Usual care for Osgood Schlatter: A mixed-methods study to understand what caretakers are delivering and patients are receiving

Background : A common knee complaint during adolescence, a crucial time for staying physically active, is Osgood Schlatter (OS). The recommended types of modalities for conservative management in the literature is abundant and conflicting, and no level 1 evidence is available. For this emerging area of research, knowing the contents of usual care, are key to developing uniform and effective management strategies.
Purpose / Aim of Study: To gain knowledge directly from OS patients and clinicians on what care is delivered in clinical practice.
Materials and Methods: Semi-structured interviews and surveys were conducted in a specialized orthopedic clinic with OS patients, and across sectors and professions with clinicians managing OS patients.
Findings / Results: Thirty-three patients (age 13.5±1.7 years, symptom-duration 23.6±16.1 months) participated in interviews and 63 clinicians (physiotherapists, GPs, pediatric orthopedic surgeons, median 13 years practicing [IQR:7.5-19.5], seeing median 10 OS patients per year [IQR:5-17.5]), participated in interviews or filled out a survey. For patients, the most common modalities received were exercises (42%), advice to take a break from sports (24%), topical analgesics (24%), and cryotherapy (21%); followed by stretching, taping, acupuncture, laser therapy, shockwave therapy, and massage (12-18%); and 20 other types of modalities (>9%). Among clinicians, the most popular modality was ‘balance or alignment exercises’ used by 81%, followed by ‘straps or taping’ (79%). Other frequently used modalities were strength training (76%), cryotherapy (64%), stretching exercises (50%), orthoses (54%), manual therapy (41%), and painkillers (33%). All clinicians (100-98%) gave advice and information regarding load, pain, and prognosis. The most agreed upon were “the prognosis is good” (90%) and “the condition is safe” (78%), and advise to “participate only with little pain” (54%) and “participate to your pain limit” (44%).
Conclusion: Numerous different modalities are received by Osgood Schlatter patients, but a set of modalities/advice seems to be the most prevalent in usual care: exercises, cryotherapy, stretching, topical/oral analgesic, advice on favorable prognosis, and advising a cautious approach to physical activity/sports.