Schlatter's disease (another name - Osgood - Schlatter) is an inflammation of the musculoskeletal system, in which one or another part of the tubular long bones suffers, that is, tuberosity of the tibia. There is a whole list of such pathologies that are most often observed in adolescents and children, they are called osteochondropathies.
The real reasons for the occurrence of such a disease have not been exactly established at present, however, most experts agree that it appears due to the disharmony of the growth processes of the blood vessels and bones that they feed during physical overload of a person.
Possible reasons
In adolescents, Schlatter's disease develops mainly during intensive growth, that is, from ten to eighteen years old. The culmination of the incidence is observed among boys aged 13-14 and among girls at 12. Pathology is quite common and occurs, according to statistics, in eleven percent of those teenagers who engage in active sports. Most often, the onset of the disease is observed after a sports injury, sometimes even very minor.
Risk factors
There are three main risk factors for this disease:
- The age of the patient. Pathology mainly affects adolescents and children, and in adulthood it is very rare and only as a residual phenomenon, manifested in the form of a bump under the knee.
- Doing sports. The disease is five times more likely to be characteristic of children who are actively involved in certain sports in comparison with leading a sedentary lifestyle. From its point of view, its most dangerous types are basketball, hockey, soccer, volleyball, figure skating, sports dancing, ballet and gymnastics.
- Floor. Osteochondropathy is especially common in boys, but recently, due to the more active participation of girls in various sports, these indicators are gradually aligned.
Disease development
In children, Schlatter's disease means the defeat of the tibial tuberosity. This portion of the bone is located directly below the knee. This anatomical formation is primarily responsible for the attachment of the patellar ligament.
The tuberosity is located in the same place as the apophysis, that is, the place due to which the bone grows in length. It is this factor that affects the development of the disease.
The fact is that at the apophysis there are separate blood vessels that provide the germination zone with oxygen and other necessary substances. During active growth in childhood, these vessels simply "do not keep pace" with an increase in the amount of bone mass, and this causes a lack of nutrients and hypoxia. The consequence of this process is that the bone area becomes more prone to damage and becomes too fragile.
When exposure to unfavorable factors, such as permanent overload of the legs and microtrauma of the patellar ligament, increases the likelihood of Schlatter's disease.
Under the influence of such pathological factors, the process of inflammation develops, and because of it, the ossification of tuberosity, which is not completely formed, is observed. As a result, you can see a hyperactive bone enlargement in this area, manifested by a specific tubercle, which is located under the knee, which is the main sign of Schlatter's disease of the knee joint.
You also need to know that the bone tissue formed as a result is very fragile and sequestration, that is, the separation of part of the bone, and sometimes the ligament of the patella, can occur with continued physical exertion. A similar complication is quite common and needs surgical treatment.
Symptoms of the pathology of the knee
A specific feature of this kind of osteochondropathy is the benign and often completely asymptomatic course of the disease. After a while, it itself regresses, and the patient may not know anything about his condition. Sometimes it happens that Schlatter's disease in adolescents is accidentally detected during radiography of the knee joints for another reason.
However, a certain number of adolescents and children still suffer from a number of manifestations of osteochondropathy. An especially frequent symptom of pathology is the “bump”, located directly under the knee joints on the leg, namely on its front surface. Such a formation is generally motionless, when probing it is very solid (bone density), the color of the epidermis above the tubercle is typical, not hot to the touch. Thus, all of these features indicate a non-infectious nature of the neoplasm. In some cases, mild edema can be seen in the cone area, with pain on palpation, but most often there are no such symptoms.
Pain
In addition to other signs of Schlatter's disease of the knee, a teenager has pain. This syndrome ranges from slight discomfort during physical exertion to the manifesting pain even with ordinary everyday movements. Soreness can be characteristic of the entire period of the disease or occur during exacerbations that were caused by physical overstrain. If the child has a pain syndrome, it is necessary to consult a doctor who will prescribe active therapy. In other cases, it remains only to observe and wait for the natural resolution of the situation.
Treatment for Schlatter's disease of the knee should be timely and comprehensive.
Possible consequences
Negative consequences of the disease are found in very rare cases. The vast majority of pathology is benign in nature and independently regresses after the person’s growth stops, that is, from 23 to 25 years. Just at this time, the growth zones of the tubular bones are closed, which means that the substrate for the occurrence of Osgood-Schlatter disease is eliminated directly. Sometimes an adult has an external defect in the form of a tubercle located under the knee. It does not affect the functioning of the knee joint and the lower limbs as a whole. However, in some cases, a complication can be diagnosed - fragmentation of tuberosity, which is understood as the detachment of bone sequestration and separation of the ligament of the patella from the tibia. In such cases, the normal functioning of the leg is returned only with the intervention of the surgeon, due to which the integrity of the ligament is restored.
Diagnostics
If Schlatter's disease of the knee proceeds typically and the risk factors described above are present, then the diagnosis does not cause any difficulties at all and the specialist can make the correct diagnosis immediately after examining the patient, without using additional research methods.
To confirm the disease, doctors advise to do an X-ray examination of the knee joint in the lateral position. Thanks to these images, osteochondropathy and bone fragmentation can be well considered, if any.
If the case is more difficult to diagnose, then the patient may be prescribed ultrasound, CT and MRI. There are no special laboratory symptoms of the disease. Urine and blood counts are within normal age limits.
Disease treatment
In the vast majority of cases, it is not necessary to specifically treat Schlatter's disease in adolescents. Pathology regresses independently for a certain period, subject to the guard regime and the absence of overvoltage of the lower extremities. However, when the disease is accompanied by pain, defects in the functioning of the leg and in general deterioration in the quality of life of a teenager or child, therapy is prescribed.
Methods for conservative treatment of Schlatter's disease
Such treatment is aimed at stopping the pain syndrome and reducing inflammatory signs in the tuberosity zone, normalizing the process of apophysical ossification and preventing further growth of bone tissue. Most often, medications are prescribed:
- short-term anti-inflammatory non-steroidal drugs and analgesics;
- medicines with vitamins E, group B, D and calcium.
Each patient is required to adhere to a diet rich in vitamins and minerals, sparing regimen. Children who are actively involved in sports during conservative therapy must necessarily interrupt all physical training (from four months to six months).
In addition, it is advisable to use a special bandage and orthopedic structures that fix the ligament of the patella, reduce the load and have a protective effect.
Physiotherapy
Also, with Schlatter's disease of the knee in a teenager , physiotherapy is necessary. Excellent results can be obtained by laser and shock wave therapy, magnetotherapy, ultrasound with hydrocortisone, UHF, electrophoresis with calcium chloride, hyaluronidase, potassium iodide, procaine, aminophylline and nicotinic acid.
Patients need to engage in special therapeutic exercises and visit a massage therapist. Treatment usually lasts from four to six months. During this period, the pathology regresses and the symptoms disappear. In the absence of a result from conservative treatment for nine months and the progression of the disease, the development of complications, it is necessary to resort to surgical intervention.
Surgery
There are the following indications for the intervention of a surgeon in the presence of Schlatter disease (ICD-10 assigns it code M92.5):
- the duration of the pathology over two years;
- lack of standard treatment effect for nine months;
- the presence of complications;
- a person is over eighteen years old during the diagnosis of the disease.
The operation is simple, but the patient will have a long rehabilitation process, and the functioning of the leg in the future, as well as the amount of recovery, will depend on it.