Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation
Identifieur interne : 002199 ( Pmc/Curation ); précédent : 002198; suivant : 002200Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation
Auteurs : Matthieu Sailly [France] ; Rod Whiteley [Australie] ; Amanda Johnson [Qatar, Royaume-Uni]Source :
- British Journal of Sports Medicine [ 0306-3674 ] ; 2012.
Abstract
The pathogenesis of the Osgood-Schlatter's disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT).
It is unknown if such changes are present in the presumed pathological tendon insertion seen in OSD, nor the relation of Doppler-positive changes to pain on clinical examination.
A prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9 years±1.3) and a comparison group of asymptomatic subjects. All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a visual analogue scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat.
Positive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47±24.5 vs 18±11.4, p<0.01) and resisted static contraction (59±20.2 vs 27±12.5, p<0.001) compared with Doppler-negative subjects. No Doppler activity was found in the comparison group. VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1±22.0 and 60.0±21.2) were significantly higher than stage 3 (17.8±12.0 and 18.9±16.9) and stage 4 (15.0±7.1 and 25.0±7.1; p<0.01).
More painful OSD is associated with the presence of neo-vessels. This may be linked with a particular stage of ATT maturation and applied compressive forces. A Doppler ultrasound scan adds practical information to develop the care plan of the patient.
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DOI: 10.1136/bjsports-2012-091471
PubMed: 22952406
PubMed Central: 3533382
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation</title><author><name sortKey="Sailly, Matthieu" sort="Sailly, Matthieu" uniqKey="Sailly M" first="Matthieu" last="Sailly">Matthieu Sailly</name><affiliation wicri:level="1"><nlm:aff id="af1">Centre de Biologie et de Medecine du Sport de Pau, Centre Hospitalier Pau, Pau, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre de Biologie et de Medecine du Sport de Pau, Centre Hospitalier Pau, Pau</wicri:regionArea></affiliation></author><author><name sortKey="Whiteley, Rod" sort="Whiteley, Rod" uniqKey="Whiteley R" first="Rod" last="Whiteley">Rod Whiteley</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="af4">University of New England, Armidale, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>University of New England, Armidale</wicri:regionArea></affiliation></author><author><name sortKey="Johnson, Amanda" sort="Johnson, Amanda" uniqKey="Johnson A" first="Amanda" last="Johnson">Amanda Johnson</name><affiliation wicri:level="1"><nlm:aff id="af5">Aspire Academy for Excellence-NSMP, Doha, Qatar</nlm:aff><country xml:lang="fr">Qatar</country><wicri:regionArea>Aspire Academy for Excellence-NSMP, Doha</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af6">University of Manchester, Manchester, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Manchester, Manchester</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22952406</idno><idno type="pmc">3533382</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533382</idno><idno type="RBID">PMC:3533382</idno><idno type="doi">10.1136/bjsports-2012-091471</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002349</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002349</idno><idno type="wicri:Area/Pmc/Curation">002199</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002199</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation</title><author><name sortKey="Sailly, Matthieu" sort="Sailly, Matthieu" uniqKey="Sailly M" first="Matthieu" last="Sailly">Matthieu Sailly</name><affiliation wicri:level="1"><nlm:aff id="af1">Centre de Biologie et de Medecine du Sport de Pau, Centre Hospitalier Pau, Pau, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre de Biologie et de Medecine du Sport de Pau, Centre Hospitalier Pau, Pau</wicri:regionArea></affiliation></author><author><name sortKey="Whiteley, Rod" sort="Whiteley, Rod" uniqKey="Whiteley R" first="Rod" last="Whiteley">Rod Whiteley</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="af4">University of New England, Armidale, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>University of New England, Armidale</wicri:regionArea></affiliation></author><author><name sortKey="Johnson, Amanda" sort="Johnson, Amanda" uniqKey="Johnson A" first="Amanda" last="Johnson">Amanda Johnson</name><affiliation wicri:level="1"><nlm:aff id="af5">Aspire Academy for Excellence-NSMP, Doha, Qatar</nlm:aff><country xml:lang="fr">Qatar</country><wicri:regionArea>Aspire Academy for Excellence-NSMP, Doha</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af6">University of Manchester, Manchester, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Manchester, Manchester</wicri:regionArea></affiliation></author></analytic><series><title level="j">British Journal of Sports Medicine</title><idno type="ISSN">0306-3674</idno><idno type="eISSN">1473-0480</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The pathogenesis of the Osgood-Schlatter's disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT).</p></sec><sec><title>Objectives</title><p>It is unknown if such changes are present in the presumed pathological tendon insertion seen in OSD, nor the relation of Doppler-positive changes to pain on clinical examination.