Anterior knee pain without trauma in the ER: Chronic Osgood

İzmir Üniversitesi Tıp Dergisi
Izmir University Medical Journal
İzm Üniv Tıp Derg 2013; 1:37-39
Izm Univ Med J 2013; 1:37-39
CASE REPORT
OLGU SUNUMU
Anterior knee pain without trauma in the ER:
Chronic Osgood-Schlatter disease in an adult
patient
Acil serviste travmaya bağlı olmayan diz ağrısı: Erişkin bir hastada
kronik Osgood- Schlatter hastalığı
1
Cem Ertan , Dilek Ertan
2
1
İzmir Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, İzmir / Türkiye
Özel Deva Tıp Merkezi, Radyoloji Kliniği, Manisa / Türkiye
2
Sorumlu Yazar/Corresponding Author:
Cem Ertan, MD, Asst. Prof. Izmir University School of Medicine, Department of Emergency Medicine
Medical Park Izmir Hospital Emergency Department Izmir/TURKEY
E posta: [email protected]
Geliş Tarihi/Received: 07.09.2013 - Kabul Tarihi/Accepted: 03.11.2013
Abstract
Osgood-Sclatter’s disease is the apophysitis of the tibial tuberosity and is a common disease of the adolescents.
It causes knee pain and may result in enlargement of the tuber tibialis. Here we present a 39 years old male
patient with knee pain and no recent trauma who ended up with diagnosis of Osgood-Sclatter’s disease.
Key words: Osgood–Schlatter disease , knee pain
Özet
Osgood-Sclatter hastalığı tuberositasis tibia’nın apofiziti olup, ergenlerde sık görülen bir durumdur. Diz ağrısına
ve tibia çıkıntısının büyümesine neden olabilir. Burada acil servise yakın zamanda travma öyküsü olmaksızın diz
ağrısı yakınmasıyla başvuran ve sonuçta Osgood-Sclatter hastalığı tanısı alan 39 yaşında bir erkek hastayı
sunuyoruz.
Anahtar kelimeler: Osgood–Schlatter hastalığı, diz ağrısı
Introduction
Osgood-Sclatter’s disease (OSD) is the
apophysitis of the tibial tuberosity and is a
common disease of the adolescents which
may cause knee pain with minor trauma and
repetitive knee flexion, and may result in
enlargement of the tuber tibialis (1). The
disease is typically seen in young boys (10-15
years of age) and young girls (8-13 years of
age) especially in those engaging with sports
activities (21% vs 4,5%) (2,3). Although it is a
disease of the young, adults may also present
with OSD related symptoms.
Case Presentation
A 39 years old male attended to our ED with
right anterior knee pain which started a few
days ago, and worsened today. He denied any
recent trauma but, recalled a sports related
injury about one year ago. Musculoskeletal
examination revealed tenderness on the
tuberositas tibia and inferior portion of the
patellar ligament at the right knee. There were
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Ertan ve ark
Ertan et al
İzmir Üniversitesi Tıp Dergisi
Izmir University Medical Journal
no findings to suggest any articular or soft
tissue problems. Antero-posterior and lateral
x-rays and the magnetic resonance imaging
(MRI) of the right knee were ordered.
Antero-posterior and lateral x-rays of the right
knee showed two bony fragments of 2x1 cm
and 1x0.5 cm on lateral view (Figure 1).
diagnostic tool of choice (4). Non-steroidal
anti-inflammatory drugs were prescribed for
the patient, and he was discharged with
orthopedic follow up suggestion.
Discussion
Figure 1. Anterior posterior and lateral Xrays of the knee.
MRI was the next diagnostic evaluation and it
showed 2 bony fragments, of which, the larger
one was measured as 12 mm (Figure 2). Also a
fluid interface was detected between the
Hoffa fat pad and the bony fragments.
OSD is a traction apophysitis of the tibial
tuberosity due to repetitive strain from the
quadriceps muscle and chronic avulsion of the
tibia, and it is a common disease of the rapidly
growing adolescents, characterized with
anterior knee pain provoked with knee
flexion, rough contact to the inflamed zone
and minor trauma (1). The diagnosis of the
disease is mostly simple in the risk group, with
physical findings and patient history,
nevertheless tumors, cystic lesions and
infections must be ruled out (5). But in adult
patients the mainstay of the diagnosis is to
conjoint the disease to the clinical condition.
In our case the clinical suspicion led to MRI
evaluation of the patient. The MRI study
excluded infectious findings and the presence
of other lesions of the bone such as cysts,
masses or fractures.
In conclusion chronic OSD must be recalled in
adults presenting to the ED with anterior knee
pain and no history of recent trauma.
References
1. Kaya DO, Toprak U, Baltaci G, et al. Knee
Surg Sports Traumatol Arthrosc. DOI
10.1007/s00167-012-2116-1
2. Köylü OK, Köylü A, Baltacı D, et al. OsgoodSclatter hastalığı olgu sunumu. Konuralp Tıp
Dergisi 2010;2(3);16-18
3. Dunn JF. Osgood-Sclatter’s disease. Am
Fam Physician. 1990;41;173-176
Figure 2. MRI of the knee.
The final diagnosis of the patient was chronic
OSD as evidenced by the MRI, which is the
İzm Üniv Tıp Derg 2013; 1:37-39
Izm Univ Med J 2013; 1:37-39
4. Tuncel E, Yazıcı Z. Çocuk Hastalıklarında
Radyolojik Bulgular, İstanbul: Nobel & Güneş
Yayınevi, 2002; pp 249.
5. Morgan B, Mullick S, Harper WM, Finlay
DB. An audit of knee radiographs performed
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for general practitioners. Br J Radiol. 1997
Mar;70:256-60
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