Schlatter's disease (another name is Osgood-Schlatter) is an inflammation of the musculoskeletal system, in which one or another part of the tubular long bones, that is, the tibial tuberosity, suffers. There is a whole list of similar pathologies that are observed most often in adolescents and children, they are called osteochondropathy.
The real causes of the occurrence of such a disease are not yet precisely established, however, most experts agree that it appears due to disharmony in the growth processes of blood vessels and bones, nourished by them, during physical overload of a person.
Possible causes
In adolescents, Schlatter's disease develops mainly during intensive growth, that is, from ten to eighteen years. The culmination of the incidence is observed in boys at 13-14 years old and in girls at 12. Pathology is quite common and occurs, in accordance with statisticalaccording to information, eleven percent of those teenagers who are involved in active varieties of sports. Most often, the onset of the disease is observed after receiving a sports injury, sometimes even very minor.
Risk factors
There are three main risk factors for this disease:
- 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 lump under the knee.
- Sports. The disease is five times more common in children who are actively involved in certain sports compared to those who lead a sedentary lifestyle. The most "dangerous" from this point of view are basketball, hockey, football, volleyball, figure skating, sports dancing, ballet and artistic gymnastics.
- Gender. Osteochondropathy is especially common in boys, but recently, due to the more active participation of girls in various sports, these indicators are gradually leveling off.
Disease development
In children, Schlatter's disease refers to the defeat of the tuberosity of the tibia. This area of the bone is located directly below the knee. This anatomical formation is primarily responsible for attaching 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 the apophysis has separate blood vessels that provide oxygen and other necessary substances to the growth zone. During active growth in childhood, these vessels simply do not keep up with the increase in 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.
Under the influence of unfavorable factors at this time, such as permanent overload of the legs and microtrauma of the patellar ligament, the likelihood of Schlatter's disease increases.
Under the influence of such pathological factors, the process of inflammation develops, and because of it, ossification of the tuberosity, which is not completely formed, is observed. As a result, one can see a hyperactive increase in the bone in this area, manifested by a specific tubercle, which is located under the knee, which is the main symptom 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 can occur with continued physical exertion, that is, separation of part of the bone, and sometimes the patellar ligament comes off. This complication is quite common and requires surgical treatment.
Symptoms of pathology of the knee joint
A specific feature of this kind of osteochondropathy is a benign and often completely asymptomatic course of the disease. After a while, it regresses on its own, andthe patient may not know anything about his condition at all. Sometimes it happens that Schlatter's disease in adolescents is accidentally discovered during an x-ray of the knee joints for another reason.
However, a certain number of adolescents and children still suffer from a number of manifestations of osteochondropathy. A particularly frequent symptom of the pathology is the “bump”, located directly under the knee joints on the leg, namely on its front surface. Such a formation is generally motionless, very hard when palpated (bone density), the color of the epidermis above the tubercle is typical, not hot to the touch. Thus, all of the above features indicate the non-infectious nature of the neoplasm. In some cases, a slight edema can be seen in the bump area, pain occurs on palpation, but most often there are no such symptoms.
Pain
In addition to other symptoms, a teenager has pain in Schlatter's disease of the knee joint. This syndrome ranges from slight discomfort during physical exertion to manifesting pain already with ordinary daily 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 of Schlatter's disease of the knee should be timely andcomplex.
Possible consequences
Negative consequences of the disease occur in very rare cases. In the vast majority, the pathology is benign in nature and regresses on its own after the growth of a person stops, that is, from 23 to 25 years. Just at this time, the growth zones of 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 extremities in general. However, in some cases, a complication can be diagnosed - fragmentation of the tuberosity, which refers to the detachment of the bone sequester and the detachment of the patellar ligament from the tibia. In such cases, the normal functioning of the leg is returned only with the help of the intervention of the surgeon, due to which the integrity of the ligament is restored.
Diagnosis
If Schlatter's disease of the knee joint is typical and the risk factors described above are present, then the diagnosis does not cause any difficulties at all and the specialist can make a correct diagnosis immediately after examining the patient, without using additional research methods.
To confirm the disease, doctors advise doing an X-ray examination of the knee joint in the lateral position. Thanks to these pictures, you can clearly see osteochondropathy and bonefragmentation, 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.
Treatment of disease
In the vast majority of cases, there is no need to specifically treat Schlatter's disease in adolescents. Pathology regresses on its own within a certain period, subject to the security regime and the absence of overstrain of the lower extremities. However, if the disease is accompanied by pain, defects in the functioning of the leg, and in general a deterioration in the quality of life of a teenager or child, therapy is prescribed.
Methods of conservative treatment of Schlatter's disease
Such treatment aims to relieve pain syndrome and reduce inflammatory signs in the area of tuberosity, normalize the process of apophyseal ossification and prevent further growth of bone tissue. The most commonly prescribed medications are:
- anti-inflammatory nonsteroidal drugs and analgesics in short courses;
- drugs with vitamins E, B, D and calcium.
Each patient is required to adhere to a diet rich in vitamins and microelements, sparing regimen. Children who are actively involved in sports during conservative therapy must definitely interrupt all physical training (from four months to six months).
Also,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 joint, a teenager needs physiotherapy. Excellent results can be obtained with 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 do special therapeutic exercises and visit a massage therapist. Treatment usually lasts four to six months. During this period, the pathology regresses and the symptoms disappear. If there is no result from conservative treatment for nine months and the progression of the disease, the development of complications, you need to resort to surgical intervention.
Surgical treatment
There are the following indications for the intervention of a surgeon in the presence of Schlatter's disease (ICD-10 assigns the code M92.5 to it):
- duration of pathology over two years;
- no effect of standard treatment after nine months;
- presence of complications;
- A person over eighteen years of age at the time of diagnosis of the disease.
The operation is simple, but the patient is waiting for a long rehabilitation process, and the functioning of the leg in the future, as well as the amount of recovery depends on it.
