Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Division of Radiology & Imaging, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2020 Mar;48(3):642-646. doi: 10.1177/0363546519899894. Epub 2020 Jan 31.
Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle caused by repetitive strain and chronic avulsion from the patellar tendon. No widely accepted anatomic risk factors have been associated with OSD.
To determine if OSD is associated with increased posterior tibial slope (PTS).
Cross-sectional study; Level of evidence, 3.
Forty knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients 10 to 15 years of age with a clinical diagnosis of OSD and available lateral radiograph and magnetic resonance imaging (MRI) were eligible. Age- and sex-matched patients with a history of knee pain but no evidence of OSD on clinical examination and without significant pathology on lateral radiograph and MRI were included in the control group. PTS was defined as the angle between a reference line perpendicular to the proximal anatomic axis and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral radiographs by 2 blinded investigators. Interrater reliability of PTS measurements was evaluated using intraclass correlation coefficient (ICC). The independent samples test was used to compare PTS between the OSD and control knees.
The mean age was 12.6 ± 1.6 years and 51% (37/72) of the knees were from male youth. There were no differences in age, sex, and laterality of knees between the OSD and control groups. The mean PTS was significantly higher in the OSD group (12.23°± 3.58°) compared with the control group (8.82°± 2.76°; < .001). The ICC was 0.931 (95% CI, 0.890-0.957), indicating almost perfect interrater reliability.
This study identifies an association between OSD and increased PTS. The clinical implications of this finding have not yet been elucidated. It may be speculated that in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS.
Osgood-Schlatter 病（OSD）是一种胫骨结节的牵拉性骨骺炎，由重复的张力和慢性髌腱撕脱引起。目前尚未发现与 OSD 相关的普遍公认的解剖学危险因素。
确定 Osgood-Schlatter 病（OSD）是否与胫骨后倾角（PTS）增加有关。
横断面研究；证据水平，3 级。
纳入了作者在 2008 年至 2019 年间检查的 40 例 OSD 膝关节和 32 例对照组膝关节。入选标准为年龄在 10 至 15 岁之间，临床诊断为 OSD，且有侧位 X 线片和磁共振成像（MRI）检查。对照组为年龄和性别匹配的患者，其临床检查无 OSD 表现，且 X 线片和 MRI 无明显病变。胫骨后倾角定义为垂直于近端解剖轴的参考线与内上胫骨平台最前、后缘相切的线之间的角度。由 2 名盲法观察者在真实侧位 X 线上进行重复测量。采用组内相关系数（ICC）评估胫骨后倾角测量的组内可靠性。采用独立样本 t 检验比较 OSD 组和对照组的胫骨后倾角。
平均年龄为 12.6±1.6 岁，51%（37/72）的膝关节来自男性青少年。OSD 组和对照组在年龄、性别和膝关节侧别方面无差异。OSD 组的平均胫骨后倾角（12.23°±3.58°）显著高于对照组（8.82°±2.76°；<0.001）。ICC 为 0.931（95%CI，0.890-0.957），表明观察者间具有近乎完美的可靠性。
本研究发现 OSD 与 PTS 增加有关。这一发现的临床意义尚未阐明。可以推测，在患有 OSD 的患者中，来自伸肌装置的力通过髌腱加载于胫骨的前侧，而不是后侧，从而导致不对称生长和 PTS 增加。
