Cite this article as:Tsakotos G, Flevas D A, Sasalos G G, et al. (March 22, 2020) Osgood-Schlatter Lesion removed Arthroscopically in one Adult Patient. wgc2010.org 12(3): e7362. Doi:10.7759/wgc2010.org.7362


Abstract

Osgood-Schlatter disease is a traction apophysitis the the tibial insertion that the patellar tendon. It consists one of the most common causes of knee pains in teens and usually presents in young males and also it is considered a self-limiting condition. Return the symptoms disappear ~ the closure the the growth plate in most cases, in some patients they might persist. A variety of conservative treatments are offered in many cases, yet surgical intervention have the right to be successful for patient who have intolerable symptoms. Most surgical choices of the Osgood-Schlatter condition include open up procedures, if arthroscopic or straight bursoscopic excision has actually been reported. We believe that the arthroscopic removed of one unresolved Osgood-Schlatter might be the most ideal treatment because that this condition, and also we current a case of a male patient through an ununited ossicle because of an Osgood-Schlatter lesion, which was removed arthroscopically utilizing a multidirectional arthroscope and a engine- semi-hooded barrel burr.

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Osgood-Schlatter condition was very first described in 1903 and also is a traction apophysitis the the tibial insertion the the patellar tendon brought about by the repetitive strain top top the quadriceps femoris muscle <1>. It consists one of the many common reasons of knee ache in teenagers and typically presents in young males aged 10 come 14 years, v a bilateral knee proportion of 25% to 33%. That is a self-limiting condition, through resolution of symptoms in around 90% of situations with or without some kind of conservative treatment and also although the symptom disappear after the closure the the expansion plate in most cases, in part patients they might persist <2-5>.

In most instances conservative treatments, which include rest, lidocaine injection, steroid injection, cylinder casts and infrapatellar straps, room adequate <6>. However, back conservative management has actually been conventionally favored, operation intervention deserve to be successful for patient who have actually intolerable symptom <7>. Most surgical alternatives of the Osgood-Schlatter an illness include open procedures, while arthroscopic or straight bursoscopic excision has been report <6,7-11,12,13>.

Hereby we report a case of a masculine patient with an ununited ossicle because of an Osgood-Schlatter lesion, i m sorry was removed arthroscopically making use of a multidirectional arthroscope and also a motor semi-hooded barrel burr.


A 26-year-old, male semiprofessional soccer player had a importance of tibial tuberosity for 10 years and also reported anterior knee pain throughout sports task and if climbing stairs. He insurance claims pain commencement around 15 years earlier and since then that mentions occasional pain episodes. That underwent conservative treatment for the last two years v anti-inflammatory drugs and also physiotherapy and he had actually three injections the corticosteroids at various times. On physics examination, there to be a irreversible tibial tubercle with pain throughout palpation (Figure 1). Radiographic examination showed an ununited ossicle in ~ the patellar tendon (Figure 2). Magnetic resonance imaging sections showed tendinitis top top the patellar tendon and also an ununited ossicle anterior come the tibial tubercle (Figure 3). Size of the ossicle to be 17 mm x 8 mm.


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Figure1:The tibial tuberosity prominence.
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Figure2:The X-ray in face (F) and profile (P) planes showing the ununited ossicle.
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Figure3:MRI scan reflecting the ossicle.

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Figure4:Marking of the arthroscopic portals in referral to the patellar, the patellar tendon and the tibial tuberosity prominence.
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Figure5:Visualization of the needle supplied as a guide. Additionally the saver functioning on the intra-articular side of the ossicle deserve to be visualized.
Figure6:The motorized semi-hooded barrel burr provided to resect many of the ossicle.
Figure7:The incisions created and also used because that arthroscopy and also removal of the lesion.
Figure8:Fluoroscopic regulate intraoperatively after the ossicle removal.

Postoperatively, instructions for partial load bearing and isometric flexion extension 0°-90° practice for 2 weeks to be given. After 2 weeks walking there is no crutches was enabled while no squatting for six weeks to be suggested. After 2 months, the patient went back to sport activities without any type of restrictions and also complaints. Postoperative X-ray showed minimal ossicle residual, and also clinically there to be no prominence (Figures 9, 10).


Figure9:Postoperative X-ray.
Figure10:No clinical prestige postoperatively.

Discussion


Although the natural history of Osgood-Schlatter lesions is that most resolve and also it is usually taken into consideration to be self-limited, part patients may still have some pain and also prominence with kneeling <14>. Krause et al. Reported the of 50 patients with an typical of ripe years follow-up, 60% were still can not to kneel there is no pain or discomfort and also 24% had extr continuing symptoms <5>. Ross and Villard reported the athletes through a history of Osgood-Schlatter disease had higher levels of handicap on both everyday living and sports task scales <15>. Conservative measures are concerned to be the treatment of choice in teens with Osgood-Schlatter disease. The objectives of conservative treatment space to diminish the anxiety on the tibial tubercle and also to minimize the tension in the quadriceps muscle <12>.

However, if conservative treatment fails, operative treatment might be considered. There space surgical procedures that incorporate drilling that the tubercle, remove of the loose fragments, autogenous bone peg insertion with the tubercle, tibial tuberosity excision, or sequestrectomy <12>. Furthermore, arthroscopic techniques for surgical procedure of Osgood-Schlatter an illness have likewise been recommended as well as bursoscopic excision <6,12,13>. Arthroscopic procedure is a less invasive operation modality if the patellar tendon is no violated and the patient avoids an incision straight over the patellar tendon that can cause pain v kneeling <6>. Bursoscopic excision allegedly has benefits over the classic arthroscopic technique because there is no need to perform an anterior expression release and also there is no violation the the infrapatellar fat pad. Likewise a possible meniscus or intermeniscal ligament damage can be avoided <6,13>. However with this approach the working an are might be minimal and the mitigate of the prestige of the tibial tuberosity might be inadequate.

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In the situation presented here, the use of multidirectional camera detailed excellent check out of the ossicle if its localization through a needle proved incredibly helpful. The use of the assisting short anterolateral portal and also of the motor semi-hooded barrel burr detailed an easy and also rapid removed of the larger component of the bony lesion. We think that the arthroscopic removed of one unresolved Osgood-Schlatter lesion showed fantastic results and might it is in the most ideal treatment because that this condition.