A New Conservative Treatment of Osgood-

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Schlatter Disease
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JACK LEVINE,M.D., AND KASHYAP,M.D.

SATISH

Osgood-Schlatter disease, a disorder in- MATERIAL A N D METHODS

volving the growing tibial tuberosity, is char- The infrapatella strap4*’is a slightly curved vi-
acterized by pain, swelling and tenderness nyl padded band 2.5 cm wide, secured posteriorly
in the proximal anterior tibia. The etiology by a Velcro fastener which passes through a D-
remains a point of controversy. Currently, ring and attaches to itself (Figs. 1A to 1C). I t is
it is believed to be a traumatically produced worn just below the patella with the convexity of
the curve directed superiorly so that the posterior
lesion in the attachment of the ligamentum band does not cut into the popliteal crease. The
patella to the tibial tuberosity.*Y6 strap is tightened just enough to keep it from slip-
The orthopedic literature is replete with ping.
both surgical and nonsurgical methods of All patients were instructed to use the strap
treatment. Watson-Jones” and Smillie* rec- only during periods of activity and not to wear it
in bed or during prolonged inactivity.
ommend complete immobilization in a cyl- This study comprised 24 knees in 17 patients
inder cast with the knee in full extension for ranging in age from eleven to 17 years (1 5 males
a period of six weeks to two months. This and two females). The most frequent complaint
is intended to rest the affected part. Local was pain over the tibial tubercle which was ex-
anesthetic and steroid combinations injected acerbated by activity and relieved by rest. Both
knees were affected in seven cases. All but four
into the tubercle or the deep infrapatella cases showed X-ray evidence of Osgood Schlat-
bursa have been reported with an apparent ter’s disease (Table 1).
high success rate.’
Surgical procedures have included drilling RESULTS
of the tubercle,” removal of a loose fragment
or fragments,” and autogenous bone peg in- Nineteen out of 24 knees (79.1%) had
sertion through the tubercle.’ definite improvement after a period of six to
The success we have had with our infra- eight weeks of use. Three of the remaining
patella strap in 17 patients has prompted us five knees achieved some relief but the other
to present this report. two had none.
Most patients who improved were able to
discard the straps within eight weeks, al-
From the Department of Orthopedic Surgery, The though two patients had occasional milder
Brookdale Hospital Medical Center, Linden Boulevard recurrences of symptoms and used the strap
at Brookdale Plaza, Brooklyn, New York 11212.
Reprint requests to Jack Levine, M.D. intermittently up to 12 months. In one pa-
Received: June 10, 1980. tient symptoms persisted for ten months,

0009-921 X / 8 I /0700/ I26 $00.65 0 J. B. Lippincott Co.

126
 Clinical Orthopaedica
127 Levine and Kashyap and Related Research

FIGS. IA-1C. The infrapatella strap as worn by a patient; the patella and joint line are outlined:
(A) front view; (B) rear view; (C) side view.

during which time he obtained relief by us- We found the infrapatella strap accept-
ing the strap to enable continued normal able among school children who are usually
activities. reluctant to wear cylinder casts or posterior
splints. It was particularly welcome as a
DISCUSSION form of treatment in bilateral cases.
The exact mechanism whereby the infra- While it is true that successful treatment
patella strap relieves the pain of chondro- has been reported using steroid injection,
malacia and other patellofemoral distur- this procedure is not without risks and should
bances is not yet understood. The most likely be avoided wherever p o ~ s i b l e .We
~ believe
explanation is that it works by lifting the that our infrapatella strap provides a very
patella slightly forward and slightly proxi- satisfactory alternative.
mally, thus relieving pressure against the
~ . ~the case of Osgood-Schlatter
f e m ~ r . In SUMMARY
disease, however, it appears to work by di-
minishing the pull of the quadriceps mech- Osgood-Schlatter disease, a disorder in-
anism against the inflamed insertion of the volving the growing tibial tuberosity, is a
patella tendon into the tibial tubercle. In this condition that causes pain, swelling and ten-
situation the strap appears to act as a derness. The pull of the ligamentum patella
damper, absorbing some of the pull of the on the tibial tuberosity may account for the
quadriceps mechanism. This is somewhat symptoms. An infrapatella strap that had
analogous to the effect of the forearm band been effective in treating patellofernoral dis-
advocated by Froimson3 for treatment of orders was found to benefit this condition as
tennis elbow, except in that case the tension well. A success rate of 79.1% was achieved
is diminished on the inflamed origin of the in treating 24 knees in 17 patients. The de-
common extensor muscles rather than on vice has a high level of patient acceptance,
insertion. particularly in bilateral cases where the
Number 158
July-August 1981 The lnfrapatella S t r a p 128

