Boyang Zhang

Background: Osgood-Schlatter Disease (OSD) is an activity and growth-associated knee pathology affecting the tibial tuberosity apophysis in adolescents. Up to 10% of adolescents are affected by OSD during their lifetime, often bilaterally.¹ While treatment is generally conservative, there is significant variation in patient presentation and symptoms. Usually, patients undergo activity modification or knee strengthening exercises, with an eventual return to activity.² This review aims to consolidate current research efforts to understand the pathophysiology and evaluate proposed treatment mechanisms. This is crucial to improving adolescents’ timelines and ability to return to sport.

Methods: A database search in PubMed was performed for relationships among the keywords “Osgood-Schlatter,” “control trial,” “biomechanics,” “prevention,” “biomarkers,” and “inflammatory markers”. Studies published more than five years before this review were excluded.

Results: A prospective cohort study found that combining activity modification and progressive knee-strengthening exercises effectively reduced pain and improved knee function and strength. At 12 weeks, 16% of adolescents aged 10-14 years could resume sports, rising to 69% at 12 months.² However, few randomized controlled trials were found in the literature to evaluate exercise types in comparison. Surgical treatments, including ossicle excision and tubercleplasty, for adolescents who did not respond to conservative treatment were able to return to sport at full capacity at an average of 21 weeks post-surgery.³ The average Lysholm score reported was 97.2, demonstrating the effectiveness of treatment. Looking into histological structure, Suito et. al. found that eccentric contractions of the quadriceps in rat models promoted increased levels of inflammatory biomarkers such as IL-6 and PGE2 and increased expression of PTGES and PTGS2. This suggests that OSD-like symptoms are promoted by inflammation and the inhibition of cartilage calcification in the tibial tuberosity.⁴ Finally, from a biomechanical perspective, Zhang et. al. found that decreased hamstring flexibility is a risk factor in OSD development. They also suggested that the accumulated force of the quadriceps muscle is a better indicator of OSD risk than peak force when controlling for hamstring optimal length.⁵

Conclusions: Current research efforts in OSD are progressing towards understanding the inflammatory and musculoskeletal environment. A recent review found inconsistent conclusions on the causal factor of injury, debating between tendinous injury and avulsion fracture.⁶ Due to the lack of consistent data that clarifies the pathophysiology and recovery process of OSD, further research is needed to uncover the intrinsic causes and metrics to evaluate OSD.

Works Cited

1. Neuhaus, C., Appenzeller-Herzog, C., & Faude, O. (2021). A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Physical therapy in sport, 49, 178-187.
2. Rathleff, M. S., Winiarski, L., Krommes, K., Graven-Nielsen, T., Hölmich, P., Olesen, J. L., … & Thorborg, K. (2020). Activity modification and knee strengthening for Osgood-Schlatter disease: a prospective cohort study. Orthopaedic journal of sports medicine, 8(4), 2325967120911106.
3. Mun, F., & Hennrikus, W. L. (2021). Surgical Treatment Outcomes of Unresolved Osgood‐Schlatter Disease in Adolescent Athletes. Case reports in orthopedics, 2021(1), 6677333.
4. Suito, H., Fujikawa, K., & Ohsako, M. (2023). Eccentric contractions during downhill running induce Osgood‒Schlatter disease in the tibial tuberosity in rats: a focus on histological structures. Scientific Reports, 13(1), 9863.
5. Zhang, X., Ren, W., Duan, Y., Yao, J., & Pu, F. (2022). The Biomechanics Effect of Hamstring Flexibility on the Risk of Osgood‐Schlatter Disease. Journal of healthcare engineering, 2022(1), 3733218.
6. Corbi, F., Matas, S., Álvarez-Herms, J., Sitko, S., Baiget, E., Reverter-Masia, J., & López-Laval, I. (2022). Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare (Basel, Switzerland), 10(6), 1011. https://doi.org/10.3390/healthcare10061011