The disease was first described by Osgood (1903) as a partial avulsion of the tibial tuberosity due to trauma, and was later reported by Schlatter as a distraction osteoarthritis of the tibial tuberosity, hence the name Osgood-Schlatter disease. disease. This disease is a common epiphyseal disorder in adolescents, most often seen in adolescents who participate in strenuous sports and heavy activity, and therefore is more common in males by gender. The prognosis of this disease is good. 1. Etiology The current consensus is that the local blood supply to the epiphysis is impaired, resulting in partial necrosis of the epiphysis accompanied by the process of new bone formation. As the disease is mostly seen in adolescents who play more sports, after strenuous sports or excessive in vivo activities, especially repeated excessive knee movements, the quadriceps attachment point, i.e., the tibial tuberosity, is often under strong tension, and so repeatedly, the tibial tuberosity avulsion fracture, the epiphyseal blood supply is affected, and the tendon inflammation at the quadriceps attachment point is accompanied by new bone formation, which leads to this disease. 2, pathology Mainly local aseptic inflammation of the tibial tuberosity and the process of osteonecrosis and new bone formation intertwined. The normal terminal tendon fibers of the quadriceps muscle cross the patella and continue as the patellar tendon, ending at the tibial tuberosity, and the connection at its attachment is a calcified cartilage layer of bone tissue, a fibrocartilage band and a tendon fiber connection. The normal tibial tuberosity epiphysis is a lingual epiphysis, which is a distraction epiphysis, and the ossification center of the tibial convexity usually appears around the age of ll. By the age of 16, the proximal tibial epiphysis unites with the ossification center of the tibial convexity to become the tibial tuberosity. The blood supply to the epiphysis at the attachment point of the quadriceps muscle, i.e., the tibial tuberosity, is affected due to strenuous exercise or excessive long-term movement of the knee joint, which manifests as a local impairment of the epiphyseal blood supply and affects the normal growth of the epiphysis, while the attachment point continues to receive external pulling stimuli, causing partial avulsion. However, due to the differentiation of fibroblasts and the activity of osteoblasts, new osteogenesis occurs in the patellar ligament and its adjacent soft tissues, leading to the production of ectopic ossification. This is manifested by both local epiphyseal necrosis and formation of new bone, resulting in local osteophytes, enlarged tibial tuberosity, and forward protrusion deformity. At the same time, some of the epiphyses are displaced due to continuous pulling, further producing deformity. 3.Clinical manifestations Prevalent in boys aged 11 to 15 years old, and more common in obese boys. The deformity occurs after a prolonged period of strenuous exercise or excessive knee movement. The main clinical manifestations are twofold: 1. Pain Mainly at the tibial tuberosity, sometimes in the form of knee flexion pain and painful gait. It is accompanied by mild swelling and obvious pressure pain, which may appear in mild cases when participating in strenuous exercise, and may be relieved immediately after rest or local stopping, and aggravated after exercise again. In some mild cases, local swelling may not be obvious, but in typical patients with chondromalacia of the tibial tuberosity, the tibial tuberosity is elevated due to the alternating process of local necrosis, new bone formation, and ectopic ossification, as well as edema-like changes in the soft tissue due to aseptic inflammation. There is no local swelling and no pressure pain in the knee joint, and local pain can be caused by pulling the quadriceps muscle. 4. Imaging manifestations: mainly x-ray examination. The positive signs of X-ray examination are: 1. local soft tissue thickening, especially in the anterior tibial tuberosity due to edema; 2. ectopic calcification due to both local bone necrosis and new bone formation, especially secondary calcification or ectopic calcification at the quadriceps attachment point or tendon; 3. changes in the epiphysis, including inconsistent epiphyseal density, partial epiphyseal fragmentation, and pain. The epiphysis is not uniform, part of the epiphysis is broken, displaced, part of the epiphysis has high-density calcification points, and the edge of the epiphysis is irregular. 5. Diagnosis and differential diagnosis: Based on the history of strenuous exercise or excessive exercise, clinical manifestations, combined with local tibial nodal pressure pain, quadriceps pulling pain, and no positive signs in the knee joint, the diagnosis can be clarified with X-ray examination. Differential diagnosis: 1. Epiphyseal avulsion fracture Epiphyseal avulsion fracture has a clear history of trauma, greater local soft tissue swelling and soft tissue petechial hemorrhage, etc. X-ray examination shows a bright line of fracture or obvious displacement of the epiphysis, with rounded epiphyseal edges and no sharp corners. 2. Epiphyseal metaphyseal variation Some adolescents are seen to have multiple local epiphyses during incidental X-ray examination, which is generally due to the formation of multiple ossification centers without any local discomfort, and can mostly be identified. 6. Treatment and prognosis: For the treatment of this disease, conservative treatment is generally used with good long-term results, and only a very small number of patients need surgery: 1. There are also documented good results with local Chinese Tuina. In severe cases, the knee should be fixed in a plaster cast in an extension position for 4 to 6 weeks, followed by physical therapy to restore knee extension and flexion and to perform restorative functional activities to promote local recovery. However, for strenuous local knee activities, the amount of exercise should be gradually increased when the symptoms disappear completely and the imaging examination is significantly better, and attention should be paid to the local situation during recovery. For the treatment of local hormone, there are positive and negative opinions, so pay attention to the observation of hormone side effects when adopting it. 2.Surgical treatment is suitable for those with recurrent pain and significantly limited knee function, and is usually performed when the epiphysis is mature. The surgery mainly involves complete scraping of the tibial tuberosity; some scholars use epiphyseal fusion, but it is easy to leave behind deformities in appearance, and a few may produce knee retroflexion.