A comprehensive MRI investigation to identify potential biomarkers of Osgood Schlatter disease in adolescents: A cross sectional study comparing Osgood Schlatter disease with controls

Background Osgood–Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD. Purpose This study aimed to systematically and...

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Published in:Scandinavian journal of medicine & science in sports 2024-05, Vol.34 (5), p.e14634-n/a
Main Authors: Sørensen, L. B., Holden, S., Oei, E. H. G., Magnusson, S. P., Olesen, J. L., Dean, B. J. F., Hever, M., Lyng, K., Rathleff, M. S.
Format: Article
Language:English
Subjects:
Adolescent
apophysis
Biomarkers
Case-Control Studies
Child
Cross-Sectional Studies
Edema
Edema - diagnostic imaging
Female
growth
Humans
Knee
Knee Joint - diagnostic imaging
Knee Joint - pathology
Magnetic Resonance Imaging
Male
MR imaging
Osteochondrosis - diagnostic imaging
Pain
Pathophysiology
Teenagers
Tibia - diagnostic imaging
tibial tuberosity
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Summary:Background Osgood–Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD. Purpose This study aimed to systematically and comprehensively characterize adolescents with OSD using magnetic resonance imaging (MRI) compared to pain‐free controls, including both tissue abnormalities that may be associated with OSD, as well as anatomical characteristics. A secondary objective was to identify potential imaging biomarkers associated with pain. Study Design Cross‐sectional study. Methods Adolescents with OSD and controls were recruited from 2020 to 2022. Following a clinical exam, demographics, pain, sports participation, and Tanner stage were collected. Knee MRI was conducted on the participants' most symptomatic knee (OSD) or the dominant leg (controls). Results Sixty‐seven adolescents (46 with OSD and 30 controls) were included. 80% of participants with OSD had at least one tissue alteration compared to 54% of controls. Compared to controls, OSD had 36.3 (95%CI 4.5 to 289.7) higher odds of bony oedema at the tibial tuberosity, and 32.7 (95%CI 4.1 to 260.6) and 5.3 (95%CI 0.6 to 46.2) higher odds of bony oedema at the  tibial epiphysis and metaphysis respectively. Participants with OSD also had higher odds of fluid/oedema at the patellar tendon (12.3 95%CI 3.3 to 46.6), and superficial infrapatellar bursitis (7.2).  Participants with OSD had a more proximal tendon attachment (mean tibial attachment portion difference, −0.05, 95% CI: −0.1 to 0.0, p = 0.02), tendon thickness (proximal mean difference, −0.09, 95% CI: −0.4 to 0.2, p = 0.04; distal mean difference, −0.6, 95% CI: −0.9 to −0.2, p = 0.01). Those with bony/tendon oedema had 1.8 points (95% CI: 0.3 to 3.2) higher pain on palpation than those without (t = −2.5, df = 26.6, p = 0.019), but there was no difference between these groups in a functional single leg pain provocation. Conclusion Adolescents with OSD present with tissue and structural abnormalities on MRI that differed from age‐matched controls. The majority had findings in the patellar tendon and bone, which often co‐occurred. However, a small proportion of OSD also presents without alterations. It appears these findings may be associated with clinical OSD‐related pain on palpation of the tibial tuberosity. Clinical Relevance Our highlight the pathophysiology on imaging, whi
ISSN:0905-7188
1600-0838
DOI:10.1111/sms.14634