Osgood-Schlatter Disease in Athletic Children

Osgood-Schlatter disease is a traction apophysitis of the tibial tuberosity caused by the repetitive pull of the patellar tendon on the tibia. This condition was described separately and simultaneously by Robert Osgood and Carl Schlatter in 1903 as a lesion where the tibial tubercle separates due to repetitive strain by the patellar tendon and becomes tender. Kicking, jumping, sprinting sports, a history of previous Sever's disease, and lower limb muscle tightness are among the risk factors that have been associated with Osgood-Schlatter disease. It is one of the leading causes of anterior knee pain in children and adolescents. Usually, patient history and physical examination are sufficient for diagnosis. It can be easily recognized by local pain, swelling, and tenderness on the tuberosity in one or both knees.

Osgood-Schlatter disease (OSD) is a common pediatric disorder. It is a growth- and sports-associated knee injury with pain around the tibial tuberosity and morphological alterations around the apophysis during adolescent growth. It often results from acute or chronic overload during sports activity, causing inflammation of the patellar tendon insertion on the tibial tuberosity. It was first described in 1903 independently by Osgood in the US and by Schlatter in Switzerland. Classically, the clinical presentation is associated with an insidious onset (usually atraumatic) of anterior functional knee pain over the tibial tuberosity along with a bony prominence, as well as tenderness at the patellar tendon insertion site.

Osgood-Schlatter disease occurs during the apophyseal phase between the ages of 12 and 15 in boys and 8 and 12 in girls. During the maturation phase, the cartilage cells of the proximal part of the tuberosity migrate distally, replacing the fibrocartilage in the middle part. This makes the tuberosity unable to withstand the force exerted by the quadriceps, resulting in micro-avulsions, with secondary ossification. These bone fragments are secondarily incorporated into the remainder of the tibial tuberosity, which can result in sequelae of an enlarged tuberosity. In rare cases, the fragments are not incorporated, and intratendinous bone fragments can remain after growth stops, requiring surgical removal. The pain usually occurs during and after physical activity and might be associated with local swelling. Many patients are completely asymptomatic, with less than 25% reporting pain at the tibial tuberosity apophysis. The age of onset is between 8 and 15 years. Boys experience it more often than girls, with a male-to-female ratio of 3:1. The prevalence of OSD is 9.8%, and it can be bilateral in 20-30% of patients. Many risk factors and activities have been associated with an increased incidence of the pathology.

Treatment is generally conservative, with rest, ice, and specific exercises recommended. It involves limiting activity until inflammation resolves and performing exercises that strengthen the surrounding musculature to reduce stress across the tibial tuberosity. Treatment with the PRICE protocol (Protection, Rest, Ice, Compression, Elevation), physical therapy, and strict activity modification is initiated. Surgical removal of ossicles may be considered. A knee strap can immobilize and protect joints, reduce pain, decrease swelling, and facilitate healing of acute injuries. Knee straps are also used for injury prevention and chronic pain reduction. Infrapatellar strapping is a treatment technique employed for various knee pathologies; however, its effect on pain and functional performance among young athletes has not been studied.

Kinesio Taping is effective in improving pain and joint function in patients with knee osteoarthritis. Kinesiology tape is used in the treatment of muscle, fascia, and tendon symptoms and for performance enhancement by way of continuous receptor stimulation. The natural healing process is instantly enhanced due to improved circulation in the taped area. When a muscle is inflamed, swollen, or stiff, the space between the skin and the muscle is compressed, resulting in constriction and congestion of lymphatic fluid and blood circulation. This compression applies pressure to pain receptors located in the space between the skin and the muscle, relaying discomfort signals to the brain and causing the sensation of pain. Stretching the skin of the affected area before applying Kinesiology Tape ensures that the taped area will form wrinkles when the applied area returns to its neutral position. This wrinkling effect is essential because the lifting of the skin creates more space for lymph and blood flow. Consequently, lymph drainage and blood circulation in the affected area are improved effectively through taping application. The friction between the tissues beneath the skin decreases due to the promoted movement of lymphatic fluid and blood circulation. Pain is reduced as the pressure on the pain receptors lessens. The end result is believed to be reduced muscle fatigue, an increased range of motion, and improved quality of muscle contraction.

• Range of motion assessment [Time frame: baseline]
• muscle power assessment [Time frame: baseline]
• functional assessment [Time frame: baseline]