Osgood-Schlatter Disease
Stephen Huang
Ayo Adu
BasicsDescription
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Traction apophysitis of the tibial tubercle at the insertion of the patellar tendon
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Overuse injury due to repetitive strain or microtrauma of the secondary ossification center of the tibial tuberosity
Epidemiology
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One of the most common causes of knee pain in active adolescents
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More prevalent in male gender
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Age of onset coincides with growth spurts, males age 10–15, females age 8–13
Risk Factors
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Adolescents
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Male sex
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Sports that involve running and jumping
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Activities that involve direct contact with the knee (eg, kneeling)
Etiology
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Chronic repetitive strain and microtrauma cause chronic avulsion of the secondary ossification center (1).
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The force is increased after periods of rapid growth.
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Chronic avulsion may cause separation of the patellar tendon insertion from the tibial tubercle, swelling, and enlargement.
DiagnosisHistory
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Anterior knee pain and swelling
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Symptoms are bilateral in 20–30% of patients.
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Pain begins as a dull ache that gradually increases with continued activity.
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Pain is worsened by running, jumping, direct trauma, kneeling, and squatting.
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Pain is improved with rest.
Physical Exam
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Enlarged prominent tibial tubercle
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Tenderness of the proximal tibial tubercle at the patellar tendon insertion
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Poor flexibility of the quadriceps and hamstrings
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Pain is exacerbated by knee extension against resistance, flexion of the knee actively or passively, or by direct trauma to the tibial tubercle.
Diagnostic Tests & Interpretation
Imaging
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Osgood Schlatter disease is a clinical diagnosis, and radiographs are not required for diagnosis. However, they may be helpful in ruling out other conditions, such as acute tibial apophyseal fracture, osteomyelitis, and tumors.
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X-ray:
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Lateral view may show an elevated tibial tubercle with anterior soft tissue swelling, fragmentation of the tibial tubercle, or calcification and ossicle formation in the distal patellar tendon (2).
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Differential Diagnosis
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Patellar tendonitis
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Sinding-Larsen-Johansson syndrome
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Tibial tubercle avulsion fracture
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Tibial plateau fracture
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Patellar fracture
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Osteochondritis dissecans
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Patellofemoral syndrome
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Pes anserine bursitis
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Patellar tendon rupture
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Patellar subluxation
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Chondromalacia patellae
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Hoffa's disease (infrapatellar fat pad impingement)
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Osteomyelitis
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Tumor
P.421
TreatmentPre-Hospital
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Relative rest or activity modification is recommended.
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Activity as tolerated, including sports, is allowed as long as symptoms are tolerable and resolve within 24 hr.
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Pain control with NSAIDs or acetaminophen
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Protective pad may be worn over tibial tubercle to prevent direct trauma
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Ice application especially after exercise
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If significant symptoms, consider physical therapy consult
Additional Treatment
General Measures
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Osgood-Schlatter disease is usually a benign and self-limited condition that resolves once growth plate closes.
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Usual course is 6–18 mos (2)
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Symptoms may continue into adulthood despite conservative measures in 5–10% of patients.
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Stretching exercises of the quadriceps and hamstring and strengthening of the quadriceps
Surgery/Other Procedures
Surgical excision of the enlarged tibial tubercle and free ossicles may be considered in skeletally mature patients if conservative treatment has failed.
References
1. Gholve PA, Scher DM, Khakharia S, et al. Osgood Schlatter syndrome. Curr Opin Pediatr. 2007;19:44–50.
2. Kienstra AJ, Macias CG. Osgood-Schlatter disease. www.uptodate.com. version 17.1. Spetember 8, 2008. 1–17.
Additional Reading
Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam Pract. 2004;53:153–156.
CodesICD9
732.4 Juvenile osteochondrosis of lower extremity, excluding foot
Clinical Pearls
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Athletes may participate in athletic activity as tolerated. Pain level should generally be tolerable, without a decrease in performance, and resolve within 24 hr of activity. If performance is decreased, the athlete should discontinue activity.
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Athlete should not “play through the pain.” Instead, pain should be used as a measure of when to stop activity.
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Pain will resolve when the growth plate closes.
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Future complications can include persistent enlargement of the tibial tubercle, pain with kneeling, and possibly some limitation of activities.
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Prognosis is excellent, provided the athlete demonstrates good compliance with the physician's recommendations.