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    Osgood-Schlatter Disease

    Introduction

    Osgood Schlatter's Disease (OSD) is very common in young adolescents, affecting millions of young people a year, and represents damage to the tendon to cartilage connection on the bony prominence just below the knee cap. If it does not respond quickly to sports limitation, it often leads to substantial alteration of sports ability/participation for a year or more, affecting career development, athlete confidence and self-esteem development and peer relationships for the young athlete. It also causes chronic pain and sports limitations even in adulthood in a substantial number of athletes as well as an obvious deformity.  The OSD study that Dr. Reeves designed and published in conjunction with primary author Gaston Topol in Argentina was directed toward investigating the potential to cure OSD early, to decrease the above consequences.


    Review of Our Latest Study
    by Essential Evidence Plus

    “POEM” stands for "Patient-Oriented Evidence that Matters."  POEMs are research reviews published by Essential Evidence Plus (www.EssentialEvidencePlus.com). These reviews are synopses of new evidence carefully filtered for relevance to patient care and evaluated for validity. Daily POEMs emerge from continuous review, grading, and critical appraisal of 3000+ studies published monthly in more than 100 journals.  About 22 articles per month out of 3,000+ are chosen for summarization by this group. The review below is from January 7, 2012.

    Please note that the reviewer's statement about scarring-down is incorrect and does not occur regardless of concentration of dextrose solution used.


    POEM Research Summary

    "Dextrose Injection Effective For Osgood-Schlatter"

    Clinical Question

    Can injection with hyperosmolar dextrose decrease sports-related symptoms in young athletes with Osgood-Schlatter disease?


    Bottom Line

    An injection of a solution of 12.5% dextrose and 1% lidocaine is an effective treatment of Osgood-Schlatter disease (OSD) symptoms in young athletes. The mechanism of action is not clear, but it likely involves local healing prompted by the increased availability of glucose rather than the scarring-down that occurs with prolotherapy using higher concentrations.  (LOE = 1b-)


    Reference

    Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh H.  Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease.  Pediatrics 2011;128(5):e1121-e1128.


    Details

    Study Design:   Randomized controlled trial (Double-blinded)

    Funding:  Self-funded or unfunded      

    Setting:  Outpatient

    Synopsis:  These researchers enrolled 51 boys (aged 10 years to 17 years) and 4 girls (aged 9 years to 15 years) identified through a screening of teams of jumping or kicking sports in a city in Argentina.  All the patients had a diagnosis of OSD, characterized as pain during sport activity, pain over the tibial tuberosity during a single leg squat, and the lack of patellofemoral crepitus or patellar tenderness. Before enrollment, all the athletes underwent 2 months of stretching and strengthening. If the pain during activity remained, the children were randomized into 1 of 3 groups.  One group received usual care (contained strengthening and stretching).  Children in the other 2 groups received an injection with either lidocaine 1% or lidocaine 1% mixed with dextrose 12.5%. After identifying the tender point, ˝ ml lidocaine or lidocaine/dextrose solution was administered via a 27-gauge needle to a depth of less than 1.25 cm.  Three to four injections at 1-cm intervals were administered over and above the tibial tuberosity, with additional injections administered 5 minutes later, either medial or lateral, until all pain was relieved. (Hence the lidocaine in both groups).  This procedure was repeated monthly for 2 more months, regardless of the degree of pain at those times.  One month after the third injection, the majority of children in both injection groups had full return to their sports (100% and 91%) as compared with 60% of children treated with usual care (P < .05 for both comparisons).  At 1 year, 32 of 38 (84%) of dextrose-treated knees were pain-free as compared with 6 of 13 lidocaine-treated knees and 2 of 14 usual care knees (P< .05 for both comparisons).

    Allen F. Shaughnessy, PharmD,  Professor of Family Medicine, Tufts University, Boston MA.


    Additional Resources

    This study has also been reviewed in these other publications.  Click each to view:


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