Osgood-Schlatter
Disease }

Pathology

Osgood Schlatter disease (OSD) involves the tibial tuberosity in growing children. The condition is characterized by local pain, swelling and tenderness of the tuberosity.

OSD is thought to be caused by repetitive strain and chronic avulsion of the secondary ossification center of the tibial tuberosity, i.e., by small injuries due to repeated overuse before the area has finished growing. The repetitive strain is from the strong pull of the quadriceps muscle produced during sporting activities, particularly during running, jumping and climbing. Accordingly, OSD is common in adolescents who play soccer, basketball and volleyball, and who participate in gymnastics. The tibial tuberosity avulsion continues to grow, ossify and enlarge. The intervening area may become fibrous, creating a localized nonunion, or may show complete bony union with mild enlargement of the tibial tuberosity. In any case, the result is a traction apophysitis of the tibial tubercle.

Diagnosis is based on the clinical features of the disease and on diagnostic imaging. Particularly in unilateral cases of OSD, plain radiographs of the knee are recommended to rule out other conditions such as acute tibial apophyseal fracture, infection, or tumor.

The true incidence of OSD is unknown. The predominant age is between 12 and 15 years in boys and between 8 and 12 years in girls, coinciding with periods of growth spurts. Boys are more affected than girls (approximately 3:1). In 20-30% of all cases OSM presents bilaterally.

The treatment of OSD should start with conservative treatment modalities including rest, icing, modification of activities, and rehabilitation exercises. Patients not responding to conservative treatment for six months (approximately 10% of all patients) should then undergo radial shock wave therapy (RSWT). Surgery should be considered for recalcitrant cases of OSD in skeletally mature patients, aiming at surgical excision of the ossicle (in case of a localized non-union) and/or free cartilaginous material.

Treatment Procedure

1. PALPATE
Locate the area of pain through palpation and biofeedback.

2. MARK
Mark the area of pain.

3. APPLY GEL
Apply coupling gel to transmit shock waves to the tissue.

4. APPLY SHOCK WAVES
Deliver Radial or Focused Shock Waves to the area of pain while keeping the applicator firmly in place on the skin.

Recommended Settings

Swiss
DolorClast }

  Treatment
Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 2000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15mm
Skin pressure Light to moderate

Clinical Proof

Titov VV, Litvinenko A
Extracorporeal shockwave therapy in the treatment of the osteochondropathy of tibial bone roughness. Abstracts 10th International Congress of the International Society for Musculoskeletal Shockwave Therapy, Toronto, Canada, 2007, pp. 46-47

Risks

Side effects of Radial Shock Wave Therapy (RSWT®) using the Swiss DolorClast®

When performed properly, RSWT® with the Swiss DolorClast® has only minimal risks.
Typical device-related nonserious adverse events are:

  • Pain and discomfort during and after treatment (anesthesia is not necessary)
  • Reddening of the skin
  • Petechia
  • Swelling and numbness of the skin over the treatment area

These device-related nonserious adverse events usually disappear within 36h after the treatment.

Accordingly the following contraindications of RSWT® using the Swiss DolorClast® must be considered:

  • Treatment over air-filled tissue (lung, gut)
  • Treatment of pre-ruptured tendons
  • Treatment of pregnant women
  • Treatment of patients under the age of 18 years (except for Osgood-Schlatter disease and muscular dysfunction in children with spastic movement disorders)
  • Treatment of patients with blood-clotting disorders (including local thrombosis)
  • Treatment of patients treated with oral anticoagulations
  • Treatment of tissue with local tumors or local bacterial and/or viral infections
  • Treatment of patients treated with cortisone

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Application }

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