TREATMENT OF OSGOOD-SCHLATTER DISEASE WITH DRILL ...

TREATMENT OF OSGOOD-SCHLATTER DISEASE WITH DRILL
CHANNELS *
BY E. J. BOZSAN, M.D., AND THOMAS J. O’KANE, M.D.,
NEW YORK, N. Y.
From. the Division of Skeletal Surgery, Morrisania City Hospital, New York
It is well known that a large majority of cases of Osgood-Schiatter
disease either require no treatment whatever or respond favorably to
conservat ive measures. However, the opinion is expressed frequently
that. there is a certain, if very small, percentage of cases that call for some
form of operative treatment. Operations ranging from the simple bone-
splitting incision1 to bone grafting2 and removal of the diseased areas3
have been devised.
The present-day conception of the disease, as it has become differen-
tiated since the original publications of Osgood4 and Schlatter5, separates
the traumatic avulsion of the tibial tubercle and the cases of bone formation
in the patella tendon, lat.er described, from this distinctly chronic
process.
Irrespective of the etiological relationship of the two groups, we are
at. this time concerned only with the chronic cases, not manifestly trau-
matic, which correspond to those described by Schiatter and those
classified as Group 2 in the description of Osgood.
Following the line of thought that prompted one of us to recommend
drill channels for treatment of the Legg-Calv&Perthes disease and of
intracapsular fractures of the neck of the femur6, we have applied this
simple procedure to cases of Osgood-Schiatter disease, with the expectation
that the fresh blood supply conducted to the diseased areas of bone would
improve the condition,-that is, facilitate and so hasten the process of
natural repair.
The technique is simple. A small incision or stab wound is made over
the affected t.ibial tubercie and one or two channels are drilled through
the diseased area, indicated on the roentgenogram, into the cancellous
upper end of the tibia. Immobilization in plaster-of-Paris seems un-
necessary. Patients are allowed to walk as soon as they are able to
do so without pain. -
During the year 1932, six cases have been treated in this manner with
gratifyingly prompt results. The clinical symptoms have subsided
within three or four weeks and complete bony restoration has been
demonstrable by x-ray examination as early as seven weeks after opera-
tion. During this time pain and swelling have disappeared; the patients
have regained their confidence in the extremity; and have been able to
bear weight in a squatting position.
* Read before the Clinical Society of the Hospital for Joint Diseases, New York
February 7, 1933.
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OSGOOD-SCHLATTER DISEASE
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292 E. J. BOZSAN AN!) T. J. 0 KANE
(.‘ASE HISTORIES
CASE 1 (Figs. 1, 2, and 3). 13. S., girl, eleven years of age (No. 29529), was admitted
to the hospital January 13, 1932. Symptoms of pain and tenderness had been present
for six months. Roent.genogram taken the following day (Fig. 1 ) revealed the tubercle
fragmented and considerably absorbed. Drilling operation was performed on February
I , 1932. On withdrawal of the (trill, a large (lrop of mucilaginous material issue(1 out of
the hole un(ler some l)resstlre. Cultures of this and hone chips were negative. Due
to the fact that this patient had to he placed in a plaster spica on account of a coexisting
process in the hip joint, the earliest postoperative roentgenogram could not be taken
until
-
May 7, 1932 (Fig. 2 . This
A
indicated
r
complete restoration of the tibial tubercle,
and a follow-up picture July 5,
1932, (Fig. 3) showed tip fused
. with main l)ody of the tibia.
CASE 2 (Figs. 4, 5, 6, and
7). E. Q., boy, aged fifteen
years (No. 28026), had been
treated in the Out-Patient
Department since the fall of
1931. Symptoms had been
present vi Ith varying intensity
for the last fourteen months.
Roentgenogram December 7,
1931, (Fig. 4) showed the tubercle
fragmented and its tip absorbed.
Patient refused opera-
t.ion but returned in the spring
of 1932 on account of exacerha-
t.ion of symptoms. X-ray (Fig.
5) April 26, 1932, revealed iden-
tical condition as four and one-
half months before. Drilling
operation was done on May 6,
1932, and the limb immobilized
for two weeks. Patient was
discharged May 30, 1932.
When he reported to the clinic
about eight. weeks after 1eration,
July 1, 1932, the roentgenogram
(Fig. 6) revealed the
previously absorbed tip of the
FIG. 4 tibial tubercle restored. All
clinical symptoms were absent
Case 2. Roent.genogram taken December 7, 1931.
Tihial tubercle fragmented and tip absorbed. and the patient had full use of
the limb. He did not report
again until March 20, 1933, on which occasion the x-ray (Fig. 7) revealed complete resto-
ration of the tihial t.iibercle and union of the small fragments with the main body of the
tuhercle, with only a small hiatus indicating the upper border of the small fragment. He
was completely free of symptoms.
CASE 3 (Figs. 8, 9, 10, and 11). J. R., boy, fourteen years old (No. 31847). Symptoms
had been present for five months previous to admission. X-ray September 8, 1932,
revealed the tip of the right tihial t.uhercle absorbed. Operation was performed September
19, 1932, and patient was discharged two days after operation with plaster-of-Paris
bandage which he wore for a period of two weeks. About eight weeks after operation

OSGOOD-SCHLATTER DISEASE 293
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294 li. J. BOZSAN AND T. J. O’KANE
FIG. S FIG. 9
Case 3. Roentgeiiogram taken Septenhl)er
5, 1932. Tip of t uherele
ahsorhed.
Case 3. Roentgenogram taken December
3, 1932. Complete restoration.
j
Case 3. Roentgenogram taken November
1, 1932, six weeks after operation.
New hone fornmtion beginning.
FIG. 11
Case 3. Roentgenogram taken January
12, 1933. Complete restoration,
firm union.

