inflammatory and analgesic medications (creams, ointments, etc.), as well as physiotherapeutic procedures. In case of severe pain, it can be relieved using drugs from the group NSAIDs . More serious injuries to the knee joint may require surgery (extremely rare).
Schlatter's disease (Osteochondropathy of the tibial tuberosity)
Schlatter's disease- this is an aseptic destruction of the tuberosity and nucleus of the tibia, which occurs against the background of their chronic injury during the period of intensive skeletal growth. It manifests itself as pain in the lower part of the knee joint, which occurs when bending it (squats, walking, running), and swelling in the area of the tibial tuberosity. Diagnosed based on an assessment of anamnesis, examination, X-ray and CT scan of the knee joint, local densitometry and laboratory tests. In most cases, it is treated with conservative methods: a gentle motor regimen, anti-inflammatory drugs, analgesics, physiotherapeutic agents, exercise therapy, massage.
General information
Schlatter's disease was described in 1906 by Osgood-Schlatter, whose name it bears. Another name for the disease, which is also used in clinical orthopedics and traumatology, reflects the essence of the processes occurring in Schlatter’s disease and sounds like “osteochondropathy of the tibial tuberosity.” From this name it is clear that Schlatter's disease, like Calve's disease, Thiemann's disease and Köhler's disease, belongs to the group of osteochondropathy - diseases of non-inflammatory origin, accompanied by necrosis of bone tissue.
Schlatter's disease is observed during the period of most intensive bone growth in children from 10 to 18 years old, much more often in boys. The disease can occur with damage to only one limb, but Schlatter's disease with a pathological process in both legs is quite common.
Trigger factors in the development of Schlatter's disease can be direct injuries (damage to the ligaments of the knee joint, fractures of the tibia and patella, dislocations) and constant microtrauma of the knee during sports. Medical statistics indicate that Schlatter's disease occurs in almost 20% of adolescents who are actively involved in sports, and only in 5% of children who are not involved in sports.
Sports with an increased risk of developing Schlatter's disease include basketball, hockey, volleyball, football, gymnastics, ballet, and figure skating. It is sports activities that explain the more frequent occurrence of Schlatter's disease in boys. The recent increase in girls' participation in sports has led to a narrowing of the gap between the sexes in terms of the development of Schlatter's disease.
As a result of overloads, frequent microtraumas of the knee and excessive tension of the patellar ligament, which occurs during contractions of the powerful quadriceps femoris muscle, a disorder of blood supply occurs in the area of the tibial tuberosity. Minor hemorrhages, rupture of patellar ligament fibers, aseptic inflammation in the bursa area, and necrotic changes in the tibial tuberosity may be observed.
Symptoms of Schlatter's disease
The pathology is characterized by a gradual, asymptomatic onset. Patients, as a rule, do not associate the occurrence of the disease with a knee injury. Schlatter's disease usually begins with the appearance of mild pain in the knee when bending, squatting, or going up or down stairs. After increased physical activity on the knee joint (intensive training, participation in competitions, jumping and squats in physical education classes), symptoms of the disease become manifest.
Significant pain occurs in the lower part of the knee, increasing when it is bent while running and walking and subsiding with complete rest. Acute attacks of cutting pain may appear, localized in the anterior region of the knee joint - in the area of attachment of the patellar tendon to the tibial tuberosity. Swelling of the knee joint is noted in the same area. Schlatter's disease is not accompanied by changes in the patient's general condition or local inflammatory symptoms such as fever and redness of the skin at the site of swelling.
When examining the knee, swelling is noted, smoothing the contours of the tibial tuberosity. Palpation in the area of the tuberosity reveals local soreness and swelling, which has a densely elastic consistency. A hard protrusion is palpated through the swelling. Active movements in the knee joint cause pain of varying intensity. Schlatter's disease has a chronic course, sometimes there is a wavy course with pronounced periods of exacerbation. The disease lasts from 1 to 2 years and often leads to recovery of the patient after the end of bone growth (at approximately the age of 17-19 years).
Diagnostics
Schlatter's disease can be diagnosed by a combination of clinical signs and typical localization of pathological changes. The age and gender of the patient are also taken into account. However, the decisive factor in making a diagnosis is an X-ray examination, which should be carried out over time for greater information. X-rays of the knee joint are performed in direct and lateral projections.
In some cases, an ultrasound of the knee joint, MRI and CT of the joint are additionally performed. Densitometry is also used to obtain data on the structure of bone tissue. Laboratory diagnostics are prescribed to exclude the infectious nature of damage to the knee joint (specific and nonspecific arthritis). It includes a clinical blood test, a blood test for C-reactive protein and rheumatoid factor, and PCR studies.
In the initial period, Schlatter's disease is characterized by a radiographic picture of flattening of the soft cover of the tibial tuberosity and raising of the lower border of the clearing, corresponding to the adipose tissue located in the anterior part of the knee joint. The latter is due to an increase in the volume of the subpatellar bursa as a result of its aseptic inflammation. There are no changes in the nuclei (or nucleus) of ossification of the tibial tuberosity at the onset of Schlatter's disease.
Over time, radiologically, a displacement of the ossification nuclei forward and upward by 2 to 5 mm is noted. The trabecular structure of the nuclei may be blurred and their contours uneven. Gradual resorption of displaced nuclei is possible. But more often they merge with the main part of the ossification nucleus to form a bone conglomerate, the base of which is the tibial tuberosity, and the apex is a spine-like protrusion, clearly visualized on a lateral radiograph and palpable in the area of the tuberosity.
Differential diagnosis of Schlatter's disease must be carried out with a fracture of the tibia, syphilis, tuberculosis, osteomyelitis, and tumor processes.
Treatment of Schlatter's disease
Patients usually undergo outpatient conservative treatment with a surgeon or orthopedic traumatologist. First of all, it is necessary to eliminate physical activity and ensure the maximum possible rest of the affected knee joint. In severe cases, it is possible to apply a fixing bandage to the joint. The basis of drug treatment for Schlatter's disease is anti-inflammatory and painkillers. Physiotherapeutic methods are also widely used: mud therapy, magnetic therapy, UHF, shock wave therapy, paraffin therapy, massage of the lower limb. To restore damaged areas of the tibia, calcium electrophoresis is performed.
Physical therapy classes include a set of exercises aimed at stretching the hamstrings and quadriceps femoris muscles. Their result is a decrease in the tension of the patellar ligament, which attaches to the tibia. To stabilize the knee joint, the treatment complex also includes exercises that strengthen the thigh muscles. After a course of treatment for Schlatter's disease, it is necessary to limit the load on the knee joint. The patient should avoid jumping, running, kneeling, and squatting. It is better to change traumatic sports to more gentle ones, for example, swimming in a pool.
With severe destruction of bone tissue in the area of the head of the tibia, surgical treatment of Schlatter's disease is possible. The operation consists of removing necrotic foci and suturing a bone graft that fixes the tibial tuberosity.
Prognosis and prevention
Most survivors of Schlatter's disease retain a pineal protrusion of the tibial tuberosity, which does not cause pain or impair the function of the joint. However, complications can also be observed: upward displacement of the patella, deformations and osteoarthritis of the knee joint, leading to pain that constantly occurs when leaning on a bent knee. Sometimes after Schlatter's disease, patients complain of aching or aching pain in the knee joint that occurs when the weather changes. Prevention includes ensuring an adequate load regime on the joint.
Schlatter's disease in children
Schlatter's disease (or Osgood-Schlatter) refers to lesions of the musculoskeletal system in which a certain area of the long tubular bones, the tibial tuberosity, is affected. There is a whole group of similar diseases that are observed mainly in children and adolescents, they are called osteochondropathy.
The true causes of the development of osteochondropathy are not exactly known today, but most experts agree that the pathology occurs due to an imbalance in the growth processes of bones and the blood vessels that feed them, against the background of physical overload in the child.
Causes and predisposing factors
Schlatter's disease in adolescents usually develops during a period of intensive growth (10-18 years). The peak incidence occurs at the age of 13-14 years in boys and 11-12 years in girls. The pathology is considered quite common and is observed, according to statistics, in 11% of all adolescents involved in active sports. The onset of the disease is most often observed after a sports injury, in some cases even minor.
There are three main risk factors for developing Osgood-Schlatter disease:
- Age. The disease occurs mainly in children and adolescents; in older adults it is detected very rarely and only as residual effects in the form of a lump under the knee.
- Floor. More often, osteochondropathy of the tibial tuberosity is observed in boys, but recently, due to the active involvement of girls in sports, these indicators are beginning to level out.
- Sports activities. Schlatter's disease is five times more likely to affect children who are actively involved in various sports than those who lead a sedentary lifestyle. The most “dangerous” sports in this regard are football, basketball, volleyball, hockey, artistic gymnastics and dance sports, figure skating, and ballet.
Development mechanism
Schlatter's disease in children involves damage to the tibial tuberosity. This part of the bone is located just below the knee. The main role of this anatomical formation is the attachment of the patellar ligament.
The location of the tibial tuberosity coincides with the apophysis (the area due to which the bone grows in length). This is what causes the development of the disease.
The fact is that the apophysis has separate blood vessels that supply the growth zone with oxygen and other necessary substances. During the period of active growth of the child, these vessels “do not keep up” with the increase in bone mass, which leads to a deficiency of nutritional components and hypoxia. As a result, this area of the bone becomes very fragile and prone to damage.
If at this moment the influence of unfavorable factors is observed in the form of constant overload of the lower extremities and microtrauma of the patellar ligament, then the risk of developing Schlatter's disease is very high.
Under the influence of such damaging factors, an inflammatory process begins to develop, which causes ossification of the not yet fully formed tibial tuberosity. As a result, one can observe hyperactive bone growth in this area, which manifests itself as a kind of lump under the knee - the main manifestation of Schlatter's disease.
It is also important to know that this formed bone tissue is very fragile and if physical activity continues, sequestration (separation of a piece) of the bone and separation of the patellar ligament may occur. This complication occurs quite often and requires surgical intervention.
Symptoms of Schlatter's disease of the knee joint
A feature of this type of osteochondropathy is the benign and often completely asymptomatic course of the disease. After some time, the pathology begins to regress on its own, and the patient never learns about his condition. In other cases, Schlatter's disease is an incidental finding during radiography of the knee joints for another reason.
But a certain proportion of children and adolescents still suffer from various symptoms of osteochondropathy. One of the most common and pathognomonic symptoms of the disease is a “bump” immediately under the knee joint on the front surface of the leg. This formation is completely immobile, very hard to the touch (bone density), the color of the skin over the tubercle is normal, it is not hot to the touch. That is, all these signs indicate the non-infectious nature of the neoplasm. Sometimes there may be slight swelling in the area of the lump and pain on palpation, but, as a rule, there are no such symptoms.
Other signs of the disease include pain. Pain syndrome varies from minor discomfort during physical activity to severe pain during normal daily physical activity. Soreness can be observed throughout the entire period of the disease, and can occur during exacerbations provoked by physical overload. If a child has pain syndrome due to Osgood-Schlatter disease, this is the main indication for active treatment; in all other cases, observation and watchful waiting are chosen.
What could be the consequences?
Negative consequences of pathology are extremely rare. In the vast majority of cases, the disease is characterized by a benign course and independent regression after a person’s growth stops (23-25 years). It is then that the growth zones of the tubular bones close and, accordingly, the very substrate for the development of Osgood-Schlatter disease disappears. In some cases, an adult may be left with an external defect in the form of a tubercle under the knee, which does not in any way affect the function of the knee joint and the lower limb as a whole.
But sometimes a complication such as fragmentation of the tuberosity can occur, that is, detachment of the sequestrum of the bone and separation of the patellar ligament from the tibia. In such cases, normal leg function can only be restored through surgery, during which the integrity of the ligament is restored.
Diagnostics
With the typical course of the disease and the presence of the described risk factors, diagnosis does not pose any difficulties, and a specialist can make the correct diagnosis immediately after examining the child without using any additional examination methods.
In cases that are more difficult to diagnose, the patient may be prescribed MRI, CT, or ultrasound. There are no specific laboratory signs of pathology. All blood and urine parameters are within the age norm.
Treatment of the disease
In most cases of Schlatter's disease, treatment is not necessary at all. The pathology itself regresses over some time if you follow a protective regime and do not overstrain the lower limbs. But if the disease is accompanied by pain, impaired leg function, or a decrease in the quality of life of a child or adolescent, then therapy is mandatory. Treatment can be conservative or surgical.
Conservative treatment methods
This therapy is aimed at relieving pain, reducing signs of inflammation in the area of the tibial tuberosity, normalizing the process of ossification of the apophysis and preventing further growth of bone tissue.
The most commonly used medications are:
- analgesics and non-steroidal anti-inflammatory drugs in short courses;
- preparations of calcium and vitamins D, E, B.
Each patient is prescribed a diet enriched with microelements and vitamins, a gentle regimen. For children who are actively involved in sports, it is necessary to stop absolutely all physical training for the period of conservative treatment (4-6 months). It is also advisable to wear a special bandage and various orthopedic devices that fix the patellar ligament, which reduce the load and have a protective effect.
The treatment program must be supplemented with physical therapy. The following procedures give good results:
- magnetic therapy;
- electrophoresis with procaine, calcium chloride, nicotinic acid, aminophylline, potassium iodide, hyaluronidase;
- shock wave therapy;
- ultrasound with hydrocortisone;
- laser therapy.
All patients are also prescribed special therapeutic exercises and a massage course. As a rule, treatment lasts 4-6 months. During this time, the pathology begins to regress, all symptoms disappear. If conservative therapy does not bring results for 9 months, and the disease progresses, complications develop - in such cases, surgery is resorted to.
Surgery
Indications for surgical treatment of Schlatter's disease:
- the duration of the disease is more than 2 years;
- ineffectiveness of conservative therapy for 9 months;
- the presence of complications - bone fragmentation or separation of the patellar ligament;
- The patient's age is more than 18 years at the time of diagnosis of the disease.
The surgical technique is considered simple, but the patient faces a long period of rehabilitation, on which the further function of the leg and the completeness of recovery depend.
Schlatter's disease and the army
Osteochondropathy of the tibial tuberosity is not grounds for exempting a young man from conscription military service. As a rule, by the age of 17-18, when conscription takes place, the disease has already regressed. If symptoms of pathology are nevertheless observed, then the young man receives a temporary deferment for the time necessary to complete treatment and complete tissue healing (6-12 months).
Thus, Schlatter's disease is a fairly common pathology of the musculoskeletal system that affects children and adolescents. The disease has a benign course and almost 100% recovery. The main thing is to identify the problem in time and begin treatment if necessary.
The whole truth about: Schlatter's disease of the knee joint and other interesting information about treatment.
Schlatter's disease of the knee joint is a serious disease. This disease, unfortunately, is more common in adolescence, but if treatment is started on time, the disease does not pose a threat. Athletes are most often at risk for the disease.
In the article you will find how the disease develops, causes and treatment, prevention and diagnosis of Schlatter's disease of the knee joint in adolescents. Also in the article you will find traditional medicine treatment and exercises that should be performed regularly. And I think you will also be interested in learning about the symptoms of Schlatter's disease of the knee joint.
This information will be useful to anyone who is faced with this disease. The article also contains videos in which the doctor will give you the advice you need and, I hope, in which you will find answers to your questions.
