Osgood-Schlatter disease associated with patellofemoral maltracking, chondrosis
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Adults with a history of Osgood-Schlatter disease are at high risk for lateral patellofemoral maltracking and high-grade patellofemoral chondrosis, according to published results.
From January 2016 to December 2019, researchers from the department of radiology at Thomas Jefferson University Hospital in Philadelphia retrospectively reviewed 10,181 unique non-contrast, non-arthrogram knee MRIs for findings of Osgood-Schlatter disease (OSD) and associated lateral patellofemoral maltracking. Additionally, researchers performed binomial logistic regression to identify predictors of maltracking in OSD and analyzed a receiver operating characteristic curve to determine optimal tibial tuberosity trochlear groove (TT-TG) distance to indicate maltracking.
Of the 171 imaging exams that had findings of OSD, 59% (n = 101) displayed maltracking and 63% (n = 107) displayed patellofemoral chondrosis. According to the study, the TT-TG distance threshold to indicate maltracking was 13 mm. Researchers also noted patella alta, trochlear dysplasia and quadriceps tendinosis were “significant predictors of maltracking.”
“A lower threshold for identifying maltracking patients, including a lower cut-off TT-TG distance can help identify those at risk,” the researchers wrote in the study. “Radiologists should maintain a high index of suspicion for maltracking in adults with OSD to guide clinical intervention,” they concluded.
Perspective
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The authors studied the prevalence of certain MRI findings in patients who have Osgood-Schlatter disease (OSD) and who had an MRI scan at this facility compared to a control group. This study does not represent the incidence of these findings in all patients who have OSD, many of whom are asymptomatic. Maltracking is a poorly defined entity in the orthopedic literature and usually refers to the path which the patella takes during knee flexion – not evaluation of a single static image. MRI findings can hardly be defined as “complications” related to the Osgood-Schlatter disease, implying cause and effect. Suggesting a lower normal for TT-TG by correlation with imaging findings, not patient symptoms or population studies, seems ill advised. Clinical suspicion of the need to pay careful attention to MRI findings related to patellar alignment and fat pad pathology should be related to careful history and physical examination, not to potentially incidental observation of OSD.
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