TABLE 1. Summary of Treated Cases

X-ray evidence
Knee of Osgood-
Patient Sex Age involved Schlatter disease Treatment Duration of trealment Results

M.D. M 13 Both Yes Bilateral 8 weeks Good

knee
straps
G.M. M 12 Both Yes Bilateral 6 weeks Good
knee
straps
R.I. M 14 Right Yes Knee strap Still uses strap after Fair
6 months use
W.M. M 14 Both No Bilateral 8 weeks Good
knee
straps
G.Q. M 11 Both Yes Bilateral 8 weeks Good
knee
straps
R.S. M 13 Left Yes Knee strap 6 weeks Good
L.W. F 11 Both Yes Bilateral 8 weeks
knee
straps Good
G.D. M 15 Right No Knee strap Still uses strap after Fair
12 months’ use
D.W. M 13 Right Yes Knee strap 10 months Fair
T.K. M 17 Left No Knee strap 8 weeks Good
T.G. M 11 Right No Knee strap 3 weeks only; cast Poor
later applied
B.S. M 13 Right Yes Knee strap 6 weeks Good
D.W. F I2 Right Yes Knee strap 8 weeks Good
R.R. M II Left Yes Knee strap 2 weeks only; cast Poor
later applied
M.P. M 14 Left Yes Knee strap 8 weeks Good
M.B. M 13 Both Yes Knee strap 8 weeks Good
S.H. M 11 Both Yes Knee strap 8 weeks Good

usual methods of knee immobilization caused 5. Levine, J., and Splain, S. H.: Use of the infrapatella
considerable disability. brace in the treatment of chondromalacia patellae.
Clin. Orthop. 139: 179, 1979.
6. Ogden, J. A,, and Southwick, W. 0.: Osgood
REFERENCES Schlatter’s disease and tibial tuberosity develop-
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1 . Bosworth, B. M.: Autogenous bone pegging for 7. Reichmister, J.: Injection of the deep infrapatellar
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16:829, 1934. Child. Hosp. DC 25:21, 1969.
2. Ehrenborg, G., and Engfeldt, B.: The insertion of 8. Smillie, 1. S.: Injuries of the Knee Joint, ed. 3. Bal-
the ligamentum patellae on the tibial tuberosity. timore, Williams and Wilkins, 1962. p. 276.
Some views in connection with Osgood Schlatter’s 9. Sweetnam, R.: Corticosteroid arthropathy and ten-
lesion. Acta Chir. Scand. 121:491, 1961. don rupture. J. Bone Joint Surg. 51 B:397, 1969.
3 Froimson, A. 1.: Treatment of tennis elbow with 10. Thomson, J. E. M.: Operative treatment of osteo-
forearm support ban. J. Bone Joint Surg. 53A:183, chondritis of the tibial tubercle. J. Bone Joint Surg.
1971. 38A:142, 1956.
4. Levine, J.: A new brace for chondromalacia patellae 11. Watson-Jones. R.: Fractures and Joint Injuries, ed.
and kindred conditions. Am. J. Sports Med. 6 4. Edinburgh and London, E & S Livingstone, 1955,
(3):137, 1978. p. 785.