Schlatter's disease of the knee joint
Schlatter's disease is an aseptic destruction of the tuberosity and nucleus of the tibia, which occurs against the background of their chronic injury during a period of intensive skeletal growth. Clinically, Schlatter's disease is manifested by pain in the lower part of the knee joint, which occurs when it is bent (squats, walking, running), and swelling in the area of the tibial tuberosity.
Schlatter's disease is diagnosed based on a comprehensive assessment of the history, examination, X-ray examination and CT scan of the knee joint, as well as local densitometry and laboratory tests. Schlatter's disease is treated in most cases with conservative methods: a gentle motor regimen for the affected knee joint.
Schlatter's disease (or Osgood-Schlatter) refers to lesions of the musculoskeletal system in which a certain area of the long tubular bones, the tibial tuberosity, is affected. There is a whole group of similar diseases that are observed mainly in children and adolescents, they are called osteochondropathy.
The true causes of the development of osteochondropathy are not exactly known today, but most experts agree that the pathology occurs due to an imbalance in the growth processes of bones and the blood vessels that feed them, against the background of physical overload in the child. Schlatter or Osgood-Schlatter disease is a unique form of osteochondropathy of the tibial tuberosity, the occurrence of which is associated with a violation of ossification processes.
The main risk group is teenagers aged 10–15 years who regularly engage in active sports. For the most part, the defeat is one-sided.
Schlatter's disease is one of the most common osteochondropathy. The disease can also be found under the name Osgood-Schlatter disease, osteochondropathy or apophysitis of the tibial tuberosity. The pathology is characterized by the formation of a lump on the front surface of the lower leg directly below the knee (the place where the patellar ligament attaches to the tibial tubercle) and the presence of pain that occurs during movement.
The disease has no general symptoms. As a rule, it is characterized by a benign course and independent regression, but sometimes consequences of the disease can be observed in the form of fragmentation of the tibial tubercle and separation of the patellar tendon.
Schlatter's disease (Osgood-Schlatter) is one of the variants of osteodystrophy (disorders of bone structure due to problems with its nutrition) in the area of the head of the tibia of the leg.
Schlatter's disease is characterized by the formation of a painful lump in the area of the lower pole of the kneecap. The disease is characteristic of adolescence, occurring between the ages of 10 and 18 years. The defeat is mostly one-sided.
Causes and predisposing factors
OLYMPUS DIGITAL CAMERASchlatter's disease in adolescents usually develops during a period of intensive growth (10-18 years). The peak incidence occurs at the age of 13-14 years in boys and 11-12 years in girls. The pathology is considered quite common and is observed, according to statistics, in 11% of all adolescents involved in active sports. The onset of the disease is most often observed after a sports injury, in some cases even minor.
There are three main risk factors for developing Osgood-Schlatter disease:
- Age. The disease occurs mainly in children and adolescents; in older adults it is detected very rarely and only as residual effects in the form of a lump under the knee.
- Floor. More often, osteochondropathy of the tibial tuberosity is observed in boys, but recently, due to the active involvement of girls in sports, these indicators are beginning to level out.
- Sports activities. Schlatter's disease is five times more likely to affect children who are actively involved in various sports than those who lead a sedentary lifestyle. The most “dangerous” sports in this regard are football, basketball, volleyball, hockey, artistic gymnastics and dance sports, figure skating, and ballet.
To date, the true cause of the appearance of this form of osteochondropathy remains unknown. But many experts are inclined to believe that the formation of pathological bone growths is based on constant microtrauma (partial tears) of the tibial tuberosity due to increased load on the quadriceps muscle.
Risk factors include:
- Age 10–15 years.
- Male gender.
- Rapid skeletal growth.
- Engaging in active sports where running and jumping prevail.
According to statistics, approximately every second teenager suffering from Schlatter's disease has suffered a knee injury. Trigger factors in the development of Schlatter's disease can be direct injuries (damage to the ligaments of the knee joint, fractures of the tibia and patella, dislocations) and constant microtrauma of the knee during sports. Medical statistics indicate that Schlatter's disease occurs in almost 20% of adolescents who are actively involved in sports, and only in 5% of children who are not involved in sports.
Sports with an increased risk of developing Schlatter's disease include basketball, hockey, volleyball, football, gymnastics, ballet, and figure skating. It is sports activities that explain the more frequent occurrence of Schlatter's disease in boys.
The recent increase in girls' participation in sports has led to a narrowing of the gap between the sexes in terms of the development of Schlatter's disease.
As a result of overloads, frequent microtraumas of the knee and excessive tension of the patellar ligament, which occurs during contractions of the powerful quadriceps femoris muscle, a disorder of blood supply occurs in the area of the tibial tuberosity.
Minor hemorrhages, rupture of patellar ligament fibers, aseptic inflammation in the bursa area, necrotic changes in the tibial tuberosity may be observed.
Osgood-Schlatter disease occurs in adolescents aged 10 to 18 years, mainly in boys during a period of intensive skeletal growth. Girls are less susceptible to this joint disease, which is due to the fact that they are less involved in sports like boys.
As you already understand, Osgood-Schlatter disease occurs during a period of intense bone growth under the influence of physical stress on the knees and thigh muscles. When playing sports such as football, basketball, hockey, gymnastics, etc., there is a strong load on the area of attachment of the ligaments to the tibial tuberosity, which causes injury, the development of an inflammatory process, the blood supply to this area is also disrupted with hemorrhages, and aseptic necrosis develops with detachments of tuberosity fragments.
This chronic course of Osgood-Schlatter disease leads to alternating processes of necrosis and regeneration, which is manifested by the formation of specific lumps under the kneecaps. This is a hypertrophied tuberosity of the tibia.
The disease mainly debuts at the age of puberty, and most often occurs in those children who are intensively involved in active sports.
Traditionally, boys play more sports, so they are more susceptible to Schlatter's disease, although today girls often suffer from this pathology. The disease occurs during the period of active skeletal traction and gradually stops as the bone skeleton grows.
Approximately 15-20% of adolescents who are actively involved in sports and participate in competitions have a similar disease. Among those who do not engage in professional sports, the percentage is lower - only 3-5% of those who are sick. Most often, Schlatter's disease occurs during jumping and traumatic sports.
Who is at risk for the disease?
The largest risk group is teenage boys from 8 to 18 years old who are actively involved in sports. According to statistics, 25% of children of a given gender and age experience Osgood-Schlatter disease in one form or another. And only 5% of them are not involved in active sports, but get sick due to various injuries or congenital defects of the knee cartilage.
Unfortunately, with the spread of women's sports, a unique risk group has formed among teenage girls. These are mostly girls from 12 to 18 years old, who are also actively involved in sports and receive sports injuries. Since the general vital activity of teenage girls is much lower than that of boys, the risk of the disease is lower - about 5-6%
The second significant risk group is professional athletes, usually young, who have suffered knee injuries of varying severity. Microtraumas in adulthood become the cause of disease much less frequently.
Development mechanism
Schlatter's disease in children involves damage to the tibial tuberosity. This part of the bone is located just below the knee. The main role of this anatomical formation is the attachment of the patellar ligament. The location of the tibial tuberosity coincides with the apophysis (the area due to which the bone grows in length). This is what causes the development of the disease.
The fact is that the apophysis has separate blood vessels that supply the growth zone with oxygen and other necessary substances. During the period of active growth of the child, these vessels “do not keep up” with the increase in bone mass, which leads to a deficiency of nutritional components and hypoxia. As a result, this area of the bone becomes very fragile and prone to damage.
If at this moment the influence of unfavorable factors is observed in the form of constant overload of the lower extremities and microtrauma of the patellar ligament, then the risk of developing Schlatter's disease is very high.
Each of the tubular bones in adolescents has special growth zones at its ends, the junction of bones with cartilage. Due to these zones, bones can stretch in length. Cartilaginous tissue and growth zones are not as dense as bone, and therefore, during injuries, jumps and compression, they can be injured and “crumpled”. This causes the bone growth area to become swollen and inflamed, causing pain in this area.
The body tries to restore the integrity of this area by growing bone tissue. This leads to Schlatter's disease - the formation of a bone lump at the site of swelling and pain. Under the influence of such damaging factors, an inflammatory process begins to develop, which causes ossification of the not yet fully formed tibial tuberosity. As a result, one can observe hyperactive bone growth in this area, which manifests itself as a kind of lump under the knee - the main manifestation of Schlatter's disease.
Manifestations of Schlatter's disease
The strength of the pain syndrome will vary: from mild pain during physical activity to severe and debilitating pain. Schlatter's disease causes symptoms such as:
- pain in the area where the knee joins the tibia and along the front surface of the lower leg,
- swelling and tenderness when touched below the kneecap,
- pain in the knee after running, jumping or climbing stairs, which goes away with rest,
- thigh muscle tension,
- Usually only one knee is affected,
- the duration of pain can be from several weeks to a couple of months,
- soreness that occurs as bones grow.
Schlatter's disease can cause complications in the form of chronic pain or persistent swelling, which are relieved by the use of cold or conventional anti-inflammatory drugs.
After the inflammation subsides, a lump of bone tissue remains in the lower leg area or under the kneecap. It can persist forever, but does not interfere with the function of the knee.
Symptoms of Schlatter's disease of the knee in adolescents
A feature of this type of osteochondropathy is the benign and often completely asymptomatic course of the disease. After some time, the pathology begins to regress on its own, and the patient never learns about his condition. In other cases, Schlatter's disease is an incidental finding during radiography of the knee joints for another reason.
But a certain proportion of children and adolescents still suffer from various symptoms of osteochondropathy. One of the most common and pathognomonic symptoms of the disease is a “bump” immediately under the knee joint on the front surface of the leg. This formation is completely immobile, very hard to the touch (bone density), the color of the skin over the tubercle is normal, it is not hot to the touch.
That is, all these signs indicate the non-infectious nature of the neoplasm. Sometimes there may be slight swelling in the area of the lump and pain on palpation, but, as a rule, there are no such symptoms.
Other signs of the disease include pain. Pain syndrome varies from minor discomfort during physical activity to severe pain during normal daily physical activity. Soreness can be observed throughout the entire period of the disease, and can occur during exacerbations provoked by physical overload.
If a child has pain syndrome due to Osgood-Schlatter disease, this is the main indication for active treatment; in all other cases, observation and watchful waiting are chosen. The leading symptom of this pathology is local pain in the knee joint, or more precisely, slightly below the patella. The pain intensifies with banal bending of the leg at the knee, running, jumping, climbing stairs, etc. At rest and with cessation of physical activity, pain decreases.
An objective examination of the patient reveals:
- Swelling and pain on palpation of the area below the patella, corresponding to the tibial tuberosity.
- Increased pain when trying to straighten the leg at the knee.
- There is no limitation of mobility in the knee joint.
- Joint effusion is not detected.
- Symptoms of meniscus lesions are negative.
- Redness of the skin may be present in the area of tenderness.
- Sometimes there is some atrophy of the quadriceps femoris muscle.
Often in children, pathological changes on the tibial tuberosity are combined with osteochondropathy of the spinal column. Schlatter's disease is characterized by a gradual, asymptomatic onset. Patients, as a rule, do not associate the occurrence of the disease with a knee injury. Schlatter's disease usually begins with the appearance of mild pain in the knee when bending, squatting, or going up or down stairs.
After increased physical activity on the knee joint (intensive training, participation in competitions, jumping and squats in physical education classes), symptoms of the disease become manifest.
Significant pain occurs in the lower part of the knee, increasing when it is bent while running and walking and subsiding with complete rest. Acute attacks of cutting pain may appear, localized in the anterior region of the knee joint - in the area of attachment of the patellar tendon to the tibial tuberosity. Swelling of the knee joint is noted in the same area.
Schlatter's disease is not accompanied by changes in the patient's general condition or local inflammatory symptoms such as fever and redness of the skin at the site of swelling.
When examining the knee, swelling is noted, smoothing the contours of the tibial tuberosity. Palpation in the area of the tuberosity reveals local soreness and swelling, which has a densely elastic consistency. A hard protrusion is palpated through the swelling. Active movements in the knee joint cause pain of varying intensity.
Schlatter's disease has a chronic course, sometimes there is a wavy course with pronounced periods of exacerbation. The disease lasts from 1 to 2 years and often leads to recovery of the patient after the end of bone growth (at approximately the age of 17-19 years).
In the initial stages, Osgood-Schlatter disease practically does not manifest itself in any way. Then the pain in the knee gradually increases, intensifying when squatting, jumping, going up and down the stairs. Later, knee pain increases when bending the knees, running, and even walking.
The pain is localized under the knee, in the area of the tibial tuberosity. Upon examination, swelling is revealed in the area of the tuberosity with smoothed contours. Pain is noted on palpation. Later, a protrusion in the form of a hump or bump is visually determined. Osgood-Schlatter disease is characterized by periods of exacerbation and remission and, as a rule, resolves by the time skeletal growth stops.
Diagnostics
With the typical course of the disease and the presence of the described risk factors, diagnosis does not pose any difficulties, and a specialist can make the correct diagnosis immediately after examining the child without using any additional examination methods.
In cases that are more difficult to diagnose, the patient may be prescribed MRI, CT, or ultrasound. There are no specific laboratory signs of pathology. All blood and urine parameters are within the age norm.
Basically, clinical data are sufficient to make the correct diagnosis. Typically, instrumental diagnostic methods are prescribed for the purpose of a detailed assessment of pathological changes and exclusion of other pathologies. X-rays can reveal:
- Fuzzy contours of the epiphyses of the tibial tuberosity.
- Areas of calcium deposition in the patellar ligament.
- Thickening of the patellar ligament.
If necessary, ultrasound examination, computed tomography and magnetic resonance imaging can be used.
Schlatter's disease can be diagnosed by a combination of clinical signs and typical localization of pathological changes. The age and gender of the patient are also taken into account. However, the decisive factor in making a diagnosis is an X-ray examination, which should be carried out over time for greater information.
X-rays of the knee joint are performed in direct and lateral projections. In some cases, an ultrasound of the knee joint, MRI and CT of the joint are additionally performed. Densitometry is also used to obtain data on the structure of bone tissue. Laboratory diagnostics are prescribed to exclude the infectious nature of damage to the knee joint (specific and nonspecific arthritis).
It includes a clinical blood test, a blood test for C-reactive protein and rheumatoid factor, and PCR studies. In the initial period, Schlatter's disease is characterized by a radiographic picture of flattening of the soft cover of the tibial tuberosity and raising of the lower border of the clearing, corresponding to the adipose tissue located in the anterior part of the knee joint.
The latter is due to an increase in the volume of the subpatellar bursa as a result of its aseptic inflammation. There are no changes in the nuclei (or nucleus) of ossification of the tibial tuberosity at the onset of Schlatter's disease.
Over time, radiologically, a displacement of the ossification nuclei forward and upward by 2 to 5 mm is noted. The trabecular structure of the nuclei may be blurred and their contours uneven.
Gradual resorption of displaced nuclei is possible. But more often they merge with the main part of the ossification nucleus to form a bone conglomerate, the base of which is the tibial tuberosity, and the apex is a spine-like protrusion, clearly visualized on a lateral radiograph and palpable in the area of the tuberosity. Differential diagnosis of Schlatter's disease must be carried out with a fracture of the tibia, syphilis, tuberculosis, osteomyelitis, and tumor processes.
