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Does Osgood-Schlatter Disease Exist in the Dog?

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Does Osgood-Schlatter Disease Exist in the Dog? Review Article © Schattauer 2009 257 Does Osgood-Schlatter Disease exist in the dog? Review of human and canine literature and proposed classification system for tibial tuberosity avulsions in the immature dog. D. J. F. von Pfeil1; C. E. DeCamp2; K. L. Diegel3; P. A. Gholve4; C. W. Probst2; L. M. Déjardin2 1Veterinary Specialists of Alaska, Anchorage, Alaska, USA; 2Department of Small Animal Clinical Sciences, Michigan State University, College of Veterinary Medicine, East Lansing, Michigan, USA; 3Eli Lilly and Company, Lilly Research Labs, Greensfield, Indiana, USA; 4Division of Pediatric Orthopaedic Surgery, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, USA Although numerous aetiological theories are Keywords tive. The term OSD has also been used for the proposed, trauma seems to be the most likely Osgood-Schlatter disease, avulsion, dog, canine patient. However, radiographs of these cause (1–9). tibial tuberosity, apophysis patients typically show an enlarged radio- The diagnosis of OSD is well established in lucent line at the apophyseal plate of the tibial people, but reports on similar conditions in Summary tuberosity. This finding is consistent with a dogs are rare (5, 10–14). The purpose of this Osgood-Schlatter disease (OSD) is a condition mild avulsion fracture of the canine tibial paper is to review the literature on OSD in affecting human adolescents in which there is tuberosity. Based on the radiographic differ- humans and to evaluate the use of this term in partial separation of bone fragments from the ences between the two species, it seems more the canine patient. In addition, a new classifi- tibial tuberosity at the site of insertion of the appropriate to use the term OSD only for cation system for tibial tuberosity avulsions patellar ligament to the tibial tuberosity. Ten- people. The purpose of this paper is to review in the immature dog is proposed, with an al- sile trauma seems to be the most likely aetiol- the literature on OSD in people and the re- gorithm for management of this injury. ogy. Clinical signs in people consist of swell- ports of injuries to the proximal tibial tuberos- ing and pain at the proximal part of the tibial ity in dogs. In addition, a new classification tuberosity and around the distal end of patel- system for tibial tuberosity avulsion injuries in The development lar ligament. Radiographs frequently show the immature dog is proposed, with an algo- small ossicles at the patellar ligament inser- rithm for management of this injury. of the tibial tuberosity tion. Conservative treatment is usually cura- The development of the tibial tuberosity can be divided into four stages: cartilagenous, Correspondence to Vet Comp Orthop Traumatol 2009; 22: 257–263 apophyseal, epipyseal and bony stage. In the Dirsko J.F. von Pfeil, Dr.med.vet, DVM, Diplomate ACVS, doi:10.3415/VCOT-08-09-0094 cartilaginous stage an ossification centre is Diplomate ECVS Received: September 25, 2008 not radiographically visible. People remain in Veterinary Specialists of Alaska Accepted: February 5, 2009 3330 Fairbanks Street Prepublished online: June 23, 2009 this stage until about 11 years of age (15). In Anchorage, Alaska 99503 the dog, this stage lasts from four to six weeks USA of age (16). The apophyseal stage in people is Phone: +1 907 274 0645 from 11–14 years, and in the dog from four to Fax: +1 907 929 3320 E-mail: [email protected] six weeks until five to six months of age (15, 16). During this stage, one ossification centre of the tibial tuberosity appears in both, people and dogs (8, 19). The epiphyseal Introduction Osgood-Schlatter Disease (OSD) became a stage is characterised by fusion of visible commonly used term in human orthopaedics tuberosity bone with the proximal tibial The first medical descriptions of a painful (3,4). Other names used in the past were trac- epiphysis. This stage is seen in people between condition affecting the tibial tuberosity in tion apophysitis, enthesopathy of the tibial 14–18 years, and in dogs between six to 10 young human active adolescents were pro- tuberosity, and aseptic necrosis of the apo- months of age (10, 15, 16). The bony stage is vided by the American surgeon Robert Bayley physis of the tibia (5–7). Osgood-Schlatter characterised by closure of the physes; this Osgood (1873–1956) and the Swiss surgeon Disease is commonly diagnosed in athlet- occurs in people at more than 18 years of Carl Schlatter (1864–1934) in 1903 (1, 2). As ically active adolescents (1, 9). Conservative age and in average sized dogs at 10–12 this specific injury was reported often, treatment usually alleviates discomfort (1–9). months of age (10, 15, 16). Ossification of the Vet Comp Orthop Traumatol 4/2009 258 D. J. F. von Pfeil et al.: Does Osgood-Schlatter