(Fig 4-B.16) Osgood Schlatter Disease: Cartilaginous Stage

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https://youtu.be/w63GyfUeIyw

 

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📌Osgood-Schlatter Disease Overview

 

✅ Introduction 

• Osgood-Schlatter disease is a common condition in active male adolescents, caused by repetitive stress on the patellar tendon at its insertion on the tibial tuberosity. 
• It often affects those involved in jumping, squatting, and kicking activities and can be bilateral in up to 50% of cases.
• Common in Active Adolescents: Particularly those involved in high-impact sports.
• Bilateral Occurrence: Up to 50% of cases can affect both knees.
• Spontaneous Healing: Most patients heal over time, although symptoms can persist.

 

✅ Pathophysiology

• The tibial tuberosity's weak apophyseal cartilage can't withstand the strong forces from the quadriceps muscles.
• Initially, the tubercle develops from fibrocartilage, providing strength.
• As it matures and ossifies, it converts to weaker columnar cartilage, increasing injury risk.

 

✅ Imaging Findings

• Fragmentation and edema of the tibial tubercle.
• Thickening and increased signal of the patellar tendon distally at the level of the tibial tubercle.
• Irregularity of the tibial tubercle, often persisting into adulthood.
• Calcification and thickening of the patellar tendon.
• Irregular ossification of the tibial tubercle and overlying soft-tissue swelling.
• Reactive secondary heterotopic bone formation at the patellar tendon insertion site, resulting in a visible and painful bump.

 

✅ MRI Findings

• Fragmentation and edema of the tibial tubercle with surrounding soft tissue edema.
• Thickening of the patellar tendon with increased signal distally at the level of the tibial tubercle.
• Transverse clefts in the damaged ossifying cartilage.
• Bone fragmentation and disordered ossification during the healing stage.
• Displaced ossicles, enlargement, and altered signal intensity of the patellar tendon, marrow, and soft-tissue edema at the tuberosity in chronic active cases.

 

✅ Stages of Osgood-Schlatter Disease

1️⃣ Cartilaginous Stage: 

• Soft-tissue findings dominate, including tendon thickening, prepatellar edema, and deep infrapatellar bursitis.
• Transverse clefts in the secondary ossification center of tuberosity

 

2️⃣ Healing Stage: 

• Bone fragmentation and disordered ossification become apparent on radiographs. 
• Most patients undergo spontaneous healing, and the bone fragments reunite with the tibia, even if symptoms persist.

 

3️⃣ Chronic Active Stage: 

• Displaced ossicles, altered signal intensity of the patellar tendon, marrow and soft-tissue edema, and a chronically distended deep infrapatellar bursa are observed. 
• Unstable avulsed fragments can displace proximally, forming symptomatic nonunited ossicles and often leading to chronic symptoms into adulthood.

 

References

RadioGraphics 2018; 38:2069–2101

RadioGraphics 2009; 29:877–886

Magn Reson Imaging Clin N Am 22 (2014) 601–620

 

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