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Osgood-Schlatter Disease Unresponsive to Nonsurgical Treatment May Require Surgery to Remove Ossicle
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Posted on: 10/18/2007
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Osgood-Schlatter disease (OSD) is a disease that affects the knee of a child or adolescent. The muscles appear to pull and cause the tendons to pull away from the tibia, or shin bone. It happens most often in very active children and those who are athletes.
While most cases of OSD heal on their own with time and rest, occasionally, the bump that can occur on the knee will not go away and will continue to cause pain. In the institution used for this study, of 3600 patients with OSD, between 1989 and 2003, only 51 patients (about 2 percent) had undergone surgery. In this study, the authors wanted to see what the outcome of this surgery would be for patients who did not respond to traditional treatment.
The researchers looked at 51 patients, 53 knees, of children who were on average 17 years old when they had their surgery. The ages ranged from 13 to 25 years. Because of patient dropping out of the study, only 15 patients (16 knees) remained for follow-up of about 7 years, ranging from 8 months to 15 years.
At the end of the study, the patients were asked about resumption of activity. They were assessed, before and after surgery, with the International Knee Documentation Committee (IKDC), which assesses the pain in terms of frequency and severity on a scale of 1 to 10 (10 being the worst),the Lysholm Knee Scale, which scores pain from 25 to 0 (0 being the worst pain), and the Tegner Activity Score, which measures pain from 0 to 10 (10 being the worst). All patients had complained of a painful bump before surgery.
After surgery, 11 patients were found to have a smaller bump than before surgery, 4 had no change in size but only 1 complained of symptoms from the bump, the other 3 had no complaints. The last patient had an increase in the size of her bump and chose to have another surgery to reduce it.
When assessing pain after surgery, the patients had an average of 3.5 on the IKDC scale, 18.3 on the Lysholm Knee Scale, and 3.2 on the Tegner Activity Scale. When asked about returning to activities, 12 patients had resumed their pre-injury activities, 2 partially, and 1 did not. The patient who had a second surgery did return to her previous level of activity.
The authors conclude that although OSD can be managed without surgery most of the time, there are situations where surgery is required and, when done after skeletal maturity, had a good success rate. The authors do point out that this was not a randomized nor a comparison study.
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References:
Jennifer M. Weiss, MD, et al. Surgical Treatment of Unresolved Osgood-Schlatter Disease. In Journal of Pediatric Orthopedics. October/November 2007. Vol. 27. No. 7. Pp. 844-847.
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