For diagnosis, it is enough to take into account clinical data with the typical localization of the pathological process, examination and palpation data, as well as taking into account the patient’s age. Additionally, radiography is performed in two projections with an emphasis on the tibial tuberosity. On X-ray images of Osgood-Schlatter disease, processes of increased and decreased density and fragmentation of the tuberosity are observed.
Ultrasound diagnostics is a very valuable diagnostic tool. As a rule, with the typical course of Osgood-Schlatter disease, diagnosis does not present any difficulties.
When contacting a doctor to determine the causes of a painful lump under the knee, he needs to provide information about the symptoms that bother the child, the connection of these symptoms with physical exercise, and do not forget to tell about problems with the knee joint in the past (especially if there have been injuries). Then the doctor will examine the sore knee joint.
Assess the characteristic signs of Osgood-Schlatter disease (growth, swelling, pain) and the range of active and passive movements in the knee. When evaluating laboratory tests, no abnormalities are found. Among instrumental studies, radiography of the affected joint, which allows visualization, is of particular importance. Ultrasound and magnetic resonance imaging are also used for diagnosis.
Treatment of Schlatter's disease in adolescents
This pathology is treated by an orthopedic surgeon; in most cases, Schlatter’s disease is quickly and easily treated, and the symptoms gradually disappear as the bones grow in length. If the symptoms are severe enough, you must:
- use of medications,
- physiotherapy,
- therapeutic gymnastics and physical therapy.
Drug therapy for Schlatter's disease includes taking painkillers and anti-inflammatory drugs from the NSAID group - usually ibuprofen, Tylenol and analogues. They are prescribed to the child only for a short course and in small doses.
Physiotherapy reduces swelling, relieves inflammation and reduces pain. The choice of a specific method is determined by the doctor and the degree of the problem, gender and age of the child.
Physical therapy techniques are used to stretch the quadriceps femoris muscle and develop the hamstrings. This allows you to reduce the load on the tendon attachment site and the formation of tears and injuries there. Exercises to stabilize the knee joint are also necessary.
In addition to treatment, it is necessary to provide lifestyle changes at least while recovering from injury and pain. It is necessary to relieve the joint and limit activities that increase symptoms. It is necessary to immediately apply cold to the site of injury and use knee pads to protect the joint, especially during active training.
During the acute period, you need to replace sports associated with jumping and running with swimming or cycling - this will relieve the joints and muscles.
Patients with Schlatter's disease usually undergo outpatient conservative treatment with a surgeon, traumatologist or orthopedist. First of all, it is necessary to eliminate physical activity and ensure the maximum possible rest of the affected knee joint. In severe cases, it is possible to apply a fixing bandage to the joint.
The basis of drug treatment for Schlatter's disease is anti-inflammatory and painkillers. Physiotherapeutic methods are also widely used: mud therapy, magnetic therapy, UHF, shock wave therapy, paraffin therapy, massage of the lower limb. To restore damaged areas of the tibia, calcium electrophoresis is performed.
Physical therapy classes include a set of exercises aimed at stretching the hamstrings and quadriceps femoris muscles. Their result is a decrease in the tension of the patellar ligament, which attaches to the tibia. To stabilize the knee joint, the treatment complex also includes exercises that strengthen the thigh muscles.
After a course of treatment for Schlatter's disease, it is necessary to limit the load on the knee joint. The patient should avoid jumping, running, kneeling, and squatting. It is better to change traumatic sports to more gentle ones, for example, swimming in a pool.
With severe destruction of bone tissue in the area of the head of the tibia, surgical treatment of Schlatter's disease is possible.
The operation consists of removing necrotic foci and suturing a bone graft that fixes the tibial tuberosity.
How to treat Osgood-Schlatter disease at home
Certain types of treatment for Schlatter's disease can also be used at home, but only after receiving comprehensive consultation from your doctor. This mainly involves local therapy and physical exercises:
- Constant intense pain in the knee is best treated with compresses at night with Ronidase or Dimexide.
- Among folk remedies, various ointments and compresses are used based on celandine, honey, St. John's wort, yarrow, nettle, etc.
- To relieve discomfort and prevent relapses of the disease during the recovery stage, it is recommended to perform a special set of exercises to strengthen and develop the knee joint.
Prognosis and consequences of Schlatter's disease in adolescents
Negative consequences of pathology are extremely rare. In the vast majority of cases, the disease is characterized by a benign course and independent regression after a person’s growth stops (23-25 years). It is then that the growth zones of the tubular bones close and, accordingly, the very substrate for the development of Osgood-Schlatter disease disappears.
In some cases, an adult may be left with an external defect in the form of a tubercle under the knee, which does not in any way affect the function of the knee joint and the lower limb as a whole.
But sometimes a complication such as fragmentation of the tuberosity can occur, that is, detachment of the sequestrum of the bone and separation of the patellar ligament from the tibia. In such cases, normal leg function can only be restored through surgery, during which the integrity of the ligament is restored. In most cases, the prognosis is quite favorable. As a rule, by the age of 18, when the process of ossification of the tibial tuberosity ends, the disease resolves.
However, despite conservative treatment, in approximately 10% of adolescents, some symptoms of Schlatter's disease persist into adulthood. Similar consequences may be associated with the presence of residual growths on the tuberosity or foci of ossification on the patellar ligament.
Most survivors of Schlatter's disease retain a pineal protrusion of the tibial tuberosity, which does not cause pain or impair the function of the joint. However, complications can also be observed: upward displacement of the patella, deformations and osteoarthritis of the knee joint, leading to pain that constantly occurs when leaning on a bent knee.
Sometimes after Schlatter's disease, patients complain of aching or aching pain in the knee joint that occurs when the weather changes.
In the majority of people who have suffered Schlatter's disease, the so-called growth in the knee joint does not disappear, otherwise the prognosis is often favorable, pain associated with stress disappears, other minor types of aching pain associated with changes in weather and localized in the knee joint are possible.
Schlatter's disease and the army
3_7_aOsteochondropathy of the tibial tuberosity is not grounds for exempting a young man from conscription military service. As a rule, by the age of 17-18, when conscription takes place, the disease has already regressed. If symptoms of pathology are nevertheless observed, then the young man receives a temporary deferment for the time necessary to complete treatment and complete tissue healing (6-12 months).
Thus, Schlatter's disease is a fairly common pathology of the musculoskeletal system that affects children and adolescents. The disease has a benign course and almost 100% recovery. The main thing is to identify the problem in time and begin treatment if necessary.
If the function of the joint is impaired due to Osgood-Schlatter disease, the conscript is not subject to conscription for military service, but if the function of the joint is not impaired, then the disease will not be an obstacle to service in the army.
Source: “moyaspina.ru; medovet.com; mednean.com.ua; diagnostics.ru; osteocure.ru; sustavu.ru"
In recent years, the level of diseases of the musculoskeletal system diagnosed has increased many times. Diseases affect not only elderly patients; some pathologies are observed in adolescents, for example Osgood-Schlatter disease. The disease is associated with impaired blood circulation in the area of the knee joint, as a result of which the core of the knee bone gradually begins to deteriorate, leading to further necrosis of the affected areas.
Impaired supply of nutrients leads to an inflammatory process in the cartilage and tibia. The majority of victims are active teenagers involved in various sports. The disease cannot be ignored; be sure to visit a doctor and start a course of treatment.
Causes of the disease
The most negative factor influencing the onset of the disease is injuries of various etiologies. Most often in adult victims, the disease is a complication after:
- dislocation and other injuries of the knee;
- fractures of the knee area.
Often patients diagnosed with Osgood-Schlatter disease are teenagers. Due to the fact that their body is growing rapidly, some organs and systems do not have time to “grow” behind them. At the same time, body weight increases significantly, and the significant load sometimes becomes unbearable for the cartilage tissue. Overload is the main cause of pathology.
Playing sports makes the situation worse. During sharp turns and active movements, the quadriceps tendons are stretched. The joint of the kneecap weakens, which leads to microdamage (tendon tears, sprains, accompanied by severe swelling and pain).
The body tries to correct the situation by filling the void with a special lump consisting of bone tissue. The formation is palpable and resembles a benign tumor.
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The main risk group includes boys aged eight to eighteen years. According to statistics, about 25% of children in this age category suffer from Osgood-Schlatter disease in varying degrees of complexity. Only 5% of people in this group complain of knee pain due to injuries or congenital pathologies of the cartilage in this area.
Unfortunately, the female gender is not spared from the disease. Girls from twelve to eighteen years old who are constantly injured and actively involved in various sports suffer from Osgood-Schlatter disease. The risk of getting the disease in girls is only 5%.
The second risk group includes professional athletes, usually young, who have recently suffered knee injuries. Microdamages in adulthood rarely cause the disease. Often such damage over time provokes the development of arthrosis.
What sports should you stay away from to prevent illness? Those associated with sudden jumps, turns, and changes in direction of movement. These include: football, athletics, rhythmic gymnastics.
There is no point in limiting your child in his favorite activity. It is important to regulate the loads received. There's no way you can keep boys away from football. Give your child to an experienced trainer; good training will have a positive effect on the teenager’s health; the supervision of a specialist will reduce the risk of pathology many times over. Similar recommendations should be applied to other sports.
Signs and symptoms
How does the disease manifest itself? The first signs of the pathology are pain that occurs immediately after physical activity. Some may attribute symptoms to a history of knee injuries. Over time, Osgood-Schlatter disease leads to constant pain in the knee joint, swelling, and normal movements become difficult to perform.
The clinical picture in advanced cases is as follows:
- swelling in the knee over time leads to a tumor consisting of bone tissue;
- acute shooting pain in the knee appears after heavy physical exertion;
- constant swelling of all areas of the knee is observed; in the morning the swelling increases significantly in size, and in the evening it decreases slightly;
- most often only one knee is affected;
- body temperature rises, chills are noted;
- the thigh muscles above the sore knee are constantly tense, which makes it difficult to move the leg.
At this stage of development, many do not seek help from doctors. Small swellings in the knee that go away over time and mild pain are rarely alarming, especially for teenagers. Children do not realize the seriousness of the situation; they report discomfort to their parents when the pain becomes severe and movements become difficult.
Diagnosis of pathology
If your child suddenly develops knee pain of varying severity, contact an experienced specialist immediately. The clinical picture of Osgood-Schlatter disease is similar to pathologies of the musculoskeletal system. Only correct diagnosis will reveal the cause of discomfort in the knee area. The following studies are most often used:
- the doctor carefully examines the teenager’s medical history, identifying the presence of injuries and other injuries to the knee;
- performs ultrasound of the knee joint, x-ray;
- from new methods: MRI and CT. The techniques allow us to assess the condition of not only the joint, but also nearby tissues.
If the infectious nature of the disease is suspected, a blood test and PCR tests are taken from the child. You can begin a course of therapy only after receiving research results.
On a note! Osgood-Schlatter disease is a signal not only for treatment, but also for lifestyle changes. Patients are advised to refrain from professional sports and get rid of bad habits (if any). Take care of the health of your musculoskeletal tissue. Joint pathologies are almost always accompanied by severe pain and make it difficult for a person to move normally, even to the point of disability.
Basic principles of therapy
There is no specific therapy for Osgood-Schlatter disease. There are instructions from doctors, and if they are followed, recovery occurs in most cases. The disease can be treated over a fairly long period of time: from six months to five years. The sooner the pathology is identified and the problem is addressed, the shorter the duration of therapy. In rare situations, surgery is required, in which case the recovery period can last a year.
Main methods of treatment:
- rest your sore leg. Sometimes doctors resort to using a cast, completely protecting the knee from further damage;
- Exercise therapy. Therapeutic exercises are an integral part of the patient’s speedy recovery. The exercises are aimed at developing the thigh muscles and gradually strengthening the teenager’s knee joint. It is recommended to stretch the quadriceps muscle, which will reduce the load on the sore area of the knee and improve the patient’s well-being;
- physiotherapy. Indicated for people with the last stage of the disease. Paraffin therapy, heating, electrophoresis slow down degenerative processes, help reduce pain, and trigger regenerative processes;
- massage. The affected area of the knee is massaged with anti-inflammatory ointments, which relieves discomfort, improves blood flow to the cartilage tissue, and recovery occurs faster;
- use of anti-inflammatory and painkillers allowed from 15 years of age. Medicines are selected exclusively by the doctor; it is strictly forbidden to give medications to the child yourself;
- Spa treatment. The healing process has a positive effect on the patient’s health; special manipulations (hydromassage, mud baths and others) trigger regenerative processes and strengthen the human immune system.
If the pathology progresses, conservative methods do not give the desired effect, and a surgical method has to be used. It involves mechanical excision of the tumor. It is necessary to remove the entire area of the joint affected by the degenerative process. The damaged joint is replaced with an artificial one. The procedure is responsible and very serious, doctors try to avoid it in every possible way, especially for teenagers.
Traditional methods
Natural drugs are not very popular, but they are used due to their non-toxicity and absolute safety for humans. Often, oil compresses are used to eliminate Osgood-Schlatter disease in the knee area:
- Heat sunflower oil in a water bath, you can use olive oil. Soak an unnecessary rag or gauze with the resulting product, apply it to the sore knee, and wrap it in plastic or a scarf. It is important to wrap your leg tightly so that the oil does not stain the bed while you sleep. Carry out the manipulations for one week. Consult your doctor first.
In most cases (if the doctor's recommendations are followed), patients recover within several months and forget about the illness. If Osgood-Schlatter disease has been advanced for a long period of time, there is a high probability that after treatment is completed, a growth will remain under the kneecap. The lump does not cause pain; it is a cosmetic defect; if necessary, it can be removed surgically.
If recovery is not complete, aching pain in the knee area remains, accompanying any physical activity. It is important to treat the disease until you feel completely comfortable.
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Preventive measures
Useful recommendations will help prevent the occurrence of Osgood-Schlatter disease:
- control physical activity during the period of active growth of the child;
- If possible, avoid injuries to the knee joint; if injury occurs, visit a doctor immediately;
- Balance your teenager’s diet by including foods rich in calcium (the substance is a bone builder). Jelly and jellied meat are also useful (contains collagen, necessary for the normal functioning of joints).
During periods of physical activity, be extremely attentive and careful. Any unsuccessful movement can provoke an illness, which will force you to give up professional sports forever. Take care of the health of musculoskeletal tissue, follow the recommendations of specialists.
Attention! Only today!
Medical statistics eloquently demonstrate that Schlatter's disease occurs in almost 20% of adolescents who experience intense physical activity as a result of sports, as well as in 5% of adolescents who do not play sports. Sports that can trigger Schlatter's disease include: football, basketball, volleyball, track and field, weightlifting, artistic gymnastics (in boys), as well as figure skating, ballet and rhythmic gymnastics (in girls). Since the percentage of boys and girls involved in sports is now comparable, this fact has led to a gap between the sexes in the development of Schlatter's disease.
In this article we will tell you what Osgood-Schlatter disease is, what are the causes of its development, treatment methods and prognosis.
What is Schlatter's disease?
Schlatter's disease has been known since 1906, when it was described by the doctor whose name it bears. Another name for the disease, “osteochondropathy of the tibial tuberosity,” reveals and explains the mechanisms that cause the development of Schlatter’s disease. From this name it is clear that the disease is non-inflammatory in nature, which is accompanied by necrosis of bone tissue. This pathology is typical for young people, children and adolescents with traumatic periostitis and refers to lesions of the musculoskeletal system. With Schlatter's disease, a certain area of the long tubular bones that make up the tibia is affected. The true causes of the development of pathology are not fully known today. However, some experts believe that there are currently several such diseases that are caused by an imbalance in bone growth processes in the context of physical overload in children and adolescents.
