Bursoscopic Ultrasound-Guided Ossicle Resection for Osgood–Schlatter Disease

Osgood–Schlatter disease commonly affects physically active adolescents. It is a common cause of anterior knee pain and inflammation in this population. Its symptoms typically subside with conservative therapy. Surgery, including resection of mobile ossicles, is considered when the pain persists on kneeling or during sports after the skeletal maturity. In this procedure, we use a direct bursoscopic approach with ultrasound-guided ossicle resection. In comparison with the classical arthroscopic approach, the bursoscopic approach uses more distally placed portals. These reduce the risk of damage to the fat pad, meniscus, and ligament. Endoscopic surgeries, including arthroscopic and bursoscopic surgeries, use intraoperative fluoroscopy to resect ossicles because the ossicle cannot be clearly identified by endoscopic imaging alone. Fluoroscopy exposes patients and surgeons to radiation. Ultrasound-guided surgery identifies the exact positional relationship between the ossicle and grasping forceps without radiation exposure since fluoroscopy is unnecessary. Moreover, the risk of residual ossicles is reduced because tiny ossicles, which are difficult to detect under fluoroscopy, are visible on ultrasound. Ultrasound-guided ossicle resection was a viable treatment option for Osgood–Schlatter disease because it eliminated radiation exposure and reduced the risk of missed ossicles.