Disease exist in the dog? cal studies suggest that, as in people, tensile trauma is the most common cause for injuries to the tibial tuberosity in the dog (10, 16, 17). History, incidence, Fig. 1 and clinical signs Radiograph of a 12-year-old boy with Regardless of the underlying aetiology, recur- Osgood-Schlatter ring trauma and high tensional stress at the Disease. Note the insertion at the patellar ligament results in small avulsed bone pain (1–9). Boys present commonly in the age at the cranial and range of 11 to 15 years, with a peak at 13 years; proximal aspect of in girls the peak age is 11 years (7, 8, 17). This the tibial tuberosity difference may be due to the fact that ossifica- (white open arrow) tion occurs approximately two years earlier in and swelling of the girls compared to boys (17). The male to fe- knee joint. male-ratio is 7:1, likely due to the greater par- ticipation in specific risk activities by boys in comparison to girls (9). Patients often have a tibial tuberosity takes place about two years using computed tomography (CT) and mag- history of recent rapid growth, or vigorous earlier in girls than in boys (17). Completion netic resonance imaging (MRI) (20, 23). participation in sports (7, 17). The overall of the bony stage may be delayed until 18–22 Avascular changes may represent another incidence in people is reported to be 12.9% months of age, especially in giant and large aetiology. Minor trauma, chronic trauma, gen- (9). Bilateral symptoms are observed in breed dogs, but delayed complete fusion of etic predisposition, fat emboli, or thrombi may 20–30% of affected individuals (29). Clinical the tibial tuberosity apophysis with the proxi- impair blood supply, resulting in multicentric signs usually consist of intermittent or mal tibial epiphysis is also possible in smaller impairment of the ossification process within chronic pain in one or both knees while stand- breeds (19). In people, symptoms of OSD can the tibial tuberosity and subsequent devel- ing, going up and down stairs, running, or initiate in stages 1–3 (girls 8–12 years, boys opment of OSD (7). This theory is supported when kneeling (1–4, 7–9). Soft-tissue swell- 12–15 years of age) and can persist in stage 4 by a microangiographic study in affected ing, erythema, and warmth over the proximal (15, 16). Dogs are most frequently presented children, which showed avascularity of the epi- tibia are present. Pain can be localised at the with injuries to the tibial tuberosity in stages physeal plate persisted until physis closure had insertion of the patellar ligament, and elicited 2, 3, and early stage 4 (3–11 months of age) occurred (24). The importance of diminished upon flexion of the knee (1–4, 7, 8). Soft tis- (10). blood supply has also been described in reports sue-damage seems to be the main reason for of a combination of OSD and aseptic necrosis the occurrence of clinical signs (22, 20). of the calcaneal apophysis (7, 9). Finally, osteo- While OSD is a well characterised con- Aetiology myelitis, hypothyroidism, a genetic predisposi- dition in people, reports of traction injury to tion, underlying osteochondrosis and infrapa- the canine tibial tuberosity apophysis with re- Most authors support the original theory of tellar bursal osteochondromatosis have been spect to OSD are rare (5, 10–14). All dogs in Osgood and Schlatter, that forceful contrac- suggested as aetiologies (7, 25–27). However, one study were between three to 11 months of tion of the quadriceps muscle in young scientific support for these theories is scarce. age when they were presented with various human individuals may exceed the tensile In the case of dogs, there are different degrees of lameness; additionally, the dogs strength of the insertion of the patellar liga- opinions on the aetiology for traction injuries exhibited signs of pain upon palpation of the ment, resulting in avulsion of small pieces of to the tibial tuberosity. One paper, describing a cranial tibia (10). The same study reports an cartilage or ossified bone from the tibial tube- litter of Greyhounds, suggests that this breed incidence of 0.08% (17 dogs out of 25,500 rosity (ǠFig.1) (8, 16, 20). This theory is sup- may be genetically predisposed to the develop- cases, which were admitted to a hospital over ported by findings from an experimental ment of osteochondrosis at the apophyseal a 10-year period) (10). The incidence of bilat- study and various histological examinations plate with subsequent mild displacement or eral occurrence is not described. (15, 16, 21). Local desmitis of the patellar liga- complete avulsion of the tibial tuberosity (12). ment at its insertion site has also been re- However, another report about racing Grey- ported as a possible aetiology for OSD (22). hounds clearly shows that trauma is the pre- Diagnostic imaging Other proposed theories such as congeni- cipitating cause for avulsion (11).
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