A Novel Injective Approach For Osgood-schlatter Disease: A Prospective Randomized Double-blind Study

OBJECTIVES: Despite first being reported more than 100 years ago, Osgood-Schlatter disease(OSD) currently has no effective treatment. The recent use of ultrasonography in the orthopedic surgery and sports medicine fields revealed that patellar tendinopathy and deep infrapatellar bursitis contributes to the pain experienced by patients with OSD. Considering the reported effectiveness and safety of hyperosmolar dextrose injection for patellar tendinopathy, here we investigated the efficacy and safety of hyperosmolar dextrose injection as a novel treatment for OSD. Our hypothesis was that hyperosmolar dextrose injection would be safe and well tolerated by patients with OSD. METHODS: We performed this prospective randomized double-blind clinical trial between April 2012 and June 2015. A total of 44 knees in 36 boys (average age, 12.3 ± 1.1 years) for whom conventional conservative therapy for >1 month was ineffective were randomly assigned to the double-blind injection of 1% lidocaine (1 mL) with saline (1 mL) (Saline group) or 1% lidocaine (1 mL) with 20% dextrose (1 mL) (Dextrose group). Half of the solution was injected into the distal attachment of the patellar tendon, while the remaining half was injected into the deep infrapatellar bursa or infrapatellar fat pad under ultrasound guidance. Injections were administered monthly for 3 months by a single investigator. The Victorian Institute of Sport Assessment (VISA) score was used to evaluate pain. RESULTS: A total of 40 knees in 33 boys were included in this clinical trial. The mean pre-injection VISA scores of the Dextrose and Saline groups were 59.6 ± 19.1 and 62.5 ± 16.6, while those at the final follow-up were 83.6 ± 19.3 and 84.1 ± 19.1, respectively. There were no significant differences in the two group pre-injection versus at the final follow-up (P = 0.61 and 0.93, respectively). In contrast, the mean VISA score significantly increased in both group between pre-injection and final follow-up (P < 0.01). There were no adverse effects of the injection. CONCLUSION: We were not able to prove the efficacy of the Dextrose injection compared with control; however, our results suggest superior symptom reduction efficacy of injection therapy for both treatments compared to usual care in the treatment of OSD. Thus, injection over the distal attachment of the patella tendon and into the deep infrapatellar bursa or infrapatellar fat pad under ultrasound guidance may become a new treatment method for OSD.