SURGICAL TREATMENT OF OSGOOD-SCHLATTER DISEASE IN ADOLESCENT ATHLETES

BACKGROUND: Osgood-Schlatter disease is an apophysitis of the tibial tubercle causing pain and difficulty kneeling. A majority of cases resolve spontaneously at skeletal maturity when the tibial tubercle apophysis fuses. Treatment is symptomatic when the physis is open. Adolescent athletes with closed physes and continued symptoms can benefit from surgery. PURPOSE: The purpose of this study is to report the outcomes of ossicle excision and tubercleplasty for unresolved Osgood-Schlatter disease that has failed conservative treatment. METHODS: A retrospective review was performed on 6 athletes who underwent ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease. Data collected include age at onset of symptoms, age at surgery, gender, laterality, radiographic findings, sports played, time to return to sport, length of follow up, and complications. Surgery involved an open ossicle excision, tubercleplasty, and repair of the patella tendon to bone using a suture anchor. A longitudinal incision was made over the antero-lateral aspect of the patella tendon. The patella tendon was reflected medially to gain access to the ossicle and bump. A direct anterior incision was avoided to minimize post-operative pain with kneeling. Post-operatively, patients were allowed to fully weight bear in an extension knee brace for 4 weeks, and then allowed to gradually resume activity. RESULTS: 4 males and 2 females were studied. The right knee was involved in 3 cases and the left knee in 3. The average age at onset of symptoms was 15.8 (range 12-18). The average age at surgery was 17.3 (range 17-18). Radiographic findings included a large bump in 3 cases, an ossicle in 2 cases, and free fragments at the tendon insertion in 3 cases. Sports played included basketball, football, running, and dancing. All patients returned to sports at an average of 23.9 weeks post-surgery (range 5-56). The average length of follow up was 14.2 weeks (range 5-27). No patients reported post-operative pain with kneeling, limp, need for a cane, locking sensations, giving way sensations, pain, swelling, difficulty climbing stairs or difficulty squatting. No patients needed additional surgery. CONCLUSION: Surgical treatment of unresolved Osgood-Schlatter disease was successful in 100% of adolescent athletes in this series. For symptomatic patients after closure of the growth plate, we recommend removal of the ossicle and adjacent bursae, smoothing down the bump with a burr, and repairing the reflected patella tendon to bone using suture anchors. The outcomes were excellent in all patients with no complications.