Causes of development of Schlatter's disease
The main factor in the development of Schlatter's disease is damage to the knee joint as a result of intense physical activity. There are a number of reasons that cause such damage and provoke this disease:
- constant overloads;
- frequent microtraumas of the knee;
- regular damage to the knee ligaments;
- direct injuries: fractures of the tibia, patella, dislocations.
Due to significant overloads, frequent injuries to the knee joint and significant tension on the patellar ligaments, which occur during contractions of the quadriceps femoris muscle, blood circulation is impaired in the area of the tibial tuberosity. Minor hemorrhages, rupture of patellar fibers, aseptic inflammation and necrosis are also noted.
The tibia is a tubular bone, its growth zones are located at its head. Since these growth plates have a cartilaginous structure, in adolescents they are not as strong as in adults whose growth has already stopped. That is, these growth zones in adults have already ossified. For this reason, such cartilaginous areas are easily vulnerable to any injury and intense physical activity. In this cartilaginous growth plate, the tendon of the quadriceps femoris muscle, which is the largest muscle in the human body, is attached to the tibia. It is involved during walking, running, jumping and in other cases of motor activity.
If a child is involved in sports professionally and experiences heavy loads on the legs, then it is possible to tear the tendons of the femoral muscle and damage the fragile cartilaginous tissue of the tibia. As a result, inflammatory processes are observed, which are accompanied by swelling of the tendon attachment area. Under constant load, the body tries to compensate for the resulting defect in the bone by filling it with bone tissue, an excessive amount of which leads to the formation of bone formation.
Schlatter's disease in adolescents
Schlatter's disease in children and adolescents usually appears during a period of intensive growth. The age limit for incidence is 12-14 years for boys and 11-13 for girls. This disease is quite common and is observed in 20% of adolescents who are actively involved in sports. Usually the disease begins for no apparent reason or after a sports injury, sometimes quite minor.
There are three main reasons that contribute to the development of this disease:
- Age factor. The disease occurs in most cases in children and adolescents. In adults, the disease is practically not observed. The disease is detected extremely rarely, and then only in the case of a residual phenomenon (bone lump).
- Gender. Medical statistics state that Osgood-Schlatter disease is more often observed in boys, but currently this situation is leveling out, since girls are also actively involved in sports.
- Physical activity. The disease is more common in children who are actively involved in various sports than in those children who lead a passive lifestyle.
The mechanism of development of the disease
Schlatter's disease in children and adolescents involves a tuberous lesion of the tibia. Part of this bone is located below the knee, its main function is to attach the patellar ligament. This is precisely the reason for the development of the disease.
The thing is that the bone process near the apophysis has its own blood vessels that supply the growth zone with the necessary substances. When a child is actively growing, these vessels simply do not have time to “grow” compared to the increase in bone mass, which naturally leads to a lack of nutrients. As a result, this area becomes very fragile and vulnerable to injury. If at this time the child experiences constant physical activity on the lower extremities, then microtraumas of the patellar ligaments occur and, as a result, Schlatter’s disease.
You should know that the resulting bone tissue is very fragile and fragile. And with regular physical activity, sequestration of the bone (severation of a piece) and the patellar ligament can occur. Such consequences are common and require surgical intervention.
This disease causes a lot of controversy among scientists. Some experts believe that Schlatter's disease of the knee is genetic. They suggest that the disease is transmitted in an autosomal dominant manner. This suggests that the tendency to the disease can be transmitted from parents to children. But this point of view cannot be fully accepted, since the factor of inheritance is not always identified. The main reason that triggers the pathology is still mechanical trauma.
Schlatter's disease can also occur in adults, but is extremely rare. In this case, it manifests itself as arthrosis, which causes swelling of the tissues under the knee. When pressing on this place, the patient feels unpleasant pain, and during an exacerbation the local temperature rises. When complications occur, bone growth develops on the front surface of the leg.
The main symptoms of Schlatter's disease
As a rule, the disease does not have an acute onset. For this reason, the onset of the disease is in no way associated with a knee joint injury. The first symptoms appear as minor pain when bending the knee, squatting, running, or climbing stairs. However, the pain tends to increase. Because such symptoms are not taken seriously, the stress on the knee joint continues, which seriously aggravates the problem. And only over time, significant pain of varying intensity is observed in the lower part of the knee, which intensifies with physical activity. Sudden sharp pain, cutting in nature, may even appear in the anterior region of the knee joint. In addition to pain, swelling and swelling of the knee joint is observed.
However, this disease is not accompanied by symptoms characteristic of inflammatory processes: redness of the skin at the site of swelling and increased temperature. On palpation, swelling of the knee joint, its pain, characteristic density and a hard knob-like protrusion are noticed. This lump persists for life, but it does not entail any problems in the future and does not in any way affect the motor function of either the knee joint or the leg as a whole.
The disease is chronic in nature with periods of exacerbation. The disease lasts 1-2 years, after which spontaneous recovery occurs, which is caused by the end of bone growth and ossification of cartilage tissue in the growth zones. Schlatter's disease completely resolves at 18-19 years of age.
Diagnosis of the disease
When diagnosing a disease, taking an anamnesis is of great importance. The combination of symptoms, the characteristic localization of pain, the age and gender of the patient allows us to accurately diagnose Schlatter’s disease. However, the determining factor in making a diagnosis remains X-ray examination in frontal and lateral projection. Sometimes additional ultrasound of the knee joint, MRI and CT of the joint are performed, which must be carried out dynamically for greater information. Densitometry is also prescribed to analyze the structure of bone tissue. Laboratory tests must be carried out in order to exclude infectious pathology (reactive arthritis).
For this purpose they prescribe:
- general blood analysis;
- blood test for C-reactive protein;
- PCR studies (polymerase chain reaction);
- blood test for rheumatoid factor.
In the initial stage of the disease, radiography demonstrates flattening of the soft cover of the tibia tuberosity. Over time, ossification may shift forward or upward. The disease must be differentiated from tumor processes, tuberculosis, osteomyelitis, and tibia fractures.
How to treat Schlatter's disease
Treatment of Schlatter's disease is carried out by several specialists: traumatologist, orthopedist, surgeon. The disease is highly treatable, and symptoms disappear as the child grows older. However, if the symptoms are significantly pronounced, then it is necessary to carry out symptomatic therapy that relieves pain and relieves swelling of the knee joint. In order to relieve pain, it is necessary to completely eliminate physical activity and provide the greatest possible rest to the affected joint.
Treatment of Schlatter's disease is carried out according to the following scheme:
- provide the patient with complete peace and comfort;
- taking medications: painkillers, muscle relaxants and non-steroidal anti-inflammatory drugs;
- physiotherapeutic methods;
- physiotherapy.
The medicines used are:
- painkillers;
- non-steroidal anti-inflammatory drugs (analgin, diclofenac, ibuprofen);
- muscle relaxants (mydocalm);
- calcium supplements and vitamin D.
Medications should be given to a child with caution, only in short courses and in small doses. You can also apply cold compresses to reduce pain.
Physiotherapeutic methods are very effective because they can relieve inflammation and reduce pain. They improve blood circulation and nutrition of the tissues of the diseased joint, help restore bone structure, and reduce inflammation and discomfort.
These methods necessarily complement the treatment program:
- ultra-high frequency therapy (UHF);
- magnetic therapy;
- electrophoresis with various drugs (calcium chloride, potassium iodide, procaine);
- shock wave therapy;
- ultrasound therapy with glucocorticoids (hydrocortisone);
- laser therapy;
- paraffin compresses (with ozokerite, healing mud);
- warming up the knee using infrared rays;
- thalassotherapy (warm baths with sea salt or mineral water).
For each patient, the optimal treatment method is selected, which is determined by the doctor.
Physical therapy includes gentle exercises to stretch the quadriceps femoris muscle and develop the hamstrings. Such exercises reduce the load at the tendon attachment site to prevent tearing and injury.
During treatment, it is necessary to avoid physical activity and limit physical activity, which can increase pain.
In the acute period, intense physical activity should be replaced with more gentle physical therapy exercises, as well as swimming or cycling, but in a reasonable amount.
Each teenager is prescribed dietary nutrition and a vitamin and mineral complex. It is also recommended to wear a special bandage and orthopedic devices that have a protective effect, reduce the load and fix the knee ligaments.
Conservative treatment is carried out for a long time. As a rule, it lasts from 2 to 5 years. The bone lump remains forever, but does not increase in size and does not hurt. Over time, patients may experience aching pain in the knee joint, which is a reaction to changing weather.
After the course of treatment, you should not immediately begin active physical activity; this is fraught with serious complications such as osteoarthritis, displacement of the patella, and deformation of the bones of the knee joint.
Surgery
Surgical treatment is indicated when the disease persistently progresses. The essence of the surgical intervention is to remove lesions that have undergone necrosis, as well as to stitch together an implant that secures the tuberosity of the tibia.
Surgical treatment of Schlatter's disease is advisable in the following cases:
- with a long course of the disease (more than two years);
- in the presence of complications (bone destruction or rupture of the patellar ligament);
- if you are over 18 years of age at the time of diagnosis.
Surgical intervention is simple, but such interventions are characterized by a long recovery period, on which subsequent motor activity of the leg depends. For quick rehabilitation, you need to follow some rules:
- after the operation, use a fixing bandage on the joint or use a knee brace for a month;
- undergo a course of physiotherapy for rapid restoration of bone tissue (electrophoresis with calcium salts);
- taking dietary supplements based on calcium and vitamin-mineral complexes (for six months);
- avoid massive physical stress on the joint throughout the year.
How to treat Schlatter's disease at home
In some cases, Schlatter's disease can be treated at home, but only after an accurate diagnosis and visit to a doctor. These are mainly physical exercises and local therapy:
- For constant and intense pain in the knee, in conjunction with medications, use compresses at night with non-steroidal topical drugs.
- The use of folk remedies in the form of a variety of ointments, cold compresses based on chamomile, celandine, wax, honey, St. John's wort, knotweed, and yarrow is encouraged.
- Massage with non-steroidal anti-inflammatory ointments for external use.
- Therapeutic exercises alleviate the patient’s condition and prevent relapses of the disease. Do stretching exercises daily
- The patient must remain calm and ensure a comfortable position of the affected joint;
- During the rehabilitation period, completely limit physical activity on the sore leg.
Possible complications
Timely diagnosis and adequate treatment of Schlatter's disease does not cause serious complications or severe consequences. However, it is impossible to predict the outcome of the disease, so prevention of the disease is necessary.
Long-term loads on the tibia tuberosity cause upward displacement of the patella, which limits the work of the knee joint, immobilizes the lower limbs as a whole, and leads to pain.
Sometimes the joint develops incorrectly, which leads to its deformation and the development of degenerative processes (arthrosis). With arthrosis, pain appears (when walking and even with the most minimal load), and stiffness and inflexibility of the knee joint also develops. All this leads to a deterioration in the teenager’s quality of life.
Prevention and prognosis of the disease
Experts say that preventing Schlatter's disease is not at all difficult. If a teenager is actively involved in sports, he should warm up thoroughly before training, perform special stretching exercises, and also use knee pads.
Factors that prevent knee injuries are as follows:
- it is necessary to avoid injuries to the knee joints;
- use special protective knee pads;
- provide a gradual increase in loads using warm-up exercises;
- take special vitamin and mineral complexes containing calcium.
Active sports with Schlatter's disease do not lead to irreversible processes in the knee joints or disruption of their functioning, they only cause severe pain. If pain interferes with training, then you should stop exercising, at least for a while, until the acute period of the disease subsides. During the training process, it is necessary to control the intensity of exercise and their frequency.
The prognosis of the disease is favorable. Over time, the disease will subside, but pain can continue to haunt adults for a long time, for example, when walking for a long time or in a kneeling position. In some cases, surgical treatment is recommended. Such operations are not scary, and their results are very good.
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Osgood-Schlatter disease can manifest itself in the form of a painful lump in the area located just below the kneecap. It can occur both in childhood and adolescence, during puberty. Schlatter's disease of the knee joint in adolescents occurs most often in those who play sports. Especially such activities as jumping and running. This also includes activities that require rapid changes in movement trajectory. For example, playing football or basketball.
Age category of susceptibility to Schlatter's disease
So, more details. Despite the fact that the disease predominantly occurs among boys, the gender gap is narrowing as girls become more involved in various sports. The disease affects any category of adolescents involved in sports in an approximate ratio of one to five. The age range for susceptibility to this disease is based on gender, since girls experience puberty much earlier than boys. Thus, for young guys this can happen at thirteen to fourteen years old, and for girls at eleven to twelve. Schlatter's disease of the knee joint in a teenager (whether it is possible to play sports, we will consider below) usually occurs on its own. As a result of cessation of bone tissue growth.
Among the main risk factors for the manifestation of the disease are the age, gender of the child and participation in sports. The disease is most often observed in boys. But the gender gap is narrowing as more girls gradually take up different sports. How does Schlatter's disease of the knee manifest itself in a teenager? Let's figure it out.
Main symptoms
The most common symptoms of this disease include the following disorders:
Nature of pain
Pain can be of different types and depends on each organism individually. Some may experience only mild pain during certain types of activities. Especially when running or jumping. For others, the pain can be constant and debilitating. Basically, Schlatter's disease of the knee joint in a teenager develops only in one limb. But sometimes it can spread to both at once. The discomfort usually lasts from a few weeks to a few months and may continue until the child stops growing.
Causes of the disease
Each tubular bone of a child, located in the arm or leg, has its own growth zones, which actively manifest themselves in the area of the end of the bones, consisting of cartilage. This tissue is not strong enough like bone, and therefore is much more likely to be damaged and overloaded, which affects the growth zones, which can ultimately lead to swelling and general pain in this area. During physical activity that involves prolonged running, jumping and bending, such as football, volleyball, basketball or ballet, children's hip muscles strain the tendons. This puts tension on the quadriceps muscle, which connects the kneecap to the tibia. This is confirmed by reviews of Schlatter's disease of the knee joint in a teenager.
Such frequently repeated loads can lead to small tears of the tendons from the tibia, which will ultimately become a prerequisite for the appearance of swelling and pain, which is directly related to Schlatter’s disease. In some situations, the child’s body attempts to close the described defect through the growth of bone tissue, which leads to the appearance of a bone lump.
Sports that can cause the development of Schlatter's disease
Further. Schlatter's disease occurs in almost twenty percent of adolescents who take part in sports competitions, while only a small part of them are not involved in active activities at all. The disease can often manifest itself against the backdrop of hobby activities that require a lot of jumping, running and changing the trajectory of movement, for example:
- football;
- ballet;
- basketball;
- gymnastics;
- volleyball;
- figure skating.
How to relieve pain in the knee joint in a teenager with Schlatter's disease? More on this later.
Possible complications
Complications of the disease are extremely rare. These may include the presence of chronic pain or local swelling, which can be treated by applying cold compresses. It often happens that even after the symptoms disappear, a bone lump may remain on the lower leg in the area of the swelling. This bump may remain to varying degrees throughout a person's life, but generally does not affect or interfere with the healthy functioning of the knee. Can a teenager with Schlatter's knee disease be drafted into the army? This is a frequently asked question. It all depends on how the disease progresses. At an advanced stage, even after all the procedures performed, the joint will not function normally. All changes in bone tissue are recorded by the doctor. At the military commission, the conscript must provide a separate extract, which will indicate the presence of functional changes in the bone tissue of the tibia. This is a guarantee that you will not have to join the army.
