There are two types of people who consider surgery:
- Adults who have been suffering from Osgood for many years.
- Teenagers who are frustrated with the results they have been getting so far
The following questions will be answered in this article:
- Is a surgical procedure recommended and safe?
- What results can be expected?
- And how long will it take to get back to practising sport again?
This article is written by experienced physiotherapists and the information provided is based on accessible scientific knowledge. Personal medical advice cannot be provided in any form as every case is unique. Please read our disclaimer.
Does Osgood Schlatter require surgery?
The overwhelming majority of Osgood Schlatter patients do not need an operation to get better. One study states that only around 2% of kids diagnosed with Osgood Schlatter disease may need an operation in adulthood.1
When to operate?
Reasons for and against an operation should always be discussed in person with a specialist orthopedic knee surgeon. In these clinical decisions, it is the surgeon's job to outweigh the risks versus the potential benefits of an operation.
In order to improve the success of an operation, every surgeon will make sure that the patient is carefully selected and appropriate for the intervention (age, specific problem & circumstances). The operation must be safe (difficulty of the procedure, risks) and the prognosis must be favorable, based on the surgeon’s previous experience and backed by scientific evidence.
The scientific community agrees that an operation, involving the removal of the bony bump, should only be considered if:
- the individual reaches the minimum age of 17 years of age2,3 or older4 (The reason for this is to reduce the risk of damaging the growth plate).
- other non-surgical treatment options such as physiotherapy / physical therapy, rest, icing, painkillers, etc have failed.
- the bony fragment affects the joint space of the knee.
What type of surgical procedures are there for Osgood Schlatter?
The reasons for ongoing knee pain with Osgood Schlatter are complex and not fully understood (Reference). As with many musculoskeletal disorders, the area of pain may not always be the driver of the problem (reference). Therefore it is the surgeon`s and, if possible, the team of health professionals’ job to unravel and narrow down the reason for ongoing pain in the individual.
If the surgical decision is made, some surgeons may decide to either remove the bony protuberance altogether, shave off parts of the bump that are reaching into the joint or remove a piece of bone that has come off the shinbone in the past and has failed to reattach naturally.
Surgical procedures for Osgood Schlatter patients are either done in an open or closed manner (see below). All procedures have their advantages and disadvantages.
Open procedures: The surgeon will gain access to the painful bump or the bony fragment, by splitting the patella tendon and removing bony fragments which are likely to cause the pain. The tendon is then sutured back together.1,2,4,5
Closed procedure (arthroscopy /nanoarthroscopy/ bursoscopy): The surgeon will gain access, by inserting cameras and instruments through two small holes on the side of the knee. The bony fragments or bony bump will be removed without damaging the patella tendon.5,6
What is the evidence for these procedures?
The evidence for which type of surgery is best remains poorly understood. The fact is, that since the 1950s, there have only been 27 scientific studies that have demonstrated the effect of specific surgical interventions for Osgood Schlatter patients.7 Many of these studies had very few participants (sometimes just one), didn't follow up how the patients did long term, did not define what “treatment success” meant and never compared conservative vs. surgical treatment.
This graph illustrates the number of studies published about anterior cruciate ligament (ACL) surgery (20,902) compared to those written about Osgood Schlatter surgery (27):
What results can you expect?
Surgery is a safe procedure and complications are rare. Many studies report “good” to “excellent” results by removing the small bone fragments in the tendon and/or reducing the bump surgically.2–4,8–10 It is reported that most individuals are pain-free during daily living and achieve “preoperative levels of sport participation”. However, the studies do not clarify what “achieving pre-operative levels” means or if the patients were ultimately satisfied with the long-term outcome.
What we also know, is that surgery doesn't help everyone. A small percentage of patients do not respond well to the surgical intervention and continue to have pain afterwards. Others still have mild symptoms after surgery, such as pain when kneeling.3,4,11
When can I get back to sport after Osgood Schlatter's surgery?
Recovery times will vary depending on the individual and the surgical procedure carried out. Individuals take longer to recover from open surgeries than from closed surgery procedures.
Recovery time is longer after open surgery, as the surgeon has to cut through the patella tendon to access the bony protuberance.6 Postoperatively, the patient is also restricted from bending the knee for a few weeks while the sutured patella tendon heals.7 Closed procedures, such as arthroscopies, where the patella tendon remains intact, tend to have shorter recovery periods.
Time for a return to sport or a favorite activity vary depending on the goal
As for a return to sports times, a definite answer cannot be given. Here is why:
The demands of each person and their sport vary: The “preoperative-activity level” will be reached much faster by someone who wants to be able to run occasionally, than someone who wants to compete as a wide receiver in a football match at varsity level.
The specific life demands are different: Knee pain may bother a tile layer who has to kneel constantly, more than an office-worker and whose knee is rarely challenged.
This is why we see a huge discrepancy in the literature. Some researchers quote return-to-sport times from 8 weeks to over one year.2
Disclaimer:
Advice given here, does not constitute professional medical advice. The circumstances do not mimic those of a review by a health professional. Advice is therefore meant for interest only, in an unofficial capacity, or to help point you in the right direction. Assessment, diagnosis and treatment recommendations are not possible, and all suggestions as such are speculative opinions.