What is Osgood-Schlatter’s Disease?

Osgood-Schlatter’s Disease is a temporary condition involving pain and swelling in the small bump of the tibia (shin) bone just below the knee. This small bump, called the tibial tubercle, is where the patellar tendon attaches the shinbone (tibia) to the kneecap (patella). The major thigh muscle (quadriceps muscle) also attaches to the kneecap and shinbone through the patellar tendon. Thus, the patellar tendon acts as a sort of pulley system over the knee with the flexion and extension of the leg while walking, running, and jumping.

When there is too much stress on the patellar tendon, it pulls on the bone and growth plate at the tibial tubercle, causing the pain and swelling that come with Osgood Schlatter’s disease.

Figure 1: Knee xray of a normal knee (A) and patient with Osgood Schlatter (B). Note the widening and prominence of the tibial tubercle (arrow).

Causes

Osgood Schlatter’s disease occurs in children and adolescents due to excessive stress on the patellar tendon and is one of the most common overuse injuries in pediatric orthopaedics.  This is commonly associated with growth spurts, when the muscles and tendons are tighter trying to keep up with the rapid growth of the bones.

Osgood-Schlatter disease is most common in:

• Boys and girls age 10-15 years old
• Young athletes playing sports that involve running, jumping and squatting
•  Athletes at risk for overuse

Signs and Symptoms

Although symptoms of Osgood-Schlatter disease vary from case to case, the most common symptoms include:

• Pain and swelling below the kneecap
• Tenderness below the kneecap
• Worsening pain with activity
• Tight muscles in the thigh (quadriceps and hamstrings)

Diagnosis

If Osgood-Schlatter disease is suspected, a Campbell Clinic orthopedic physician will take a complete history from the child and family before performing a physical exam to assess pain and check for other pertinent signs and symptoms.

During the physical exam, the physician may apply pressure to the tibial tubercle to assess pain and sensitivity level. The child may also be asked to run or jump to assess pain levels.

In some cases, the physician may order diagnostic imaging such as X-ray and in rare cases an MRI scan of the affected area in order to rule out other problems with the knee.

Treatment

Due to the overuse nature of Osgood Schlatter, the first step in treatment is taking a break from strenuous activity and athletics while resting, icing, compressing, and elevating the knee (R.I.C.E. protocol). Over the counter anti-inflammatory medications such as motrin or naproxsyn are helpful as well.

Activities that involve knee bending and squatting can be gradually resumed based on your child’s symptoms.  Occasionally a brace which restricts deep knee bending can be used to help with symptoms.Surgical treatment consisting of removal of the painful bone fragment (ossicle) is extremely rare. (Figure 2)

Figure 2: Knee xray of a patient with large painful ossicle (arrow) that required surgical removal after unsuccessful rest, bracing and activity modification.

Outlook (Prognosis)

Children with Osgood-Schlatter disease typically experience full recovery after proper treatment and rest, but the pain may come and go while the child is still growing and playing sports.  Most children/adolescents, especially those who stay very active, will have intermittent symptoms over 12-18 months but they will resolve once the child stops growing (skeletal maturity)

While this can be very painful and frustrating due to activity restrictions, most patients will recover fully with no long term problems or complications.