From the Research
The recommended treatment for Osgood Schlatter disease with tuberosity fragmentation leading to patellar tendinitis in adulthood is a multimodal approach, with surgical excision of ossicles or repair of the patellar tendon considered in severe cases that fail conservative measures, as supported by the most recent and highest quality study 1. The treatment approach should prioritize conservative measures, including:
- Relative rest and activity modification
- A structured physical therapy program emphasizing quadriceps and hamstring stretching and strengthening exercises performed 3-4 times weekly for at least 6-8 weeks
- Pain management with NSAIDs, such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily), for short periods during pain flares
- Ice application for 15-20 minutes after activity and before bed to reduce inflammation
- Use of a patellar tendon strap during physical activity to redistribute forces across the tendon If conservative measures fail after 3-6 months, more advanced interventions may be considered, including:
- Corticosteroid injections, although these carry risks of tendon weakening
- Platelet-rich plasma injections
- Surgical excision of ossicles or repair of the patellar tendon, with arthroscopic techniques being a beneficial option due to early postoperative recovery and better cosmetic results, as noted in 1. It is essential to address both the underlying fragmentation from childhood Osgood Schlatter disease and the resultant patellar tendinitis by reducing inflammation, improving biomechanics, and strengthening the supporting musculature around the knee. Key considerations in treatment include:
- The presence of pain with kneeling due to an ossicle that does not respond to conservative measures, which is an indication for surgery, as stated in 2
- The formation of a true joint between an ossicle in the patellar ligament and a facet on the tibia, which may require surgical treatment, as reported in 3
- The potential for pseudoarthrosis between a patellar tendon ossicle and the tibial tuberosity, which may require exploration and treatment, as described in 4.