Treatment of Osgood-Schlatter Disease in a 25-Year-Old Male
For a 25-year-old male with persistent Osgood-Schlatter disease, arthroscopic excision of intratendinous ossicles and prominent tibial tubercle is the treatment of choice, as conservative management is ineffective after skeletal maturity. 1, 2
Why Surgery is Indicated at Age 25
- Osgood-Schlatter disease is a self-limiting condition that typically resolves spontaneously with skeletal maturity (closure of the tibial growth plate), which occurs during adolescence 1, 3
- By age 25, skeletal maturity is complete, and any persistent symptoms represent unresolved ossicles or prominent tibial tubercle that will not improve with conservative measures 1, 4
- In one surgical series, 26 out of 142 patients (18%) who initially received conservative treatment ultimately required surgical intervention due to persistent functional impairment 4
Surgical Approach: Arthroscopic vs. Open
Arthroscopic excision is superior to open procedures and should be the preferred surgical technique. 1, 2
The advantages of arthroscopic surgery include:
- Early postoperative recovery compared to open procedures 1
- No anterior incisional scar over the tuberosity, which typically causes discomfort with kneeling in open procedures 1
- Better cosmetic results 1
- Ability to address concomitant intra-articular pathology if present 1, 2
Specific Surgical Technique
The procedure involves:
- Arthroscopic removal of all loose intratendinous ossicles within the patellar tendon 1, 5
- Excision of prominent tibial tubercle if present 5
- Use of multidirectional arthroscope and motorized semi-hooded barrel burr for ossicle removal 2
This approach yields clearly better functional and cosmetic outcomes compared to alternative procedures, with minimal fair or poor results 5
Conservative Management is NOT Appropriate at This Age
While conservative treatment (activity modification, NSAIDs, ice, physical therapy) is the standard for adolescents with active growth plates 1, 3, this approach is futile in adults with closed growth plates and persistent symptoms 1, 4. The pathophysiology involves unresolved ossification that cannot spontaneously resolve after skeletal maturity 4.
Expected Outcomes
- Complete ossification of the tibial tuberosity and fusion with the tibial metaphysis occurs postoperatively 4
- Normal function of the leg returns after surgical excision 4, 5
- Overall prognosis is excellent, though some patients may experience minor discomfort with kneeling 1
Critical Pitfall to Avoid
Do not continue conservative management indefinitely in adults with persistent symptoms—this only delays definitive treatment and prolongs functional impairment, as the ossicles will not spontaneously resolve after skeletal maturity 1, 4.