Ultrasound-Guided Ossicle Excision for Chronic Osgood–Schlatter Disease and Sinding-Larsen-Johansson Syndrome: A Case Series and Review of the Literature

OBJECTIVE: To describe a novel, minimally invasive, ultrasound-guided technique for excision of ununited ossicles in patients with chronic Osgood-Schlatter disease (OSD) and Sinding-Larsen-Johansson syndrome (SLJS) who failed conservative management. DESIGN: Retrospective case series. SETTING: Ambulatory surgical center. PATIENTS: Five skeletally mature patients (ages 16-44 years), including competitive athletes and adults with chronic anterior knee pain due to OSD (n = 3) or SLJS (n = 2), all of whom remained symptomatic despite standard conservative treatments. MAIN INDEPENDENT VARIABLE: Ultrasound-guided resection of intratendinous ossicles using a TX-bone device under local anesthesia, followed by a structured rehabilitation protocol. MAIN OUTCOME MEASURES: Pain relief, ability to return to sport or prior activity, and functional recovery at 2 to 12 weeks postprocedure. RESULTS: All 5 patients successfully underwent ultrasound-guided ossicle excision without perioperative complications. Each reported meaningful pain reduction and returned to unrestricted activities within 2 to 12 weeks. Follow-up ranged from 6 to 14 months, with sustained symptom relief and return to prior sport participation. Outcomes compared favorably with open and arthroscopic techniques described in the literature. CONCLUSIONS: This case series is the first to describe an ultrasound-guided technique for excision of chronic, symptomatic OSD and SLJS ossicles. The approach demonstrated rapid recovery, excellent pain relief, and favorable functional outcomes. Further prospective studies with larger cohorts are warranted to validate efficacy and long-term safety.