22nd Annual Pain Medicine Meeting 2023

Title: Osgood-Schlatter Disease Oddly Diagnosed in Adulthood

Authors: Henry Dinh MS DO Candidate, Kyaw Lin DO

Touro University California, CA

Sutter Health Palo Alto, CA

Introduction:

Knee pain can arise from a variety of orthopedic conditions.
Osgood-Schlatter disease (OSD) is a common diagnosis in the active adolescent population.
Sports and activities that heavily utilize the quadriceps can lead to OSD.
Repetitive quadriceps use can lead to stress on the tibial tubercle and lead to acute onset of anterior knee pain1.
It is luckily a self-resolving knee pain for adolescence.
OSD is seen atypically in adult populations.

Case History

A 50-year-old male presented to the clinic to follow up for acute on chronic bilateral anterior knee pain. Previous knee x-rays showed evidence of Osgood-Schlatter disease (OSD). OSD initially appeared to be an unlikely diagnosis given his age and clinical presentation. Sports medicine believed his symptoms may be related to lumbar radiculopathy.

Diagnostic Studies

Electromyography revealed equivocal chronic multilevel lumbar motor radiculopathy.
Lumbar spine MRI did not show any pathology that may be irritating the nerve root to the knees.
Bilateral knee XR had confounding results for OSD without a prior history.
Bilateral knee MRI revealed mild thickening and intrasubstance signal in the proximal tendon compatible with jumper’s knee and sequelae for OSD.

Physical Findings

Prominent bilateral tibial tuberosity
Bilateral knee pain at the patellofemoral joint space
Knee ROM: flexion wnl, extension wnl, positive for mild crepitus

Discussion

Knee pain associated with OSD commonly resolves itself upon fusion of the growth plate1.
The fusion of patient’s epiphyseal plates should have resolved OSD related knee pain given his age1.
Since the initial XR results were confounding, the utilization of MRI provided further sensitivity to diagnose patients with OSD as seen in recent literature.
The repetitive motions of the knee joint can cause the thickening of the patellar tendon and add stress to the tibial tuberosity, which commonly leads to OSD3.

Conclusion

Although widely seen in a younger demographic, OSD should not be quickly dismissed in adults.
Reports are emerging that untreated childhood OSD can lead to chronic knee pain in adults4.
OSD can also present with a wide range of tibial tuberosity shapes, number of loose ossicles, and location of the patellar tendon affected5.
It is important to start considering OSD for chronic knee pain in adults as a differential until an ultrasound or MRI is ordered for diagnosis.

References

Tsakotos, G., Flevas, D. A., Sasalos, G. G., Benakis, L., & Tokis, A. V. (2020). Osgood-Schlatter lesion removed arthroscopically in an adult patient. Cureus. doi:10.7759/cureus.7362
Vaishya, R., Azizi, A. T., Agarwal, A. K., & Vijay, V. (2016). Apophysitis of the tibial tuberosity (Osgood-Schlatter Disease): A Review. Cureus. doi:10.7759/cureus.780
Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of osgood–schlatter disease: Review of the literature. MUSCULOSKELETAL SURGERY, 101(3), 195–200. doi:10.1007/s12306-017-0479-7
Sahar, N. H., Ramli, A. S., Badlishah-Sham, S. F., & Mohd Miswan, M. F. (2023). Osgood-Schlatter Disease in adult: Would early diagnosis and treatment improve the prognosis? Journal of Clinical and Health Sciences, 8(1), 76–81. doi:10.24191/jchs.v8i1.21453
Woolfrey, B. F., & Chandler, E. F. (1960). Manifestations of osgood-schlatterʼs disease in late teen age and early adulthood. The Journal of Bone & Joint Surgery, 42(2), 327–369. doi:10.2106/00004623-196042020-00011

22nd Annual Pain Medicine Meeting 2023

OSGOOD SCHLATTER’S DISEASE ODDLY DIAGNOSED IN ADULTHOOD

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