Surgical treatment of residual osgood-schlatter disease in young adults: role of the mobile osseous fragment.

Osgood-Schlatter disease is a well-known condition in late childhood characterized by pain over the tibial tubercle. This condition usually resolves spontaneously at skeletal maturity. Few patients develop pain over the tibial tubercle. Radiological examination demonstrates a round regular ossification over the tubercle. Treatment is usually symptomatic, but occasionally surgical treatment is necessary, usually due to the development of a painful ossicle. This article reports our experience with refractory Osgood-Schlatter disease in 22 patients. Most patients were operated under local anesthesia. A midline longitudinal skin incision was used, followed by subperiosteal dissection of the osseous fragment. The knee was put in soft dressing. Patients were encouraged to resume daily activity immediately postoperatively. No wound complications were noted. All patients returned to their previous level of physical activity within 12 weeks postoperatively. All but 1 were free of pain on kneeling or direct pressure over the knee joint. Based on our experience, we devised a treatment algorithm. We believe that the key factors for successful surgical treatment are clear visualization of separation on lateral knee radiographic view and a clinical mobility positive test (firm grasping of the prominent part of the tubercle and its sliding movement). Our results are uniformly good; the only failure related to mistaken inclusion criteria where the lateral radiograph did not show a distinctly separated fragment.