Ahead of the Pain: Temporal Precursors to Osgood-Schlatter’s Disease in Male Premier League Academy Footballers – A Nested Case-Control Study
DOI:
https://doi.org/10.64255/9yanh259Keywords:
Adolescence, Puberty, Injury Prevention, Soccer, Apophysis, Bone HealthAbstract
Introduction: Osgood-Schlatter Disease (OSD) is a growth-related apophyseal injury affecting 7–21% of athletic adolescents. It is commonly linked to repetitive loading of the tibial tuberosity during periods of rapid growth. OSD can have long-term implications on function and quality of life. Despite previous research, it is still unclear which functional, and growth-related factors predispose young athletes to OSD. The aim of this study is to identify functional, growth, and maturation-related factors associated with the development of OSD in male Premier League academy footballers.
Methods: Retrospective data from 2019 to 2024 were analysed from 88 male academy footballers (48 with OSD, 40 controls) from age U12 to U18. OSD onset was clinically diagnosed by academy medical staff. Somatic maturation was estimated using the Khamis-Roche method to calculate percent of Predicted Adult Height (PAH), categorised as: pre-peak height velocity (PHV) (<88%), circa-PHV (88–93%), and post-PHV (>93%). Functional assessments included countermovement jump height, hip rotation, hamstring flexibility, and ankle mobility. Temporal associations with OSD onset were assessed using generalised linear mixed-effects models on a lagged dataset. Mediation analyses were conducted evaluating the temporal relationships between associated variables.
Results: OSD risk peaked at 88.3% PAH (p=0.02). A linear increase in risk was observed with growth rate for stature (OR = 1.16, p=0.006) and leg length (OR = 1.16, p=0.011). Hip external rotation was negatively associated with OSD risk (OR = 0.94, p=0.012). Exploratory trends were observed for hip internal rotation (p=0.069) and hamstring flexibility (p=0.088). Mediation analysis indicated no temporal relationship between growth rate and hip external rotation (p=0.464).
Conclusion: OSD risk increases linearly with growth rate and peaks during the Circa-PHV period. Reductions in specific physical functions may also be associated with elevated risk.
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