Diagnosis of the disease
As part of the diagnosis, the history of the disease is important. Therefore, the doctor may need the following information:
- A thorough description of any symptoms and sensations the patient is experiencing.
- Information about family health and family heredity.
- The presence of a relationship between symptoms and physical activity.
- Information about all medications and nutritional supplements that the child takes.
- Information about the existence of medical ailments in the past, in particular in relation to any previous injuries.
To diagnose Schlatter's disease, the doctor must examine the patient's knee joint to determine if there is tenderness, redness, or swelling. In addition, the amount and degree of movement in the knee and hip will be assessed. As instrumental diagnostic methods, radiography of the lower leg and knee joint is mainly used, which allows one to visualize the area where the patellar tendon and tibial bone combine.
Treatment of Schlatter's disease of the knee joint in a teenager
Usually this disease can be cured on its own, and its symptoms disappear immediately after bone growth stops. However, if the symptoms are severe, you should include medication, physiotherapy and physical therapy - exercise therapy.
As part of the medical treatment of Schlatter's disease of the knee in a teenager, ointments and tablets are usually prescribed painkillers such as acetaminophen, Tylenol and other drugs. Another medication that may be suitable is ibuprofen. Physiotherapy makes it possible to reduce inflammation and relieve swelling along with pain.
Exercise therapy
Physical therapy is necessary to select exercises aimed at stretching the quadriceps muscle and hamstrings, which will subsequently certainly reduce the load on the area where the tissues of the patella attach to the tibia. Exercises aimed at strengthening the thigh muscles can also help stabilize the knee joint. It wouldn't hurt to change your lifestyle. Knee surgery for Schlatter's disease in a teenager is required only in the most extreme cases.
Among other things, the following measures for treatment, prevention and pain reduction are proposed:
- You should provide complete unloading of the joint and limit those activities that increase symptoms, for example, jumping, kneeling, or running.
- You can apply cold to the damaged area.
- Use knee pads while playing sports.
- Replace sports based on running and jumping with sports such as cycling or swimming. It is advisable to do this at least for the time necessary for the symptoms to subside.
Among other things, it will be useful to massage the lower extremities. During physical therapy exercises, it is advisable to include exercises specially designed for this purpose, which will reduce the tension of the patellar tissue attached to the tibia. In addition, the treatment complex must certainly include exercises that will be aimed at general strengthening of the thigh muscles. An excellent addition to therapeutic measures can be the use of folk remedies.
Surgery
In situations where there is pronounced destruction and deformation of bone tissue in the area of the head of the tibia, it may be necessary to resort to surgical intervention. The general essence of such an operation is to eliminate necrotic foci and areas with subsequent suturing of the fixing tuberosity of the tibial bone graft. This is serious.
Among the majority of patients who suffered from Schlatter's knee joint disease in a teenager (photo above) and underwent treatment, a pronounced protrusion of the tibial tuberosity in the form of a lump remains. But this causes absolutely no pain or discomfort and completely preserves the normal functioning of the knee joint. Although in some cases various complications may occur, during which the patella shifts slightly upward and it begins to deform. In addition, it is possible to develop osteoarthritis of the knee joint, as a result of which pain will be constantly felt while supporting the bent knee. A number of patients who have completed the course of treatment continue to complain about persistent discomfort and aching aches that occur in the knee due to changing weather.
Thus, even despite the possibility of treating Schlatter’s disease of the knee joint in a teenager at home, it is still advisable not to heal this disease on your own. And in accordance with the treatment course prescribed by the orthopedist, traumatologist or surgeon.
Osgood-Schlatter disease can present as a painful lump in the area below the kneecap during childhood and adolescence as puberty begins. Osgood-Schlatter disease occurs most often in children who participate in sports, especially sports such as running, jumping, or sports that require rapid changes in movement trajectories, such as football, basketball, figure skating and gymnastics.
And although Osgood-Schlatter disease is more common in boys, the gender gap narrows as girls become more involved in sports. Osgood-Schlatter disease affects more adolescents who play sports (by a ratio of one to five). The age range of incidence has a gender factor, as girls experience puberty earlier than boys. Osgood-Schlatter disease usually occurs in boys between 13 and 14 years of age and in girls between 11 and 12 years of age. The disease usually goes away on its own as bone growth stops.
General information
Osgood-Schlatter disease is a specific disease of the musculoskeletal system, namely the knee joints, characterized by dystrophic damage to the tibia in the area of its tuberosity. Such aseptic destruction of bone tissue occurs against the background of permanent or acute trauma and usually affects only young people at the stage of intensive skeletal development.
Clinically, the disease is manifested by swelling of the knee joint, the formation of a kind of growth (bump) under it and pain in its lower part, which occurs during normal physical activity (running, squats, etc.) or even without it.
This pathology was first described in 1878 by the French surgeon O. M. Lannelong under the name “Apophysitis of the tibia,” and in 1903, thanks to the work of the American orthopedist R. B. Osgood and similar works of the Swiss surgeon K. Schlatter (Schlatter), it appeared its more detailed nosography. Wikipedia defines this painful condition with the term “Osteochondropathy of the tibial tuberosity,” and the international classification assigned it the ICD-10 code – M92.5 “Juvenile osteochondrosis of the tibia and fibula.” Despite this, in medical practice this disease is still most often referred to as “Osgood-Schlatter disease” or simply “Schlatter disease”.
Schlatter's disease and military service
The conscription age in the Russian Federation applies to young people over 18 years of age. By this time, this pathology is in the stage of regression. And therefore it is not a reason for exemption from military service and conscription into the army.
A deferment is possible if there is a need to carry out a full course of treatment measures (usually it ranges from 6 to 12 months). The call is not carried out if Schlatter's disease has led to a functional impairment of the motor ability of the joint.
Pathogenesis
The mechanism of occurrence and further development of Osgood-Schlatter syndrome is directly related to the patient’s age and physical activity. According to statistics, in the vast majority of cases, doctors diagnose Schlatter's disease in children and adolescents in the age group from 10 to 18 years, while young people involved in sports suffer from it 5 times more often than their peers leading a passive lifestyle . The same reason for more intense physical activity explains the fact that this osteochondropathy mainly affects boys.
As is known, two large bones are involved in the formation of the human knee joint - the femur (above the knee) and the tibia (below the knee). In the upper part of the last of them there is a special area (tuberosity), to which the quadriceps femoris muscle is attached by means of a tendon. It is this part of the bone that is responsible for its growth in childhood and adolescence and is therefore particularly susceptible to various injuries and damage. During active physical activity, in some cases, the knee joint is subject to a large load and the quadriceps muscle is overstrained, which leads to stretching or tearing of the tendon and a lack of blood supply in this area. As a result of such a traumatic effect and a decrease in nutrition in the area of the tibial tuberosity, gradual necrotic changes develop in it, up to the death of individual parts of its core.
In addition, any injury to the knee joint or constant impact on its musculoskeletal structure (for example, jumping) can cause cracks and microfractures of the tibial tuberosity, which the growing body tries to quickly compensate for by the growth of new connective tissue. As a result of this, a person develops a bone growth (bump), typical of Osgood-Schlatter osteochondropathy, that forms just below the knee. Such a pathological process usually involves one leg, but bilateral involvement of the lower extremities is also possible.
The mechanism of occurrence of Schlatter's disease
This disease belongs to osteochondropathy - a group of pathologies that occur with various changes in the structure of cartilage and bones.
Frequent training leads to regular contraction of the quadriceps femoris and stretching of the patellar tendon. This causes trauma to insufficiently strengthened periarticular tissues.
Since the load does not stop, microtraumas and microtears do not have time to heal. As a result, the tibial tuberosity becomes an area of chronic injury and its blood supply is disrupted.
Due to insufficient nutrition, aseptic inflammation (non-purulent) occurs; the bone tissue at the site of damage is deformed, turning into a painful growth, and then gradually dies.
Since such microdamages do not appear overnight, the symptoms increase gradually:
- at first the person feels slight pain when moving;
- then, against the background of incessant loads, it intensifies, and a painful swelling appears on the lower leg.
Sometimes the pathology occurs in combination with tendonitis (inflammation of the patellar and quadriceps tendons), so pain is also felt along the tendon.
The disease can occur in waves - more acute periods are followed by complete recovery, and then the symptoms resume. But more often, more or less pronounced pain persists constantly, for a long time - from 12 to 24 months.
By the end of growth, all symptoms of Schlatter osteochondropathy disappear without a trace in 99% of cases without treatment. This usually happens between 17 and 20 years of age.
In adults, Schlatter's disease is diagnosed in 1% of cases. It is usually the result of ineffective treatment or complications of pathology during adolescence or young adulthood.
Classification
In the orthopedic environment, this pathology is usually classified according to the degree of its severity and the severity of the observed external and internal symptoms. Regarding this, there are three degrees of Schlatter’s disease, namely:
- initial – visual manifestations in the form of a lump-like growth under the knee are absent or minimal, pain in the area of the knee joint is episodic, mild and occurs mainly at the time of physical activity on the leg;
- an increase in symptoms - swelling of the soft tissues around the affected knee appears, a lump becomes visually visible directly below it, pain syndrome manifests itself during the period of loads on the leg and for a certain period of time after them;
- chronic - a lump-like formation is clearly visible under the knee, which is most often surrounded by swelling, discomfort and pain in the joint is persistent and is observed even at rest.
How to treat Schlatter's disease at home
In some cases, Schlatter's disease can be treated at home, but only after an accurate diagnosis and visit to a doctor. These are mainly physical exercises and local therapy:
- For constant and intense pain in the knee, in conjunction with medications, use compresses at night with non-steroidal topical drugs.
- The use of folk remedies in the form of a variety of ointments, cold compresses based on chamomile, celandine, wax, honey, St. John's wort, knotweed, and yarrow is encouraged.
- Massage with non-steroidal anti-inflammatory ointments for external use.
- Therapeutic exercises alleviate the patient’s condition and prevent relapses of the disease. Do stretching exercises daily
- The patient must remain calm and ensure a comfortable position of the affected joint;
- During the rehabilitation period, completely limit physical activity on the sore leg.
Causes
There are two main physical activity-related underlying causes of Osgood-Schlatter disease in adolescents and children:
- direct injuries to the tissues of the knee joint (subluxations and dislocations, sprains, bruises, fractures);
- systematic microtraumas (external and internal) of the knee joint that occur as a result of intense sports or other activities associated with excessive physical stress on the lower extremities.
The greatest risk factors for Schlatter's disease in adolescents and children are:
- football, basketball, handball, hockey, volleyball, tennis;
- track and field athletics, acrobatics, gymnastics;
- judo, kickboxing, sambo;
- skiing, sports tourism, figure skating, cycling;
- ballet, sports and ballroom dancing.
What could be the consequences?
Negative consequences of pathology are extremely rare. In the vast majority of cases, the disease is characterized by a benign course and independent regression after a person’s growth stops (23-25 years). It is then that the growth zones of the tubular bones close and, accordingly, the very substrate for the development of Osgood-Schlatter disease disappears. In some cases, an adult may be left with an external defect in the form of a tubercle under the knee, which does not in any way affect the function of the knee joint and the lower limb as a whole.
Consequence of Schlatter's disease in the form of a lump under the knee in an adult
But sometimes a complication such as fragmentation of the tuberosity can occur, that is, detachment of the sequestrum of the bone and separation of the patellar ligament from the tibia. In such cases, normal leg function can only be restored through surgery, during which the integrity of the ligament is restored.
Symptoms of Osgood-Schlatter disease
The severity of the negative manifestations of this pathology in different patients may differ depending on the nature of the injuries received, the degree of physical activity and the personal characteristics of the body.
At the beginning of the development of the disease, the patient begins to experience vague pain in the knee area, which usually appears after or during physical activity on the affected limb. As a rule, such pain is not yet associated with an internal pathological process and therefore there are quite few visits to the doctor during this period.
Over time, pain symptoms begin to increase, are localized in one place and can appear not only during physical activity, but also at rest. At the same time, swelling caused by edema appears around the affected knee, and a lump-like growth appears just below it. During this period of illness, it becomes increasingly difficult for the patient (especially the athlete) to perform his usual exercises, and sometimes even natural leg movements. The greatest intensity of pain is observed in the body position - kneeling.
Photo of a “bump” in Osgood-Schlatter disease
In addition, the patient may experience other negative symptoms:
- tension in the leg muscles (mainly the thigh muscles);
- limited mobility of the knee joint;
- outbreaks of sharp “shooting” pain in the knee area, arising when it is overstrained;
- severe morning swelling in the upper or lower part of the knee, which forms the day after physical activity.
When you independently palpate the affected knee, points of pain are felt, as well as smoothness of the contours of the tibia. The texture of the knee joint is felt as densely elastic, and a hard lump-like formation is felt under the swollen soft tissues. The general well-being of the patient, despite the accompanying pain and pathological processes in the knee, does not change significantly. The skin over the affected joint does not turn red, temperature indicators remain normal.
In most clinical cases, this disease occurs in a measured chronic form, but sometimes its wave-like course can be observed with periods of sudden exacerbation and relative calm. Without medical intervention and with continued physical activity, negative symptoms can persist for many months and worsen against the background of further mechanical damage to the knee joint. However, the manifestations of the disease gradually disappear on their own over 1-2 years, and by the time the period of bone tissue growth ends (approximately 17-19 years) they usually eliminate themselves. Before treating Osgood-Schlatter, the need for such therapy should be comprehensively and individually assessed, since in some cases it may be inappropriate.
What is Osgood-Schlatter disease of the knee?
For the first time, this type of pathology of the knee joint was systematized and described by the doctor Osgood Schlatter (or Osgood Schlatter) in 1906, after whom this disease was later named.
In addition, in the medical literature the disease can be found under other names:
- Aseptic lesion of the tibia with localization in the epiphysis.
- Osteochondropathy of the tuberosity of the tibia.
The pathological process develops gradually, initially affecting the cartilage tissue of the knee joint. This causes a protrusion (in the form of a lump) to form under the kneecap.
Over time, cartilage tissue degenerates into bone tissue, and as a result, the range of motion of the knee joint may be impaired.
Schlatter's disease of the knee joint
A detailed study of this disease allows us to establish that, in essence, it is a manifestation of osteochondrosis. In this regard, according to the international classification (ICD 10), it was assigned the digital code M92.5 (osteochondrosis in adolescence, localized on the tibia).
Tests and diagnostics
In general, the doctor can suspect the development of Schlatter’s disease due to the complexity of the patient’s clinical manifestations and the localization of the pathological process typical for this disease. The gender and age of the patient also play an important role in correct diagnosis, since adults, as a rule, are not exposed to this type of damage. Even through a simple visual examination and the usual collection of anamnesis regarding previous injuries or overloads of the knee joint, an experienced orthopedic traumatologist is able to make the correct diagnosis, but it would be useful to confirm it using some hardware diagnostic methods.
The decisive factor in making a definitive diagnosis of Osgood-Schlatter disease in children and adolescents has been and remains radiography, which, in order to increase the information content of the pathology course, is best carried out dynamically. To exclude other orthopedic diseases, such an examination of the affected knee joint must be carried out in two projections, namely lateral and direct.
