La malattia di Osgood-Schlatter

La malattia di Osgood-Schlatter (OSD) detta anche osteocondrosi dell’apofisi tibiale anterioreè una lesione cronica da fatica dovuta a ripetuti microtraumi che coinvolgono l’inserzione del tendine rotuleo sulla tuberosità tibiale. 

La patologia interessa sia femmine che maschi, ma in questi ultimi la frequenza è tre volte superiore. Nei maschi si manifesta generalmente nel periodo compreso tra gli 11 e i 15 anni di età, mentre nelle femmine in quello compreso  fra gli 8 e i 13 anni; ciò è dovuto al fatto che nel sesso femminile il processo di ossificazione dell’apofisi tibiale inizia più precocemente. Nel 25% dei casi, la patologia colpisce bilateralmente. Solitamente, i soggetti colpiti dal morbo di Osgood-Schlatter sono bambini che praticano sport in modo attivo, si riscontra specialmente in quelli che usano largamente il muscolo quadricipite (come accade, per esempio, nell’atletica, nel basket, nel calcio, nella danza, nel pattinaggio ecc.); la patologia è dovuta infatti alla ripetuta azione traumatica causata dalla trazione del tendine rotuleo sulla sua inserzione a livello dell’apofisi tibiale nella fase di contrazione del muscolo estensore della gamba.

La sintomatologia del morbo di Osgood-Schlatter è caratterizzata dal dolore, generalmente localizzato a livello del terzo inferiore del tendine; talvolta però si riscontra un’irradiazione verso la rotula o la tibia; l’intensità del dolore è maggiore al termine dei movimenti di flessione o di estensione del ginocchio; in alcuni casi è possibile riscontrare la formazione di una tumefazione locale. Una complicanza abbastanza frequente della sindrome di Osgood-Schlatter è la formazione di una salienza ossea che in genere è abbastanza piccola e non procura dolore a meno che non sia sottoposta a una discreta pressione diretta; in alcuni casi è possibile la formazione di calcificazioni intra-tendinee che potrebbero essere, in età adulta, causa di processi infiammatori. Un’altra complicanza, invero molto rara, che potrebbe verificarsi è il distacco della tuberosità tibiale.

Schema sagittale del ginocchio: il tendine rotuleo (grigio) per ripetuta trazione inserzionale da ipersollecitazione si ispessisce per fenimeni infiammatori al suo interno (alone rosso) e determina nella fasi più tardive frammentazione del nucleo di ossificazione dell’apofisi tibiale (in questo caso in 2 frammenti) che negli adoloscenti ancora non è completamente saldato alla tibia ma solo in una sua parte; può verificarsi, come in questo esempio, il distacco e la frammentazione del nucleo, come la sola degenerazione del nucleo stesso che subisce modificazioni morfologiche (vedi esempi radiografici).

DIAGNOSI STRUMENTALE

L’indagine diagnostica per eccellenza, nel caso si sospetti la sindrome di Osgood-Schlatter, è l’esame radiografico che, generalmente, viene effettuato anche sull’arto controlaterale per permettere una migliore valutazione delle condizioni della tuberosità della tibia; il reperto radiografico mostra spesso una tuberosità tibiale dall’aspetto irregolare e in qualche caso frammentato. L’indagine radiografica, oltre a precisare lo stadio di evoluzione della malattia, consente di verificare la presenza o meno di altre forme di osteocondrosi a carico del ginocchio.

L’ecografia è indagine di complemento che consente la conferma dell’irregolarità ossea in corrispondenza dell’apofisi tibiale ma soprattutto il riconoscimento dello stato infiammatorio del tendine, ed eventualmente della borsa infrapatellare, nonché  l’ispessimento dello spessore cartilagineo che riveste l’apofisi tibiale (immagine sottostante).

RISONANZA MAGNETICA

La Risonanza Magnetica è la metodica più sensibile e specifica nel dimostrare l’ispessimento per reazione infiammatoria dei tessuti molli che sovrastano l’apofisi tibiale;  l’interessamento patologico del tendine segnalato dall’ispessimento dello stesso e da possibili aree di focale alterazione intraparenchimale espressione di frammenti ossei o di calcificazioni peritendinee; la possibile presenza di borsite infrapatellare.

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