Developmental stage and lower quadriceps flexibility and decreased gastrocnemius flexibility

Our take

In adolescent male soccer players, what factors predict who will develop Osgood-Schlatter disease?

In young male soccer players, growth timing and leg flexibility appear to predict who develops Osgood-Schlatter disease. Players whose growth spurt was within about 6 months of baseline, who had a more developed tibial tubercle, looser quadriceps, and worsening calf flexibility were more likely to develop the condition.

DescriptiveRead paper

Primary study302 ParticipantsLimited evidence

Key points

Tracked 302 Japanese male soccer players aged 12-13 over 6 months, with 209 analyzed after exclusions.
Being within about 6 months of peak growth velocity at baseline was a predictor.
A more developed (apophyseal stage) tibial tubercle was strongly associated with developing the disease.
Looser quadriceps (flexibility of 35 degrees or more) at baseline and worsening calf flexibility over 6 months were both predictors.
Findings point to monitoring growth timing plus quadriceps and calf flexibility on the support leg.

How it was conducted

Design: Prospective observational cohort, 6 months of follow-up
Participants: 302 Japanese male soccer players aged 12-13 enrolled; 209 analyzed after exclusions
Measures: Baseline exam, ultrasound of the tibial tubercle, and flexibility testing
Outcome: Osgood-Schlatter disease on the support leg, diagnosed at 6 months

What they found

Peak height velocity age within plus or minus 6 months at baseline was a predictor (p=0.046).
Apophyseal stage of the tibial tuberosity was a predictor (p<0.001).
Quadriceps flexibility of 35 degrees or more at baseline was a predictor (p=0.017).
A decrease in gastrocnemius (calf) flexibility over 6 months was a predictor (p=0.009).

Limitations

Observational design, so it shows association and prediction but cannot prove these factors cause the disease.
Studied only male soccer players in a narrow age band (12-13), so results may not generalize to girls, other ages, or other sports.
Short 6-month follow-up window and assessment limited to the support leg.
Reported as p-values only, with no effect sizes or confidence intervals to gauge the strength of each association.

Why it matters

For patients: If your son plays soccer around age 12-13 and is in a growth spurt, tight or changing leg flexibility may raise his risk of this common knee condition, so stretching and monitoring may help.
For clinicians: Screening adolescent male soccer players for growth timing, tibial tubercle maturation, and quadriceps and calf flexibility on the support leg may help flag those at higher risk of Osgood-Schlatter disease.
For readers: This study identifies risk markers for a frequent adolescent knee complaint but does not test whether changing them prevents the disease.

Source

doi:10.1007/s00167-023-07378-z

Read the original paper