In the initial phase of the development of the disease, X-ray images show a flattening of the tibial tuberosity in its soft part and a rise in the lower edge of the clearing, corresponding to the adipose tissue located in the anterior lobe of the knee joint. The last discrepancy with the norm is caused by an increase in the size of the infrapatellar bursa, which occurs as a result of its aseptic inflammation. There are most often no visible changes in the ossification nucleus itself at this stage of Schlatter’s disease.
As the pathology progresses, the x-ray picture changes for the worse. The photographs show a shift of the ossification nucleus by 2-5 mm upward and forward relative to the standard location of the tuberosity or its fragmentation. In some cases, there may be unevenness of the natural contours and unclear structure of the ossification nucleus, as well as signs of gradual resorption of its parts, but most often it fuses with the main body of the bone with the formation of a bone conglomerate in the form of a spiky protrusion. This “bump”, characteristic of Schlatter’s disease, in the later stages of the disease is especially clearly visible on a lateral radiograph and is clearly palpable during palpation in the area of the tuberosity.
In some atypical cases, an appointment may be necessary MRI, CT and/or Ultrasound problem knee and adjacent tissues, allowing you to clarify the expected diagnosis. It is also possible to use a technique such as densitometry, which will provide comprehensive data on the structural state of the bones being studied. Other laboratory diagnostic methods, including PCR studies and blood tests for rheumatoid factor and C-reactive protein, are carried out in order to exclude the possible infectious nature of problems with the knee joint (mainly nonspecific and specific arthritis).
Differential diagnosis of Osgood-Schlatter syndrome must be carried out with any fractures in the knee joint, tuberculosis of the bones, tendonitis patella, osteomyelitis, infrapatellar bursitis, Sinding-Larsen-Johanson disease and tumor neoplasms.
In order to make a diagnosis, the therapist only needs to examine and interview the patient. But in order to exclude the presence of complications or concomitant pathologies, the doctor prescribes additional diagnostic tests:
- X-ray examination.
X-rays will allow you to take a clear picture of the fragmentation of the tibial tuberosity, as well as determine the exact size and location of the new bone formation.
- Ultrasonography.
An ultrasound machine is not often used to diagnose Schlatter's disease. However, only ultrasound waves can show the echogenicity of the tumor. Seals usually indicate the presence of inflammation.
- MRI and CT.
The results of these examinations are the most informative, but the procedures themselves are quite expensive and take a long time to complete. Therefore, if there is no suspicion of complications, an ultrasound or radiography is prescribed.
Treatment with folk remedies
With the permission of the attending physician and in addition to traditional methods of treating Schlatter's disease, the use of folk remedies is allowed, which mainly boil down to the use of various compresses and rubbing that relieve pain and inflammation. The following recipes have proven themselves well in this direction.
Honey compress
To make such a product, natural fresh honey should be mixed in equal proportions with medical alcohol and heated in a water bath until the honey is completely liquefied. Immediately after this, you need to moisten a clean piece of gauze in this mixture, apply it to the problem joint and wrap it first with cellophane and then with a warm cloth (preferably wool). Such procedures can be carried out twice a day for a month, keeping the compress on the knee for approximately 2 hours.
St. John's wort and yarrow
A kind of ointment is prepared from a crushed mixture of these herbs (in equal proportions), for which they are mixed with rendered pork fat, and then heated over low heat for 15 minutes. After cooling, the ointment is considered ready for use and can be rubbed into the skin around the injured knee 2-3 times a day.
Garlic
Two medium heads of garlic are peeled, passed through a garlic press and mixed with 400 ml of regular apple cider vinegar. Before use, this drug should be infused for a week in a dark glass container, where it can then be stored for six months. The method of application is to rub a small volume of this tincture into the damaged knee area 2-3 times a day.
Burdock
Finely chop a few fresh burdock leaves, place them on clean gauze and wrap it around the painful part of the leg for 3 hours. This dry compress is placed at night and applied once every 24 hours for one month (instead of burdock, you can take cabbage or plantain leaves).
Onion
Grate two small peeled onions on a fine grater and mix them with 1 tsp. granulated sugar. The resulting mixture is used for night compresses for about a month.
Healing oils
Camphor, clove, eucalyptus, menthol oil and aloe juice should be carefully mixed in equal proportions. This mixture should be rubbed into the skin over the damaged area several times a day, and then wrapped with a warm cloth.
Traditional healing recipes
As an additional treatment at home, after consultation with the doctor, you can use alternative medicine methods:
- An infusion of dry comfrey and black root rhizomes is very suitable for a compress. To prepare the infusion, take 5 spoons of each ingredient, after which they are poured with boiling water and infused for 10-12 hours. The bandage with the compress should remain on the knee for no more than 8 hours.
- Fir oil will help relieve pain, if used morning and evening.
- Using sunflower seed oil or olive oil also allowed for compress.
Prevention
Prevention of the first occurrence or re-development of Schlatter's disease in general consists of controlling the intensity of physical activity performed by a child or adolescent on the lower extremities, especially if he is actively involved in sports, dancing, etc. This largely depends on the parents, since young people are rarely aware of the adequacy of their own training and can constantly overexert themselves. Also, an important role in the preservation of the joints and the entire skeletal system during the period of its growth is played by good nutrition, which should include the entire complex necessary for a developing organism. minerals And vitamins. In addition, it is imperative to undergo full professional treatment for any injuries sustained by children, even if at first glance they seem insignificant.
Surgery
Surgical treatment is indicated when the disease persistently progresses. The essence of the surgical intervention is to remove lesions that have undergone necrosis, as well as to stitch together an implant that secures the tuberosity of the tibia.
Surgical treatment of Schlatter's disease is advisable in the following cases:
- with a long course of the disease (more than two years);
- in the presence of complications (bone destruction or rupture of the patellar ligament);
- if you are over 18 years of age at the time of diagnosis.
Surgical intervention is simple, but such interventions are characterized by a long recovery period, on which subsequent motor activity of the leg depends. For quick rehabilitation, you need to follow some rules:
- after the operation, use a fixing bandage on the joint or use a knee brace for a month;
- undergo a course of physiotherapy for rapid restoration of bone tissue (electrophoresis with calcium salts);
- taking dietary supplements based on calcium and vitamin-mineral complexes (for six months);
- avoid massive physical stress on the joint throughout the year.
Osgood-Schlatter disease in adults
The age group at increased risk of developing Schlatter's disease includes only children and adolescents, whose tibia in the area of their tuberosity are in the process of intensive growth. As it stops and the body naturally matures, the tuberosity zone becomes stronger and eventually completely ossifies, which in itself excludes the development of this disease in adults. The only thing that can connect adults with this osteochondropathy is its residual changes in the form of small tubercles under the knees.
Possible complications
Very rare but dangerous complications of osteochondropathy are:
- patella displacement;
- bone destruction (destruction of bone and cartilage tissue);
- osteoarthritis of the knee (destruction of the articular surfaces).
If treatment is untimely or ineffective, they usually persist in adults.
Click on photo to enlarge
Complications and consequences of Osgood-Schlatter
Most often, Osgood-Schlatter disease does not lead to any serious complications in the damaged knee joint and goes away over time with virtually no consequences. Sometimes, at first after treatment, local swelling or minor pain persists in the knee area, which usually occurs after excessive physical exertion.
Also, quite often, in the area of the previously affected lower leg, a formed bone growth remains noticeable, which, as a rule, does not affect the mobility of the knee joint and does not cause a feeling of discomfort both in everyday life and during sports. In rare cases, with severe cases and/or improper treatment of Schlatter's disease, such a bone growth can provoke deformation and displacement of the patella. Patients with this complication in adulthood often suffer from knee osteoarthritis and may experience pain when kneeling, as well as aching pain when weather conditions change.
Characteristic symptoms
The disease begins with mild pain in the lower leg associated with strong movements of the leg. After stopping activity, the pain goes away. At this stage, the pathology does not worsen the patient’s quality of life or limit his ability to work.
Gradually, pain appears with normal movements such as walking.
After another workout, sometimes for no apparent reason, the pain intensifies to the point of being unbearable. A swollen, painful lump appears on the lower leg, noticeably protruding above the surface of the skin.
Edema on the lower leg due to Schlatter's disease
At this stage, any movement causes pain and limited mobility in a person.
The pain can be constant, of varying degrees of severity, with sudden attacks during exercise. Or it subsides completely for a certain period, and then resumes again.
In this case, the patient never has a fever or signs of general intoxication. There are also no local changes above the cone area.
In all adults who suffered from the disease in childhood, a protrusion is felt on the lower leg. Active movements in the joint are preserved in full. Some people are bothered by aching pain and aching in the knee when there is a sudden change in weather conditions.
Osteochondropathy often affects both legs.
List of sources
- Abalmasova E.A. Osteochondropathies // Orthopedics and traumatology of childhood. - M., 1983. - P. 385-393.
- Gorodnik A.G., Lantsov V.P. The problem of Osgood Schlatter's disease // Vestn. X-ray Radiol. - 1963.- No. 38.-С14-17.
- Pozharsky V.F., Osteochondropathy of the tibial tuberosity (Osgood Schlatter disease) // Medical assistant Obstetrics.- 1982.- No. 47(9).- P.53.
- Pudovnikov S.P., Tarabykin A.N. “Method of surgical intervention for Osgood-Schlatter disease” // Military Medical Journal 1987. - No. 7. - P. 62.
- Esedov E.M. “Osgood-Schlatter syndrome” in the practice of a therapist // “Clinical Medicine”. - 1990, - No. 1. - P. 109-111.
Proper nutrition for Schlatter's disease
The basis of dietary nutrition for this disease is the consumption of foods with a high content of vitamins and calcium:
- The daily diet should include vegetables rich in coarse fiber(cabbage, beets and pumpkin, bell peppers and tomatoes). Among fruits, you should give preference to apricots, citrus fruits, and persimmons.
- Fermented milk products have a high calcium content(kefir, fermented baked milk and yogurt).
- Try to avoid eating fatty meats, if possible, replacing them with lean beef, chicken, and seafood (sardines, flounder, tuna).
Pathogenesis of the disease
The quadriceps muscle is designed to extend the leg at the knee. It is located on the thigh, its lower part is attached to the kneecap (patella), which in turn is connected to the upper part of the tibia, where the ossification zone has not yet closed in adolescents. Excessive contraction of a poorly stretched quadriceps muscle leads to excessive stress on the patellar ligaments.
The tibia in adolescents is not fully formed and continues to grow. She is not strong enough for such loads. Therefore, inflammation and pain occur at the site of attachment of the ligaments to it. As a result of circulatory disorders, small hemorrhages appear. In more severe cases, separation of the upper epiphysis and aseptic (microbial-free) necrosis of the osteochondral areas occurs. Detachment of the periosteum may occur.
Pathogenesis of Schlatter's disease
The disease is characterized by alternating periods of death of small areas of tissue and their restoration. The necrosis zone is replaced by dense connective tissue. Gradually, a growth forms at the site of a long-term injury - a callus. Its value depends on the intensity and duration of the damaging effect. In the popliteal region, a thickened tuberosity is identified - a bump. It can be detected by palpating the lower leg, and if large, during examination.
Preventive actions
As with any disease, it is better to prevent Schlatter’s disease than to waste time and money on its treatment. To do this, you should pay attention to the following preventive rules:
- if you send your child to professional sports, you are obliged to monitor his nutrition;
- any sports training should be alternated with rest breaks;
- in case of an injury of any severity, it is necessary to completely heal it in order to avoid unforeseen consequences;
- If you experience pain of any kind, consult a doctor immediately4
- try to avoid increased stress on the knee area.
Preventive measures will help avoid disease. But, if Schlatter’s disease has already occurred, then for a complete cure you should follow all medical prescriptions.
During the treatment process, it is advisable to avoid stress in the knee area, up to complete cessation of sports activities. After all, there is nothing more important than a healthy body.
Diagnostic methods
In the case of a typical course of pathology and the presence of characteristic external signs of osteochondropathy, diagnosis is not difficult. To do this, the specialist only needs to examine the patient and find out the characteristic complaints and risk factors for the disease.
X-rays are used to confirm the diagnosis. The photographs reveal an increase in the size of the tibial tuberosity and its heterogeneous structure. In the case of fragmentation, the images show the separation of a bone fragment with a visible fracture zone. In difficult to diagnose cases, they resort to magnetic resonance and computed tomography.
X-ray of a patient with Osgood-Schlatter disease
Another valuable diagnostic method is ultrasound. In this case, the ultrasound doctor can see an increase in the size of the tuberosity and its heterogeneous echostructure, as well as an increase in the size of the patellar ligament.
Differential diagnosis should be carried out with infrapatellar bursitis, cartilage or bone tumor, osteomyelitis, and handromalacia of the patella. The latter pathology is especially often disguised as Osgood-Schlatter disease in teenage girls, so below are criteria that will distinguish these two conditions.
If an adult is diagnosed with Osgood Schlatter disease, treatment includes simple remedies that can help manage the pain.
Treatment tips:
- Get plenty of rest. It is necessary to allow the joint to rest - this is the most important thing that can be done in the situation of this disease. In addition, it is necessary to limit any load and not put any supporting weight on the joint during any movements.
- Apply cold compresses. They will help reduce inflammation. The compress can be done three times a day for 10-15 minutes, repeating the procedure every day.
- Massage. Massaging the quadriceps muscle is effective in stretching it and making it flexible enough to take on the everyday stresses placed on the joint. One method involves massaging the leg from the ankle up one side of the leg to the thigh and back down. Massage can be done 5 to 10 times a day.
- Using knee pads. Applying a patellar tendon or knee brace can be a great help in treating the condition in adults. This is achieved by reducing muscle tension and supporting the knee joint. A knee brace helps absorb shock to the knee and change the angle of forces that affect the tendon. The knee brace can be worn whenever there is pain in the knee. You can try different types of knee pads to find the one that suits you best.
- Taking medications. Your doctor will likely suggest nonsteroidal anti-inflammatory drugs, or NSAIDs, to reduce inflammation, such as ibuprofen. However, if the patient has asthma or heart problems, Ibuprofen is not allowed for use.
- Use of external support. If a serious case of the disease is diagnosed, a cast may be needed to relieve pain. An x-ray will help determine damage to the bones of the joint.
- Surgery. In extreme cases, surgical treatment of this disease in adults is possible. Sometimes a broken bone fragment can cause severe pain, in which case it will need to be operated on. One of the side effects of the surgery is a problem with blood circulation below the knee, but this problem is short-term and regular blood flow is restored quite quickly.
The long-term consequences of Osgood-Schlatter disease are usually minor. The disease stops when sports activity decreases or the growth spurt ends in children and when necessary measures are taken to protect the joint in adults.
In rare cases, a painful bone spur develops below the kneecap, which can be removed surgically. Surgical treatment of the disease is considered effective in eliminating its complications in adulthood.
How does the disease manifest?
During sports training you have to perform a lot of sudden movements. The result has the following consequences:
- the tendon is greatly stretched;
- microscopic tendon ruptures occur;
- The tibia does not receive the necessary nutrition obtained from normal blood circulation. As a result, a growth appears.
