Overview
Definition
Osgood-Schlatter disease is an apophysitis, a painful traction injury, of the cartilage and bone on the anterior, proximal tibial tubercle, where the distal patella tendon inserts.
Osgood-Schlatter disease: a painful inflammation of the tibial tuberosity caused by repetitive traction by the patellar tendon due to repetitive exertion, such as running or jumping
Image by Lecturio.Epidemiology
- Occurs in children 10–14 years of age:
- Boys: 12–14 years
- Girls: 10–13 years
- More common in teens who participate in sports that involve running or jumping (e.g., soccer, football, basketball, volleyball, sprinting, gymnastics, figure skating, and ballet)
- More common in boys than girls
- Usually occurs during periods of accelerated relative growth
- Bilateral in 25%–50% of cases
Pathophysiology
Osgood-Schlatter disease occurs due to overuse injury.
- Mechanical forces applied to the knee, especially during running and jumping, cause microtrauma to the patellar tendon.
- Repetitive microtrauma leads to small chronic avulsions of patellar tendon at the point of insertion into the tibial tubercle.
- Swelling and ossification of the distal patellar tendon at point of insertion into the tibia follow.
Clinical Presentation
Osgood-Schlatter disease typically presents during early adolescence with the chief complaint of knee pain.
- Knee pain:
- Usually refers exclusively to tibial tubercle
- Chronic, lasting weeks or months
- No history of traumatic event marking beginning of symptoms
- Aggravated by activity, especially jumping
- Clinical exam findings:
- Swelling or increased prominence of tibial tubercle
- Tenderness to palpation at area of swelling
- Pain evoked when rising from squat or extending knee against resistance
- Findings can be unilateral or bilateral
Diagnosis
- Clinical examination is usually sufficient to diagnose this condition.
- X-rays may be taken to rule out other diagnoses:
- Tumor
- Acute avulsion
- Osteomyelitis
- Other knee pathology
- X-ray findings may include:
- Soft tissue swelling anterior to tibial insertion of patella tendon
- Fragmentation or irregularity to tibial tubercle
Management
Treatment
Most cases are treated successfully with relative rest and symptom management.
- Reassurance and education to the teen and parents:
- Explain that the condition is self-limited.
- Discuss management and reasons to return or be reevaluated.
- Control of pain and swelling:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for limited duration
- Application of ice for 15–20 minutes up to 2 times/day
- Modification of activity:
- Avoid activity that puts strain on the tibial epiphysis.
- Complete rest not recommended
- Consider knee sleeve or pad.
- Physical therapy: core, hip, and lower extremity stretching and strengthening exercises
- Surgery:
- Rarely performed
- Excision of ossicle after closure of growth plate if pain persists
Complications
The majority of patients are asymptomatic after cessation of growth. Uncommon sequelae include:
- Persistence of prominence of tibial tubercle, typically pain-free:
- Most noticeable cosmetic sequelae
- Some patients note discomfort with kneeling on prominence.
- Residual ossicles occur in 10% of patients; rarely cause persistent pain that requires removal.
- Rare association with genu recurvatum (knee hyperextension)
References
- Cassas, K. J., & Cassettari-Wayhs, A. (2006). Childhood and adolescent sports-related overuse injuries. American Family Physician, 73(6), 1014. https://www.ncbi.nlm.nih.gov/pubmed/16570735
- Ebraheim, N. A., Thomas, B. J., et al. (2019). Orthopedic surgery. In F. C. Brunicardiet al. (Ed.), Schwartz’s principles of surgery, 11th ed. McGraw-Hill Education.
- Lawrence, J. T. (2020). The knee. In R. M. Kliegman, et al. (Ed.), Nelson textbook of pediatrics, pp. 361–3623.e1.
