Osteochondroses

Osteochondroses are a loose grouping of conditions affecting the growing epiphysis. They all show healing in radiographs. Common examples that occur in growing children at traction epiphyses are Osgood-Schlatter disease (at tibial tuberosity), Sever's disease (at insertion of Achilles tendon), and Larsen-Johansson disease (at lower pole of patella). Others that affect articular surfaces are Freiberg's disease (head of second or third metatarsal) and Panner's disease (capitellum). These disorders result because physical activity in vigorous growing children produces stresses at the bone-ligament junction or on articular surfaces.

Osgood-Schlatter disease is caused by a traumatic avulsion of the patellar tendon from the tibial tuberosity and occurs commonly in children aged 11-13. There is pain and discomfort over the tibial tuberosity after exercise. Examination shows local tenderness and prominence of the tuberosity. The best treatment is to ignore the symptoms. Parents should be advised that symptoms usually last for 12-18 months. Rest will relieve the pain. If the children wish to be active they will aggravate their symptoms but come to no harm. Surgery is rarely required but may be necessary for excision of unfused ossicles deep in the ligamentum patellae. These cause pain on kneeling in adulthood.

Larsen-Johansson disease has a similar pattern of symptoms to Osgood- Schlatter disease but occurs at the lower pole of the patella owing to traction by the …