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. Mr. Fergus Paterson
Private Consulting © Fergus Paterson 2003/4/5 |
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Osgood-Schlatters Disease is far less sinister than it sounds, it is a common and harmless "growing pain" and occurs at the top of the shin bone where the patellar tendon is inserted. This tendon exerts a strong pull at its insertion and in soft growing bone can produce a tender lump typically in sporty youngsters, particularly footballers. When skeletal maturity is reached, and the bone hardens up, the symptoms of this condition will subside but can leave behind a permanent bony lump which can go on causing problems in adulthood where it may be sore and can interfere with kneeling. X-rays in the child may show some elevation of the bony epiphysis (growth plate) where the patellar tendon is inserted, and in the adult there may be a separate bony fragment where this portion of the epiphysis has remained ununited. Treatment of Osgood-Schlatters Disease in children is simply to recommend rest from all sporting activity for a week or two until the acute flare-up subsides. Occasionally a short course of an anti-inflammatory tablet such as Nurofen can be helpful. Very occasionally the pain is so severe that it is necessary to immobilise the knee in a weight-bearing cast for three to four weeks followed by a more gradual return to normal activity. In adults treatment may have to be surgical in the form of shaving the lump or removing any ununited fragments that may be present. Chondromalacia Patellae is extremely common among teenage girls, indeed it is one of the commonest causes of referral to knee clinics. It produces discomfort around the kneecap (patella) which is typically worse with running, climbing stairs, and sitting still for long periods, and may produce a sensation of crunching or clicking under the kneecap with walking. The exact cause of chondromalacia patellae is poorly understood but it may be related to wearing a shoe with a raised heel or playing a lot of sport. The under surface of the kneecap, when viewed through the arthroscope, looks soft and may be cracked superficially. Although at times a nuisance, this condition is essentially benign and does not go on to cause arthritis. However the symptoms themselves may be difficult to treat effectively. Reassurance is given in the majority of cases but occasionally keyhole surgery can be helpful. Patella Dislocation, where the kneecap (patella) slips sideways round to the outer side of the knee, is both painful and alarming when it occurs. Once again it is commoner in girls and there may be predisposing factors such as generalised joint hypermobility, knock-knees, etc. If dislocation of the kneecap occurs repeatedly the only treatment likely to be effective is surgical realignment of the patella. This operation involves a scar three to four inches long on the outer side of the knee and is followed by immobilisation in a long leg cast for about a month. After that a period of physiotherapy is needed to get the knee moving normally again. Sometimes patella dislocation can occur in both knees and may be associated with instability of other joints, e.g. the shoulder. Osteochondritis Dissecans is when a fragment of joint
surface splits off within the knee causing pain and locking. It tends to be
seen in the more sporty individuals and causes a persistent nagging pain
towards the inner side of the knee, made worse by activity. Examination
findings may be few or absent altogether, but X-rays are diagnostic. Treatment
in the early stage of the disease is rest; but once a loose fragment has
developed it should be removed by keyhole surgery.
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