In adolescents, the tubular bones connecting to the cartilage have growth zones and are able to stretch in length. Unlike bone tissue, cartilage does not have a very dense structure, so it is often injured during training. The site of injury begins to swell, pain and inflammation appear.
The body, trying to protect itself from injury, begins to independently restore the damaged growth zone, which leads to the formation of a growth at the site of edema.
Treatment methods
Treatment of Schlatter's disease of the knee joint is provided by several methods:
Regardless of the treatment prescribed for Schlatter’s disease of the knee joint, it is necessary to adhere to a certain lifestyle during the treatment and recovery period. Activities that cause pain should be avoided and stress on the knee area should be limited or removed.
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During periods when the disease worsens, you should not engage in intensive training. Swimming and gentle exercise on exercise bikes are allowed.
Symptoms
The symptoms of the disease are so specific and not expressed that initially the patient does not pay the slightest attention to the first “alarm bells”. He does not in any way associate the mild pain that periodically occurs in the knee joint with a previous knee injury. At first, pain begins to bother you when going up/down, bending your leg, squatting, and running. As the load on the knee increases - intense training and participation in sports - the symptoms of the disease begin to appear more clearly.
Previously, mildly disturbing pain in the lower part of the knee intensifies over time, becomes intolerable during movement, and subsides in a calm state. Sometimes a sharp, paroxysmal pain appears in the front of the knee joint - in the area where the patellar tendon attaches to the tibial tuberosity. A slight swelling of the knee joint becomes noticeable. However, the patient's general condition does not change - increased body temperature and redness of the skin are not typical for Schlatter's disease.
A visual examination of the knee allows us to draw conclusions about its swelling, due to which the contours of the tibial tuberosity are slightly smoothed. Palpation reveals the presence of a hard protrusion under the swelling, pain in the affected area and its swelling. The latter is characterized by a densely elastic consistency. During the process of bending/extending the knee, pain appears - and its intensity may vary.
Symptoms and degrees
The main symptom of Schlatter's disease is a specific neoplasm in the area of the tibial tuberosity in the form of a dense and immobile lump directly under the kneecap. The skin over the formation is unchanged, there are no signs of inflammation (redness, hyperthermia). In some cases, there may be slight swelling and tenderness when pressed.
The second sign is pain. The pain syndrome varies in intensity and occurs, as a rule, during physical activity and after physical exertion. With rest the pain goes away.
The function of the knee joint is not impaired unless there are complications. Tension and tenderness in the quadriceps femoris muscle are also detected.
There are 3 degrees of clinical course of the disease:
- first - external signs of pathology are minimal or completely absent (no lump yet), but pain is observed;
- second – characteristic external signs of the disease appear in the form of a lump under the knee, the pain becomes more intense;
- third - the pathological process becomes chronic, accompanied by a constant feeling of discomfort, pain and external signs of osteochondropathy.
In the photo of the knee joint of a patient with Osgood-Schlatter disease, a specific lump is clearly visible - the main symptom of the pathology
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Causes of the disease
Doctors consider bruises and injuries to be the provocateur of Schlatter's disease. These include:
- Displacement of articular surfaces;
- complete or partial disruption of the integrity of the bone tissue in the knee;
- rupture of the knee ligaments;
- systematic microtraumatization possible during competitive activities.
Twenty percent of teenagers who are actively involved in sports suffer from this pathology. Only 5% of cases occur among unsportsmanlike children who do not play sports. That's what the statistics say.
Doctors have identified a number of sports games in which the risk of developing the pathology in question increases:
- Hockey;
- basketball;
- football.
Teenagers involved in other sports also fall under the disease:
- Figure skating;
- gymnastics;
- ballet.
Doctors believe that the disease progresses due to the following circumstances:
- A fragile, young organism;
- Heavy, prolonged physical activity;
- Psychological pressure under the influence of competitive activity.
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How is the treatment carried out?
Conservative therapy
After the patient has undergone x-rays and other diagnostic methods that have confirmed the occurrence of Osgood-Schlatter disease, treatment begins. Its essence is to completely get rid of the inflammatory process, which is localized in the area of attachment of the patellar ligament. First of all, patients will need to give up physical activity for a while and follow a gentle daily routine.
Sometimes, if there is tibial tuberosity, you need to fix it using a special bandage. A tight bandage can also be used, with the help of which it is possible to reduce the amplitude of displacement. As for medications, they resort to the use of analgesics, painkillers and non-steroidal anti-inflammatory drugs. Osgood-Schlatter disease in adults will also need to be treated with vitamins B and E.
Physiotherapeutic methods
The method of physiotherapy prescribed by the doctor is directly related to the results of the x-ray. After receiving the answer, patients are divided into 3 groups:
- First. Ultraviolet irradiation and magnetic therapy are used.
- Second. Electrophoresis is used, during which lidocaine is used. After this, nicotinic acid and calcium chloride are prescribed, then magnetotherapy is prescribed.
- Third. First of all, they resort to electrophoresis with aminophylline, after which potassium iodine is used. The final stage of physiotherapeutic treatment for this radiology group is magnetic therapy.
In addition, the following physiotherapy methods can be used:
- phonophoresis,
- laser therapy,
- shock wave treatment.
Thanks to an integrated approach, during which drug treatment and physical therapy are used, it is possible to improve the patient’s condition and relieve him of pain. Moreover, it disappears not only at rest, but also during physical activity. However, therapy takes a fairly long period. Most often it lasts from 3 months to six months.
Is surgery necessary?
Surgical intervention is resorted to if conservative therapy lasts more than 2 years and does not bring the required effect. In addition, surgery is also prescribed when patients suffering from Osgood-Schlatter disease experience the following conditions:
- severe pain that cannot be eliminated with medication,
- fragmentation of the tibial tuberosity.
Doctors consider the operation quite easy. In its process, separated bone fragments are removed and plastic surgery of ligaments and tendons is performed. Mostly, the rehabilitation period after surgery takes a short time. The patient will need to wear a pressure bandage for a month. It is applied to the area of the tibial tuberosity.
The recovery period involves prescribing certain medications to the patient, as well as physical therapy. 14 days after the operation, pain in the knee, which is observed at rest, disappears from patients. As for disability, the period will take mainly 3 months. You are allowed to return to sports activity no earlier than six months after surgery to eliminate Schlatter's disease of the knee joint.
Treatment in Israel and Europe
Therapy for this pathology in medical clinics in Israel has a number of advantages, since the treatment process is based on the latest technologies, which make it possible to eliminate the symptoms of the disease in the shortest possible time.
In addition, unlike treatment centers in Germany or Italy, the cost of treatment is much lower.
The treatment process includes the use of the full scope of physiotherapeutic procedures, and if necessary, after 14 years of age, surgical intervention can be used, followed by a rehabilitation period.
Sports that can cause the development of Schlatter's disease
Further. Schlatter's disease occurs in almost twenty percent of adolescents who take part in sports competitions, while only a small part of them are not involved in active activities at all.
The disease can often manifest itself against the backdrop of hobby activities that require a lot of jumping, running and changing the trajectory of movement, for example:
- football;
- ballet;
- basketball;
- gymnastics;
- volleyball;
- figure skating.
How to relieve pain in the knee joint in a teenager with Schlatter's disease? More on this later.
Treatment
The disease can be easily cured; the main thing is to seek help in time and follow all the doctor’s recommendations.
Can I exercise during treatment? During the period of therapy and rehabilitation, you need to forget about sports, you need to avoid any overload of the joint. Treatment of Schlatter's disease will only be effective if you change your lifestyle. Therapeutic exercises and diet are required. It is necessary to take multivitamin complexes.
Schlatter's disease of the knee can be treated conservatively or surgically. The latter method is resorted to only when complications arise.
In children
Schlatter's disease in children and adolescents can resolve on its own without treatment. Therapy is needed only if complications develop:
- transition of the disease to the chronic stage, when symptoms persist even after the end of skeletal growth;
- the formation of a lump on the knee, which does not resolve and causes pain while walking;
- significant swelling of the knee joint.
Therapy depends on the degree of development of Schlatter's disease. Treatment may be limited to the use of a bandage or elastic bandage to fix the knee. You may need to wear a brace to immobilize the limb.
For severe pain, it is necessary to use anti-inflammatory and analgesic ointments, for example, Diclofenac.
Physiotherapeutic procedures have a good effect in treating the disease:
- ultrasound therapy;
- laser therapy;
- magnetic therapy;
- electrophoresis;
- thermal procedures - heating with paraffin, ozokerite;
- hydromassage;
- shock wave therapy;
- massage.
The course of physiotherapeutic procedures is 3-6 months.
During the period of treatment, patients need to limit the load on the sore knee joint. You cannot run, jump, squat or kneel. Swimming is allowed in the pool.
The operation is contraindicated for children under 14 years of age.
In adults
Treatment of the disease in adults is similar to that for children. It is necessary to wear a bandage and attend physical therapy. If there is no effectiveness from conservative therapy, then surgery is indicated.
The operation is performed using an endoscope. In the postoperative period, the patient must wear a bandage, engage in exercise therapy and attend physiotherapeutic procedures.
Causes and predisposing factors
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Schlatter's disease in adolescents usually develops during a period of intensive growth (10-18 years). The peak incidence occurs at the age of 13-14 years in boys and 11-12 years in girls. The pathology is considered quite common and is observed, according to statistics, in 11% of all adolescents involved in active sports. The onset of the disease is most often observed after a sports injury, in some cases even minor.
There are three main risk factors for developing Osgood-Schlatter disease:
- Age. The disease occurs mainly in children and adolescents; in older adults it is detected very rarely and only as residual effects in the form of a lump under the knee.
- Floor. More often, osteochondropathy of the tibial tuberosity is observed in boys, but recently, due to the active involvement of girls in sports, these indicators are beginning to level out.
- Sports activities. Schlatter's disease is five times more likely to affect children who are actively involved in various sports than those who lead a sedentary lifestyle. The most “dangerous” sports in this regard are football, basketball, volleyball, hockey, artistic gymnastics and dance sports, figure skating, and ballet.
To date, the true cause of the appearance of this form of osteochondropathy remains unknown. But many experts are inclined to believe that the formation of pathological bone growths is based on constant microtrauma (partial tears) of the tibial tuberosity due to increased load on the quadriceps muscle.
Risk factors include:
- Age 10–15 years.
- Male gender.
- Rapid skeletal growth.
- Engaging in active sports where running and jumping prevail.
According to statistics, approximately every second teenager suffering from Schlatter's disease has suffered a knee injury. Trigger factors in the development of Schlatter's disease can be direct injuries (damage to the ligaments of the knee joint, fractures of the tibia and patella, dislocations) and constant microtrauma of the knee during sports. Medical statistics indicate that Schlatter's disease occurs in almost 20% of adolescents who are actively involved in sports, and only in 5% of children who are not involved in sports.
Sports with an increased risk of developing Schlatter's disease include basketball, hockey, volleyball, football, gymnastics, ballet, and figure skating. It is sports activities that explain the more frequent occurrence of Schlatter's disease in boys.
The recent increase in girls' participation in sports has led to a narrowing of the gap between the sexes in terms of the development of Schlatter's disease.
As a result of overloads, frequent microtraumas of the knee and excessive tension of the patellar ligament, which occurs during contractions of the powerful quadriceps femoris muscle, a disorder of blood supply occurs in the area of the tibial tuberosity.
Minor hemorrhages, rupture of patellar ligament fibers, aseptic inflammation in the bursa area, necrotic changes in the tibial tuberosity may be observed.
Osgood-Schlatter disease occurs in adolescents aged 10 to 18 years, mainly in boys during a period of intensive skeletal growth. Girls are less susceptible to this joint disease, which is due to the fact that they are less involved in sports like boys.
As you already understand, Osgood-Schlatter disease occurs during a period of intense bone growth under the influence of physical stress on the knees and thigh muscles. When playing sports such as football, basketball, hockey, gymnastics, etc., there is a strong load on the area of attachment of the ligaments to the tibial tuberosity, which causes injury, the development of an inflammatory process, the blood supply to this area is also disrupted with hemorrhages, and aseptic necrosis develops with detachments of tuberosity fragments.
This chronic course of Osgood-Schlatter disease leads to alternating processes of necrosis and regeneration, which is manifested by the formation of specific lumps under the kneecaps. This is a hypertrophied tuberosity of the tibia.
The disease mainly debuts at the age of puberty, and most often occurs in those children who are intensively involved in active sports.
Traditionally, boys play more sports, so they are more susceptible to Schlatter's disease, although today girls often suffer from this pathology. The disease occurs during the period of active skeletal traction and gradually stops as the bone skeleton grows.
Approximately 15-20% of adolescents who are actively involved in sports and participate in competitions have a similar disease. Among those who do not engage in professional sports, the percentage is lower - only 3-5% of those who are sick. Most often, Schlatter's disease occurs during jumping and traumatic sports.
When to see a doctor
You need to see a doctor:
- if the knee is swollen or red;
- if knee pain affects your ability to perform normal, daily activities;
- if knee pain provokes fever, “locking” or “instability” of the knee joint.
When meeting with a doctor, it is important:
- describe in detail the symptoms of the problems encountered;
- talk about the child’s past physical problems;
- talk about physical problems common in the child’s family;
- tell about all the medications and nutritional supplements your child is taking.
The doctor may ask some questions:
- How severe is the leg pain?
- Are there any noticeable swellings near the kneecap?
- were there any injuries that could have caused the knee injury?
- Is there pain before, during, or after exercise – or is it constant pain?
- Was there any treatment at home? If so, did any of this help?
- Have you had any problems with joint mobility or stability before?
- What is your child's regular exercise or sports training regimen?
- Have there been any recent changes to your child's training regimen or training methods?
- Is the child able to tolerate the pain he experiences during sports at normal intensity?
- Do the symptoms affect the ability to perform normal, daily tasks, such as walking up the stairs?
Questions to ask when visiting your doctor:
- Is it possible to continue sports performances?
- What signs or symptoms may indicate the need for a complete break from sports activities?
- Do you need to make any changes to your sporting activity, such as changing your training or exercise plan, and if so, for how long?
- What other measures can help in this situation?
What is the essence of the disease
The development of osteochondropathy in this localization is based on a discrepancy between the intensity of blood flow and the rate of bone tissue growth in the area of the apophysis of the tibia, which occurs at the age of 8-16 years. The fact is that the apophysis has separate blood vessels, which must provide this area with oxygen and all the necessary substances. This is a very important function, since it is due to the apophysis that the bone grows in length.
During the intensive growth of a child, the increase in bone mass occurs very quickly, and blood vessels cannot grow at such a rapid pace. As a result, part of the bone in the area of the tibial tuberosity experiences oxygen starvation and a deficiency of other substances necessary for normal development. The bone becomes very fragile and vulnerable to various kinds of negative influences, for example, microtrauma.
If during this period the body experiences physical overload (sports), due to constant microtrauma in the area of the patellar tendon, an aseptic type of inflammation develops in the thickness of the tibial tuberosity, its necrosis and fragmentation with possible separation of the ligament and dysfunction of the knee joint.
The disease has a chronic and long-term course (up to 2 years). As a rule, it is characterized by benign quality and resolves on its own without any consequences.
Conventionally, there are 4 stages of the pathological process:
- Ischemia and necrosis of bone tissue.
- Revascularization (ingrowth of new blood vessels into damaged bone).
- Restoring the integrity of the tibial tuberosity.