FIG. 12
Case 4. Hxentgenogram taken October
14, 1932. Fragmentation and
absorption of the tubercie.
FIG. 14
Case 5. Rnentgenogram taken December
10, 1932. Tubercle fragmented
and considerably absorbed.
OSGOOD-SCHLATTER DISEASE 29s
FIG. 13
Case 4. Roentgenogram taken December
1, 1932, seven weeks after operation.
Complete restorat ion.
FIG. 15
Case 5. Roentgenogram taken February
25, 1933, ten weeks after operation.
Fragments united. Size of tubercle
considerably increased.

296 E. J. BOZSAN AND T. J. O’KANE
FIG. 16 FIG. 17
Case 6. It()entgenogranl taken’De- Ca.se 6. Roentgenogram taken Febcember
10, 1932. Tuberele fragmented ruary 25, 1933, ten weeks after operaaII(I
rarefied. tion. Fragments united and size of
tibial tubercle considerably increased.
the boy viItS entirely free from clinical symptoms. Roentgenogram November 1, 1932
(Fig. 9 revealed bone formation at the site of the previously absorbed tip and apposition
of new bone over the body of the tuhercie. X-ray on December 3, 1932 ( Fig. 10) showed
tibial tubercle totally restored, as did another (Fig. 1 1 ) taken January 12, 1933.
CASE 4 (Figs. 12 and 13). \V. P., boy, thirteen years of age (No. 32670), had had
symptoms for eight months. Roentgenogram (Fig. 12) taken on October 14, 1932
revealed fragmentation and absorption of right tihial tuhercle. Operation was done on
October 15, 1932, and patient. was discharged October 17, 1932, without application of
plaster-of-Paris. On December 1, 1932, patient was free of all symptoms, and an x-ray
(Fig. 13) at this time, seven weeks after operation, revealed complete bony restoration
of the tibial tubercle.
CAsE 5 (Figs. 14 and 15). .J. 5., boy fifteen years old (No. 34838). Symptoms
had been present on 1)0th sides for eight. months. X-ray (Fig. 14) December 10, 1932,
revealed diffuse absorption of the right tibia! tuhercle and a fracture at its base. Operation
was performed on December 19, 1932, and patient was discharged December 21, 1932,
without any immobilization. On February 25, 1933, the patient was free of symptoms,
and roent.genogram (Fig. 15) taken at this time revealed bony formation, increasing the
size of the tibia! tul)ercle, and union of fracture line.
CASE 6 (Figs. 16 and 17). Same patient as Case 5. X-ray (Fig. 16) December 10,
1932, revealed left tibial tubercie fragmented. Operation was done the same day as
that on the right. side. When seen on February 25, 1933, the patient was free of symptoms.
Roentgenogram at this time (Fig. 17) revealed considerable restoration of the
outline of the tibia! tubercle and disappearance of the fragment.
It is difficult to decide when to consider conservative measures in-
adequate. The intensity of symptoms, the ensuing disability, and the

OSGOOD-SCHLATTER DISEASE 297
period of recovery vary so widely that it seems futile to try to establish an
average picture of the disease. Schlatter’s observation that the older the
child, the better are the chances of spontaneous recovery is of little help
in the great number of cases between the ages of eleven and fourteen.
Osgood speaks of “severe handicap and long continued serious annoy-
ance “, Schlatter of “recurrent attacks of pain over a long period of time”.
Campbell7 mentions instances in which one or more years elapse before
the symptoms entirely subside.
We wish to emphasize that these are the cases, and these only, for
which this simple operative procedure is recommended.
REFERENCES
1. JONES, SIR ROBERT, AND LovFrrr, R. W.: Orthopedic Surgery. Ed. 2. New York,
William Wood and Co., p. 36, 1929.
2. BOSWORTH, DAVID M.: Avulsion of the Tibia! Tubercle (Osgood-Schlatter) Treated
by Fixation of the Tubercie with Bone Pegs. Section of Orthopedic Surgery, New
York Academy of Medicine, Dec. 16, 1932.
3. CorroN, F. J.: Fractures. In Dean Lewis’ Practice of Surgery. Hagerstown, Md.,
W. F. Prior Co., Inc., Vol. II, Chap. 4, p. 127, 1927.
4. OSGOOD, R. B.: Lesions of the Tibial Tubercle Occurring During Adolescence.
Boston Med. and Surg. J., CXLVIII, 114, 1903.
5. SCRLATFER, CARL: Verletzungen des SchnabelfOrmigen Fortsatzes der Oberen
Tibiaepiphyse. Bruns’ Beitr. z. KIm. Chir., XXXVIII, 874, 1903.
6. BOZSAN, E. J.: A New Treatment of Intracapsular Fractures of the Neck of the Femur
and Calv#{233}-Legg-Perthes Disease. J. Bone and Joint Surg., XIV, 884, Oct. 1932.
A New Treatment of Intracapsular Fractures of the Neck of the
Femur and Legg-Calv#{233}-Perthes Disease. Technique. J. Bone and Joint Surg.,
XVI, 75, Jan. 1934.
7. CAMPBELL, WILLIS C.: A Text-Book on Orthopedic Surgery. Philadelphia, W. B.
Saunders Co., p. 165, 1930.