From OT Europe

Injections for Osgood-Schlatter disease associated with symptom reduction

Pre-injection VISA scores increased significantly at final follow-up in patients who received monthly dextrose or saline injections for 3 months.

COLORADO SPRINGS, USA — Compared with usual care, treatment of Osgood-Schlatter disease with hyperosmolar dextrose or saline injection therapy suggested patients had superior symptom reduction efficacy, according to results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.

“We were not able to verify the efficacy of dextrose compared with saline, and the injection of the distal attachment of the patellar tendon and deep infrapatellar bursa or infrapatellar fat pad under ultrasound guidance may become a new treatment method for Osgood-Schlatter disease,” Junsuke Nakase, MD, PhD, said.

Nakase and Hiroyuki Tsuchiya, MD, PhD, randomly assigned 43 knees with Osgood-Schlatter disease in 33 boys to a 1 mL saline injection group or a 1 mL dextrose injection group. Both types of injection were coupled with 1% lidocaine (1 mL) and administered by the same investigator. The investigator and patients were blinded to which treatment was received.

Junsuke Nakase, MD, PhD
Junsuke Nakase

Dextrose vs saline injection studied

“Half of the solution is injected into the deep infrapatellar bursa or infrapatellar fat pad, while the remaining half is injected into the distal attachment of the patellar tendon and ultrasonography guidance,” Nakase said.

Patients received the designated injections monthly for 3 months. Researchers used the Victorian Institute of Sport Assessment (VISA) score to evaluate the patients’ pain pre-treatment, as well as at final follow-up.

Pre-injection mean VISA scores significantly increased from 62.5 in the saline group and 59.6 in the dextrose group to approximately 84.1 in the saline group and 83.6 in the dextrose group at final follow-up. Nakase noted significant differences in the saline group and dextrose group at all other time points, as well as no adverse effects of the injection.

“Injection in the deep infrapatellar bursa, infrapatellar fat pad and distal attachment of the patella tendon under ultrasonographic guidance may become a new treatment method for [Osgood-Schlatter disease] OSD,” Nakase told Orthopaedics Today Europe.

Future research required

According to Nakase, the study was limited in that it did not include a no-treatment control group because this may have deterred patients from enrolling in the study.

“The patients had undergone conservative therapy for more than 1 month,” Nakase said. “We cannot deny that the result of this clinical study shows natural course of anterior knee pain.”

Future research should aim at classifying the stage of Osgood-Schlatter disease with ultrasound, determining the acceptable treatment for each stage of the disease and confirming the effect of lidocaine injection alone.

In terms of his usual treatment for Osgood-Schlatter disease, Nakase told Orthopedics Today Europe, “I order rest and compression in the early stage, because the delamination of the secondary ossification is the precise pathology in the early stage. Patellar tendinosis and deep infrapatellar bursitis contribute to the pain of Osgood-Schlatter disease in the middle stage. In the middle stage, injection of some kind of solution in [the] deep infrapatellar bursa, infrapatellar fat pad and distal attachment of [the] patellar tendon is an effective treatment,” he said. – by Casey Tingle

Disclosure: Nakase reports no relevant financial disclosures.

COLORADO SPRINGS, USA — Compared with usual care, treatment of Osgood-Schlatter disease with hyperosmolar dextrose or saline injection therapy suggested patients had superior symptom reduction efficacy, according to results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.

“We were not able to verify the efficacy of dextrose compared with saline, and the injection of the distal attachment of the patellar tendon and deep infrapatellar bursa or infrapatellar fat pad under ultrasound guidance may become a new treatment method for Osgood-Schlatter disease,” Junsuke Nakase, MD, PhD, said.

Nakase and Hiroyuki Tsuchiya, MD, PhD, randomly assigned 43 knees with Osgood-Schlatter disease in 33 boys to a 1 mL saline injection group or a 1 mL dextrose injection group. Both types of injection were coupled with 1% lidocaine (1 mL) and administered by the same investigator. The investigator and patients were blinded to which treatment was received.

Junsuke Nakase, MD, PhD
Junsuke Nakase

Dextrose vs saline injection studied

“Half of the solution is injected into the deep infrapatellar bursa or infrapatellar fat pad, while the remaining half is injected into the distal attachment of the patellar tendon and ultrasonography guidance,” Nakase said.

Patients received the designated injections monthly for 3 months. Researchers used the Victorian Institute of Sport Assessment (VISA) score to evaluate the patients’ pain pre-treatment, as well as at final follow-up.

Pre-injection mean VISA scores significantly increased from 62.5 in the saline group and 59.6 in the dextrose group to approximately 84.1 in the saline group and 83.6 in the dextrose group at final follow-up. Nakase noted significant differences in the saline group and dextrose group at all other time points, as well as no adverse effects of the injection.

“Injection in the deep infrapatellar bursa, infrapatellar fat pad and distal attachment of the patella tendon under ultrasonographic guidance may become a new treatment method for [Osgood-Schlatter disease] OSD,” Nakase told Orthopaedics Today Europe.

Future research required

According to Nakase, the study was limited in that it did not include a no-treatment control group because this may have deterred patients from enrolling in the study.

“The patients had undergone conservative therapy for more than 1 month,” Nakase said. “We cannot deny that the result of this clinical study shows natural course of anterior knee pain.”

Future research should aim at classifying the stage of Osgood-Schlatter disease with ultrasound, determining the acceptable treatment for each stage of the disease and confirming the effect of lidocaine injection alone.

In terms of his usual treatment for Osgood-Schlatter disease, Nakase told Orthopedics Today Europe, “I order rest and compression in the early stage, because the delamination of the secondary ossification is the precise pathology in the early stage. Patellar tendinosis and deep infrapatellar bursitis contribute to the pain of Osgood-Schlatter disease in the middle stage. In the middle stage, injection of some kind of solution in [the] deep infrapatellar bursa, infrapatellar fat pad and distal attachment of [the] patellar tendon is an effective treatment,” he said. – by Casey Tingle

Disclosure: Nakase reports no relevant financial disclosures.