</p></sec><sec><title>Methods</title><p>A prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9 years±1.3) and a comparison group of asymptomatic subjects. All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a visual analogue scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat.</p></sec><sec><title>Results</title><p>Positive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47±24.5 vs 18±11.4, p<0.01) and resisted static contraction (59±20.2 vs 27±12.5, p<0.001) compared with Doppler-negative subjects. No Doppler activity was found in the comparison group. VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1±22.0 and 60.0±21.2) were significantly higher than stage 3 (17.8±12.0 and 18.9±16.9) and stage 4 (15.0±7.1 and 25.0±7.1; p<0.01).</p></sec><sec><title>Conclusions</title><p>More painful OSD is associated with the presence of neo-vessels. This may be linked with a particular stage of ATT maturation and applied compressive forces. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Br J Sports Med</journal-id><journal-id journal-id-type="iso-abbrev">Br J Sports Med</journal-id><journal-id journal-id-type="hwp">bjsports</journal-id><journal-id journal-id-type="publisher-id">bjsm</journal-id><journal-title-group><journal-title>British Journal of Sports Medicine</journal-title></journal-title-group><issn pub-type="ppub">0306-3674</issn><issn pub-type="epub">1473-0480</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22952406</article-id><article-id pub-id-type="pmc">3533382</article-id><article-id pub-id-type="publisher-id">bjsports-2012-091471</article-id><article-id pub-id-type="doi">10.1136/bjsports-2012-091471</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject></subj-group><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Sailly</surname><given-names>Matthieu</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Whiteley</surname><given-names>Rod</given-names></name><xref ref-type="aff" rid="af2">2–</xref><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Johnson</surname><given-names>Amanda</given-names></name><xref ref-type="aff" rid="af5">5</xref><xref ref-type="aff" rid="af6">6</xref></contrib></contrib-group><aff id="af1"><label>1</label>Centre de Biologie et de Medecine du Sport de Pau, Centre Hospitalier Pau, Pau, France</aff><aff id="af2"><label>2</label>Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar</aff><aff id="af3"><label>3</label>University of Sydney, Sydney, Australia</aff><aff id="af4"><label>4</label>University of New England, Armidale, Australia</aff><aff id="af5"><label>5</label>Aspire Academy for Excellence-NSMP, Doha, Qatar</aff><aff id="af6"><label>6</label>University of Manchester, Manchester, UK</aff><author-notes><corresp><label>Correspondence to</label> Dr Matthieu Sailly, Centre de Biologie et de Medecine du Sport de Pau, Centre Hospitalier Pau, Pau, France; <email>matthieusailly@yahoo.fr</email></corresp></author-notes><pub-date pub-type="ppub"><month>1</month><year>2013</year></pub-date><pub-date pub-type="epub"><day>5</day><month>9</month><year>2012</year></pub-date><volume>47</volume><issue>2</issue><fpage>93</fpage><lpage>97</lpage><history><date date-type="accepted"><day>12</day><month>8</month><year>2012</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link> and <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/legalcode">http://creativecommons.org/licenses/by-nc/3.0/legalcode</ext-link></license-p></license></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="bjsports-2012-091471.pdf"></self-uri><abstract><sec><title>Background</title><p>The pathogenesis of the Osgood-Schlatter's disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT).</p></sec><sec><title>Objectives</title><p>It is unknown if such changes are present in the presumed pathological tendon insertion seen in OSD, nor the relation of Doppler-positive changes to pain on clinical examination.</p></sec><sec><title>Methods</title><p>A prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9 years±1.3) and a comparison group of asymptomatic subjects. All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a visual analogue scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat.</p></sec><sec><title>Results</title><p>Positive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47±24.5 vs 18±11.4, p<0.01) and resisted static contraction (59±20.2 vs 27±12.5, p<0.001) compared with Doppler-negative subjects. No Doppler activity was found in the comparison group. VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1±22.0 and 60.0±21.2) were significantly higher than stage 3 (17.8±12.0 and 18.9±16.9) and stage 4 (15.0±7.1 and 25.0±7.1; p<0.01).</p></sec><sec><title>Conclusions</title><p>More painful OSD is associated with the presence of neo-vessels. This may be linked with a particular stage of ATT maturation and applied compressive forces. A Doppler ultrasound scan adds practical information to develop the care plan of the patient.</p></sec></abstract><kwd-group><kwd>Adolescents</kwd><kwd>Ultrasound</kwd><kwd>Children's injuries</kwd><kwd>Knee</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>special-feature</meta-name><meta-value>unlocked</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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