Tibial tuberosity maturation assessment by ultrasonography and screening for Osgood- Schlatter Disease in children and adolescent athletes: a cross sectional study

Abstract

Background The tibial tuberosity maturation process is a developmental period during which insertional injuries can occur, such as Osgood-Schlatter disease. A four-stage classification system is commonly used to assess the developmental features of the tibial apophysis. Previous studies have shown that this maturation process begins earlier in girls which tend to progress 1 to 2 years earlier to the maturity stage than boys. Osgood-Schlatter disease is classified as traction apophysitis caused by excessive sports-related stress and occurs at the anterior aspect of the tibial tuberosity. This study was aimed to analyze the progression of tibial tuberosity maturation in relation to age of children and adolescent athletes. In addition, subjects included in the study were screened clinically and through ultrasound for development of Osgood-Schlatter disease. Methodology This was a single center cross-sectional study on 116 children and adolescent subjects with ages between 7 and 18 years. All subjects were practicing at least one sport regularly. All subjects were screened for symptoms related to Osgood-Schlatter disease and examined by ultrasound of the knee in order to establish the maturation stage of the tibial tuberosity based on a 4-point scale. Results Tibial tuberosity maturation grade was distributed as follows: grade 1 (n = 31, 26.72%), grade 2 (n = 9, 7.76%), grade 3 (n = 27, 23.28%) and grade 4 (n = 49, 42.24%). On clinical examination, only three cases presented symptoms associated with Osgood-Schlatter disease, which results in a very low prevalence of only 2.6% in the study population. All three cases displayed suggestive features on ultrasound examination. The majority of subjects over the age of 14 showed complete bone maturation. Between the ages of 13 and 15 years, female subjects showed higher proportions of complete bone maturation compared to males. Conclusion Our study describes the age pattern of the tibial tuberosity maturation process in children and adolescent athletes. Ultrasound imaging allowed for an accurate differentiation between the four stages of bone maturation and also offered a detailed view of the pathologic features associated with Osgood-Schlatter disease.