NEW YORK (Reuters Health) – Injection of a dextrose/lidocaine solution into the area of attachment of the patellar tendon to the tibia is effective for recalcitrant Osgood-Schlatter disease symptoms in children and adolescents, according to a report in the November issue of Pediatrics.

“A significant component of the effect seems to be associated with the dextrose component,” the authors report. “Dextrose injection resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than did usual care.”

Dr. Kenneth Dean Reeves, at the University of Kansas Medical Center in Kansas City, and colleagues in Argentina, describe Osgood-Schlatter disease as “a tendinopathy/apophysosis of the patellar tendon/tibial tubercle.” While it resolves with closure of the tibial growth plate, the symptomatic period can be prolonged, and the symptoms often lead to limitations in sports activities.

The researchers noted that injection of 10% to 25% dextrose in areas of damaged ligament, tendon, and cartilage in adults has been shown to be effective, but such a strategy has not been reported in a pediatric population.

They therefore conducted a study of dextrose injection versus lidocaine injection versus usual care in 65 knees of 54 subjects aged 10 to 17 years who were involved in sports (mostly soccer) and diagnosed with Osgood-Schlatter disease.

“The injection groups received solution that always contained lidocaine 1% because, in each session, completeness of injection was determined by complete anesthesia of pain with single-leg squat,” the investigators explain. “Half of injected subjects received 12.5% dextrose in their injection; half received lidocaine only.”

After 3 months of blinded treatment, the team found that scores on the 0-7 Nirschl Pain Phase Scale, which measures sport inhibition and sport-related symptoms, improved more in lidocaine/dextrose treated knees (3.9) than lidocaine-only treated knees (2.4; p=0.004) or exercise treated knees (1.2; p<0.0001).

Sports activity at that point was asymptomatic in 14 of 21 knees in the dextrose group, 5 of 22 in the lidocaine-only group and 3 of 22 in the usual care group.

In a second, open-label phase of the study, the participants were offered optional dextrose injections for 9 more months. Overall, at 12 months, sports were pain-free for 32 of 38 dextrose-treated knees, 6 of 13 knees treated only with lidocaine, and 2 of 14 given usual care.

Summing up, Dr. Reeves and colleagues conclude: “These results suggest that both the duration of sports limitation and the duration of sports-related symptoms may be reducible by dextrose injection in those with recalcitrant OSD (Osgood-Schlatter disease).”

Reference:
Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease
Pediatrics 2011;128.