- The stage of closure of the apophysis and cessation of the disease (as a rule, completely occurs by the age of 21-23).
Diagnostic measures
As soon as signs of the disease become noticeable, you must contact an orthopedist for medical advice and treatment.
An X-ray examination is usually prescribed. The images are taken in two projections to obtain complete information about the disease. Using the images, the doctor examines the attachment points of the patella tendons to the area of the tibia.
In some cases, when X-rays are not enough for diagnosis, MRI, ultrasound or computed tomography are used.
Consequences
If you do not pay attention to the obvious signs preceding the disease, the following consequences may occur:
- the mobility of the joint part will be impaired;
- the tumor will begin to grow, taking on a spherical shape.
Do not delay or ignore medical advice. Even after surgery, you can return to active training in the second month.
Why is this dangerous?
- In the absence of the correct influence, the disease develops into the form chronic type. The painful effect manifests itself constantly; after the child’s growth is complete, joint movement is limited, swelling appears immediately after heavy exertion.
- The appearance of a large lump on the knee. Its dimensions may be different, but it practically does not interfere with movement. At the same time, if it does not resolve on its own (this happens quite often), then it will remain forever.
- Against the background of increased articulation, inflammatory processes are formed (when soft tissues are damaged, purulent processes occur).
Surgical intervention
If the pathology continues to progress and conservative treatment does not bring any results, then surgical intervention cannot be avoided. Doctors perform an operation to mechanically remove the resulting tumor. If there is a need, they can even remove the entire area that was affected by the degenerative process. The diseased joint is replaced with a plastic implant. This method can be called radical, so it is used only after resorting to non-surgical methods of therapy.
The largest risk group is teenage boys from 8 to 18 years old who are actively involved in sports. According to statistics, 25% of children of a given gender and age experience Osgood-Schlatter disease in one form or another. And only 5% of them are not involved in active sports, but get sick due to various injuries or congenital defects of the knee cartilage.
Unfortunately, with the spread of women's sports, a unique risk group has formed among teenage girls. These are mostly girls from 12 to 18 years old, who are also actively involved in sports and receive sports injuries. Since the general vital activity of teenage girls is much lower than that of boys, the risk of the disease is lower - about 5-6%
The second significant risk group is professional athletes, usually young, who have suffered knee injuries of varying severity. Microtraumas in adulthood become the cause of disease much less frequently.
Medical statistics eloquently demonstrate that Schlatter's disease occurs in almost 20% of adolescents who experience intense physical activity as a result of sports, as well as in 5% of adolescents who do not play sports. Sports that can trigger Schlatter's disease include: football, basketball, volleyball, track and field, weightlifting, artistic gymnastics (in boys), as well as figure skating, ballet and rhythmic gymnastics (in girls). Since the percentage of boys and girls involved in sports is now comparable, this fact has led to a gap between the sexes in the development of Schlatter's disease.
In this article we will tell you what Osgood-Schlatter disease is, what are the causes of its development, treatment methods and prognosis.
What is Schlatter's disease?
Schlatter's disease has been known since 1906, when it was described by the doctor whose name it bears. Another name for the disease, “osteochondropathy of the tibial tuberosity,” reveals and explains the mechanisms that cause the development of Schlatter’s disease. From this name it is clear that the disease is non-inflammatory in nature, which is accompanied by necrosis of bone tissue. This pathology is typical for young people, children and adolescents with traumatic periostitis and refers to lesions of the musculoskeletal system. With Schlatter's disease, a certain area of the long tubular bones that make up the tibia is affected. The true causes of the development of pathology are not fully known today. However, some experts believe that there are currently several such diseases that are caused by an imbalance in bone growth processes in the context of physical overload in children and adolescents.
Causes of development of Schlatter's disease
The main factor in the development of Schlatter's disease is damage to the knee joint as a result of intense physical activity. There are a number of reasons that cause such damage and provoke this disease:
- constant overloads;
- frequent microtraumas of the knee;
- regular damage to the knee ligaments;
- direct injuries: fractures of the tibia, patella, dislocations.
Due to significant overloads, frequent injuries to the knee joint and significant tension on the patellar ligaments, which occur during contractions of the quadriceps femoris muscle, blood circulation is impaired in the area of the tibial tuberosity. Minor hemorrhages, rupture of patellar fibers, aseptic inflammation and necrosis are also noted.
The tibia is a tubular bone, its growth zones are located at its head. Since these growth plates have a cartilaginous structure, in adolescents they are not as strong as in adults whose growth has already stopped. That is, these growth zones in adults have already ossified. For this reason, such cartilaginous areas are easily vulnerable to any injury and intense physical activity. In this cartilaginous growth plate, the tendon of the quadriceps femoris muscle, which is the largest muscle in the human body, is attached to the tibia. It is involved during walking, running, jumping and in other cases of motor activity.
If a child is involved in sports professionally and experiences heavy loads on the legs, then it is possible to tear the tendons of the femoral muscle and damage the fragile cartilaginous tissue of the tibia. As a result, inflammatory processes are observed, which are accompanied by swelling of the tendon attachment area. Under constant load, the body tries to compensate for the resulting defect in the bone by filling it with bone tissue, an excessive amount of which leads to the formation of bone formation.
Schlatter's disease in adolescents
Schlatter's disease in children and adolescents usually appears during a period of intensive growth. The age limit for incidence is 12-14 years for boys and 11-13 for girls. This disease is quite common and is observed in 20% of adolescents who are actively involved in sports. Usually the disease begins for no apparent reason or after a sports injury, sometimes quite minor.
There are three main reasons that contribute to the development of this disease:
- Age factor. The disease occurs in most cases in children and adolescents. In adults, the disease is practically not observed. The disease is detected extremely rarely, and then only in the case of a residual phenomenon (bone lump).
- Gender. Medical statistics state that Osgood-Schlatter disease is more often observed in boys, but currently this situation is leveling out, since girls are also actively involved in sports.
- Physical activity. The disease is more common in children who are actively involved in various sports than in those children who lead a passive lifestyle.
The mechanism of development of the disease
Schlatter's disease in children and adolescents involves a tuberous lesion of the tibia. Part of this bone is located below the knee, its main function is to attach the patellar ligament. This is precisely the reason for the development of the disease.
The thing is that the bone process near the apophysis has its own blood vessels that supply the growth zone with the necessary substances. When a child is actively growing, these vessels simply do not have time to “grow” compared to the increase in bone mass, which naturally leads to a lack of nutrients. As a result, this area becomes very fragile and vulnerable to injury. If at this time the child experiences constant physical activity on the lower extremities, then microtraumas of the patellar ligaments occur and, as a result, Schlatter’s disease.
You should know that the resulting bone tissue is very fragile and fragile. And with regular physical activity, sequestration of the bone (severation of a piece) and the patellar ligament can occur. Such consequences are common and require surgical intervention.
This disease causes a lot of controversy among scientists. Some experts believe that Schlatter's disease of the knee is genetic. They suggest that the disease is transmitted in an autosomal dominant manner. This suggests that the tendency to the disease can be transmitted from parents to children. But this point of view cannot be fully accepted, since the factor of inheritance is not always identified. The main reason that triggers the pathology is still mechanical trauma.
Schlatter's disease can also occur in adults, but is extremely rare. In this case, it manifests itself as arthrosis, which causes swelling of the tissues under the knee. When pressing on this place, the patient feels unpleasant pain, and during an exacerbation the local temperature rises. When complications occur, bone growth develops on the front surface of the leg.
The main symptoms of Schlatter's disease
As a rule, the disease does not have an acute onset. For this reason, the onset of the disease is in no way associated with a knee joint injury. The first symptoms appear as minor pain when bending the knee, squatting, running, or climbing stairs. However, the pain tends to increase. Because such symptoms are not taken seriously, the stress on the knee joint continues, which seriously aggravates the problem. And only over time, significant pain of varying intensity is observed in the lower part of the knee, which intensifies with physical activity. Sudden sharp pain, cutting in nature, may even appear in the anterior region of the knee joint. In addition to pain, swelling and swelling of the knee joint is observed.
However, this disease is not accompanied by symptoms characteristic of inflammatory processes: redness of the skin at the site of swelling and increased temperature. On palpation, swelling of the knee joint, its pain, characteristic density and a hard knob-like protrusion are noticed. This lump persists for life, but it does not entail any problems in the future and does not in any way affect the motor function of either the knee joint or the leg as a whole.
The disease is chronic in nature with periods of exacerbation. The disease lasts 1-2 years, after which spontaneous recovery occurs, which is caused by the end of bone growth and ossification of cartilage tissue in the growth zones. Schlatter's disease completely resolves at 18-19 years of age.
Diagnosis of the disease
When diagnosing a disease, taking an anamnesis is of great importance. The combination of symptoms, the characteristic localization of pain, the age and gender of the patient allows us to accurately diagnose Schlatter’s disease. However, the determining factor in making a diagnosis remains X-ray examination in frontal and lateral projection. Sometimes additional ultrasound of the knee joint, MRI and CT of the joint are performed, which must be carried out dynamically for greater information. Densitometry is also prescribed to analyze the structure of bone tissue. Laboratory tests must be carried out in order to exclude infectious pathology (reactive arthritis).
For this purpose they prescribe:
- general blood analysis;
- blood test for C-reactive protein;
- PCR studies (polymerase chain reaction);
- blood test for rheumatoid factor.
In the initial stage of the disease, radiography demonstrates flattening of the soft cover of the tibia tuberosity. Over time, ossification may shift forward or upward. The disease must be differentiated from tumor processes, tuberculosis, osteomyelitis, and tibia fractures.
How to treat Schlatter's disease
Treatment of Schlatter's disease is carried out by several specialists: traumatologist, orthopedist, surgeon. The disease is highly treatable, and symptoms disappear as the child grows older. However, if the symptoms are significantly pronounced, then it is necessary to carry out symptomatic therapy that relieves pain and relieves swelling of the knee joint. In order to relieve pain, it is necessary to completely eliminate physical activity and provide the greatest possible rest to the affected joint.
Treatment of Schlatter's disease is carried out according to the following scheme:
- provide the patient with complete peace and comfort;
- taking medications: painkillers, muscle relaxants and non-steroidal anti-inflammatory drugs;
- physiotherapeutic methods;
- physiotherapy.
The medicines used are:
- painkillers;
- non-steroidal anti-inflammatory drugs (analgin, diclofenac, ibuprofen);
- muscle relaxants (mydocalm);
- calcium supplements and vitamin D.
Medications should be given to a child with caution, only in short courses and in small doses. You can also apply cold compresses to reduce pain.
Physiotherapeutic methods are very effective because they can relieve inflammation and reduce pain. They improve blood circulation and nutrition of the tissues of the diseased joint, help restore bone structure, and reduce inflammation and discomfort.
These methods necessarily complement the treatment program:
- ultra-high frequency therapy (UHF);
- magnetic therapy;
- electrophoresis with various drugs (calcium chloride, potassium iodide, procaine);
- shock-wave therapy;
- ultrasound therapy with glucocorticoids (hydrocortisone);
- laser therapy;
- paraffin compresses (with ozokerite, healing mud);
- warming up the knee using infrared rays;
- thalassotherapy (warm baths with sea salt or mineral water).
For each patient, the optimal treatment method is selected, which is determined by the doctor.
Physical therapy includes gentle exercises to stretch the quadriceps femoris muscle and develop the hamstrings. Such exercises reduce the load at the tendon attachment site to prevent tearing and injury.
During treatment, it is necessary to avoid physical activity and limit physical activity, which can increase pain.
In the acute period, intense physical activity should be replaced with more gentle physical therapy exercises, as well as swimming or cycling, but in a reasonable amount.
Each teenager is prescribed dietary nutrition and a vitamin and mineral complex. It is also recommended to wear a special bandage and orthopedic devices that have a protective effect, reduce the load and fix the knee ligaments.
Conservative treatment is carried out for a long time. As a rule, it lasts from 2 to 5 years. The bone lump remains forever, but does not increase in size and does not hurt. Over time, patients may experience aching pain in the knee joint, which is a reaction to changing weather.
After the course of treatment, you should not immediately begin active physical activity; this is fraught with serious complications such as osteoarthritis, displacement of the patella, and deformation of the bones of the knee joint.
Surgery
Surgical treatment is indicated when the disease persistently progresses. The essence of the surgical intervention is to remove lesions that have undergone necrosis, as well as to stitch together an implant that secures the tuberosity of the tibia.
Surgical treatment of Schlatter's disease is advisable in the following cases:
- with a long course of the disease (more than two years);
- in the presence of complications (bone destruction or rupture of the patellar ligament);
- if you are over 18 years of age at the time of diagnosis.
Surgical intervention is simple, but such interventions are characterized by a long recovery period, on which subsequent motor activity of the leg depends. For quick rehabilitation, you need to follow some rules:
- after the operation, use a fixing bandage on the joint or use a knee brace for a month;
- undergo a course of physiotherapy for rapid restoration of bone tissue (electrophoresis with calcium salts);
- taking dietary supplements based on calcium and vitamin and mineral complexes (for six months);
- avoid massive physical stress on the joint throughout the year.
How to treat Schlatter's disease at home
In some cases, Schlatter's disease can be treated at home, but only after an accurate diagnosis and visit to a doctor. These are mainly physical exercises and local therapy:
- For constant and intense pain in the knee, in conjunction with medications, use compresses at night with non-steroidal topical drugs.
- The use of folk remedies in the form of a variety of ointments, cold compresses based on chamomile, celandine, wax, honey, St. John's wort, knotweed, and yarrow is encouraged.
- Massage with non-steroidal anti-inflammatory ointments for external use.
- Therapeutic exercises alleviate the patient’s condition and prevent relapses of the disease. Do stretching exercises daily
- The patient must remain calm and ensure a comfortable position of the affected joint;
- During the rehabilitation period, completely limit physical activity on the sore leg.
Possible complications
Timely diagnosis and adequate treatment of Schlatter's disease does not cause serious complications or severe consequences. However, it is impossible to predict the outcome of the disease, so prevention of the disease is necessary.
Long-term loads on the tibia tuberosity cause upward displacement of the patella, which limits the work of the knee joint, immobilizes the lower limbs as a whole, and leads to pain.
Sometimes the joint develops incorrectly, which leads to its deformation and the development of degenerative processes (arthrosis). With arthrosis, pain appears (when walking and even with the most minimal load), and stiffness and inflexibility of the knee joint also develops. All this leads to a deterioration in the teenager’s quality of life.
Prevention and prognosis of the disease
Experts say that preventing Schlatter's disease is not at all difficult. If a teenager is actively involved in sports, he should warm up thoroughly before training, perform special stretching exercises, and also use knee pads.
Factors that prevent knee injuries are as follows:
- it is necessary to avoid injuries to the knee joints;
- use special protective knee pads;
- provide a gradual increase in loads using warm-up exercises;
- take special vitamin and mineral complexes containing calcium.
Active sports with Schlatter's disease do not lead to irreversible processes in the knee joints or disruption of their functioning, they only cause severe pain. If pain interferes with training, then you should stop exercising, at least for a while, until the acute period of the disease subsides. During the training process, it is necessary to control the intensity of exercise and their frequency.
The prognosis of the disease is favorable. Over time, the disease will subside, but pain can continue to haunt adults for a long time, for example, when walking for a long time or in a kneeling position. In some cases, surgical treatment is recommended. Such operations are not scary, and their results are very good.