Successful Treatment of Osgood Schlatter Disease (OSD)

Published: September, 2017

PART 1 – OSD treated with Plasma
PART 2 – OSD leading to osteoarthritis treated with Plasma & Stem Cells

PART 1 –
Introduction

Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia).

Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. Physical activity is known to place additional stress on bones and muscles, children who participate in athletics  (especially running and jumping sports) are at an increased risk for this condition. However, less active adolescents may also experience this problem. (Orthoinfo, 2018)

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(Orthoinfo, 2018)

Therapy is usually conservative, in most cases of Osgood-Schlatter disease, simple measures like rest, over-the-counter medication, and stretching and strengthening exercises will relieve pain and allow a return to daily activities. Surgery is only required in a minority of cases. Individuals who suffer from typical treatment-resistant cases of OSD have attempted alternative applications, such as;

  1. Platelet Rich Plasma Therapy (early stages)
  2. Stem Cell Therapy (for long term degenerative cases leading to osteoarthritis)

This publication describes two cases in which plasma therapy was used to treat OSD.

Case 1

A 23-year-old male tennis player with a childhood history of OSD resolving with age presented with right knee pain after a direct frontal impact onto the head of the tibia. On examination, he had tenderness at the tibial tuberosity and a small effusion, but no overlying erythema or limited range of motion. Knee X-rays demonstrated patellar tendon edema, and a sliver-like osseous density anterior to the apophysis of the tibial tuberosity, confirming the diagnosis of OSD. Sonographic imaging revealed a fluid layer or inflammatory fluid collection around the completely healed apophysis. Gait analysis revealed internal rotation of the lower leg.
(Danneberg D., 2017)

Case 2

A 14-year-old male patient presented with reoccurring bilateral knee pain from persisting treatment-resistant OSD. He first presented with knee pain at the age of 12, and played tennis 5 to 6 times/week. Previous repeated therapeutic interventions included extended resting phases, orthopedic insoles, physiotherapy, ultrasound therapy, and pulsed magnetic field therapy. Due to the existing diagnosis of treatment-resistant OSD, only confirmatory sonography and magnetic resonance imaging (MRI) scans were performed. (Danneberg D., 2017)

Treatment

Patients received once-weekly subcutaneous injections of 1 mL plasma on either side of the palpable Osgood–Schlatter lesion/swelling, for a total of three to five applications. The first patient, was treated in the right knee for 3 weeks, and the second patient in both knees for 4 weeks. Post treatment, during the day, patients wore a PUSH Patella Brace to reduce the traction force on the lower leg until 6 months after resolution of pain. At night, kinesiology tape was used to bandage across the tibial head. The patients underwent physiotherapy and gait optimization to correct foot malposition and received dynamic shoe insoles. Targeted training during the injection therapy was prohibited. The sonographic evaluation was performed before, during, and after the conclusion of the Plasma injection therapy. (Danneberg D., 2017)

Results

There were no post-injection complications. The first patient experienced a subjective pain reduction of approximately 50% after one injection. After 3 weeks, the patient was pain-free and able to return to sport. The second patient was pain-free after 6 weeks and able to return to sports; he has not experienced a relapse in OSD since treatment. (Danneberg D., 2017)

 

PART 2 –
Further Degenerative Case Leading to Osteoarthritis

Stem Cell Therapy Case

A 47-year-old male,  presented with complaints of arthritic pain in both of his knees. A formerly athletic patient, riding up to 300 km and alternatively running up to 50 km per week. The patient’s active lifestyle through his 30’s through to early 40’s has stressed his joints greater than the average male. Patient’s early OSD in combination with persistent training and competing lead him to develop early stages of osteoarthritis in his knees at a young age. Current knee X-ray reports indicate mild loss of articular cartilage and residual damage to the tibial tuberosity. This is consistent with many OSD and osteoarthritis cases.

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Image: Above mentioned patient competing in riding events, France.

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Image: pre-stem cell treatment, February, 2018

Initial treatment followed similar plasma injection protocols as mentioned previously. The patients own Stem Cells were harvested and re-injected to repair arthritic degeneration and to regulate constant pain. The fat was harvested using liposuction from the abdomen. The autologous stem cells were injected into both knees under ultrasound guidance. No complications were observed.

4 days post treatment, patient has confirmed some discomfort due to liposuction fat harvest procedure. No signs of infection were observed.  Patient reported the constant pain in his knees has resolved completely. He has had a very rapid response, though this is not entirely unusual. As per our standard treatment protocol, he has been advised to rest for a further 4 weeks.
Ongoing progress will be monitored after 1, 3, 6 and 12 months respectively. Further follow-up is required to identify improvements  in relation to degenerative changes.

 

REF 1: Orthoinfo.aaos.org. (2018). Osgood-Schlatter Disease (Knee Pain) – OrthoInfo – AAOS. [online] Available at: https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatter-disease-knee-pain/ [Accessed 13 Feb. 2018].

REF 2: Danneberg, D. (2017). Successful Treatment of Osgood–Schlatter Disease with Autologous-Conditioned Plasma in Two Patients. Joints, 05(03), pp.191-194.

Keywords: Osgood–Schlatter disease, autologous plasma injection, platelet rich plasma, osteoarthritis, stem cell, stem cell therapy, stem cell treatment, macquarie stem cells, Dr. Ralph Bright

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