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Introduction: The pathogenesis of the Osgood Schlatter's Disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT). Maturation staging of the ATT was developed using ultrasonography principally in asymptomatic subjects. This case series aims to assess the ATT with ultrasound in both symptomatic and asymptomatic athletes by using a four-stage classification of maturation while noting Doppler activity. It is unknown if changes are present in the presumed pathologic tendon insertion seen in OSD, nor the relation of Doppler positive changes to pain on clinical examination. Methods: A prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9 years ± 1.3) and a comparison group of 35 asymptomatic male athletes (12.4 years ± 2.6). All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a Visual Analogue Scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat. Results: The four-stage classification was a valid, uncomplicated, and effective way to assess the ATT maturation with ultrasound in both groups. Within the OSD subjects, VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1 ± 22.0 and 60.0 ± 21.2) were significantly higher than stage 3 (17.8 ± 12.0 and 18.9 ± 16.9) and stage 4 (15.0 ± 7.1 and 25.0 ± 7.1) (p < 0.01). Positive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47 ± 24.5 vs 18 ± 11.4, p < 0.01) and resisted static contraction (59 ± 20.2 vs 27 ± 12.5, p < 0.001) compared to Doppler negative subjects. 90% of athletes showing Doppler activity were stage 2. Within the asymptomatic comparison group, no Doppler activity was found. Discussion: More painful OSD is associated with presence

Background: The pathogenesis of the Osgood- Schlatter's disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT). Objectives: It is unknown if such changes are present in the presumed pathological tendon insertion seen in OSD, nor the relation of Doppler-positive changes to pain on clinical examination. Methods: A prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9 years±1.3) and a comparison group of asymptomatic subjects. All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a visual analogue scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat. Results: Positive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47±24.5 vs 18±11.4, p<0.01) and resisted static contraction (59±20.2 vs 27±12.5, p<0.001) compared with Doppler-negative subjects. No Doppler activity was found in the comparison group. VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1±22.0 and 60.0±21.2) were significantly higher than stage 3 (17.8±12.0 and 18.9 ±16.9) and stage 4 (15.0±7.1 and 25.0±7.1; p<0.01). Conclusions: More painful OSD is associated with the presence of neo-vessels. This may be linked with a particular stage of ATT maturation and applied compressive forces. A Doppler ultrasound scan adds practical information to develop the care plan of the patient.