What is Osgood-Schlatter disease?

Osgood-Schlatter Disease

Osgood-Schlatter disease is a common, self-limiting traction apophysitis of the tibial tubercle that primarily affects adolescents during growth spurts, causing localized pain and swelling over the anterior aspect of the proximal tibia. 1

Clinical Presentation

• Pain characteristics: Dull ache localized to the anterior aspect of the proximal tibia over the tibial tuberosity
• Exacerbating factors: Pain worsens with activities involving knee extension such as:
  • Jumping
  • Running
  • Climbing stairs
  • Kneeling 1, 2
• Physical examination: Tender, prominent tibial tuberosity that may appear swollen
• Demographics:
  • Traditionally more common in boys aged 12-15 years
  • Recent evidence shows equal distribution between sexes, likely due to increased female participation in high-impact sports 3
  • Affects up to 10% of adolescents 4

Pathophysiology

The most widely accepted theory involves repetitive stress on the patellar tendon insertion:

1. Mechanical factors: Repetitive contraction of the knee extensor mechanism during activities creates traction forces at the tibial tubercle 1
2. Anatomical factors: Research using MRI has shown that patients with Osgood-Schlatter disease have:
   • More proximal attachment of the patellar tendon to the tibia
   • Broader attachment area of the tendon to the tibia 5
3. Growth-related factors: Occurs during rapid growth spurts when bones grow faster than muscles and tendons, creating increased tension at the tibial tuberosity 3
4. Risk factors:
   • Increased body weight
   • Muscle tightness (particularly rectus femoris)
   • Weakness during knee extension
   • Reduced hamstring flexibility 3

Diagnostic Evaluation

• Clinical diagnosis: Based on history and physical examination findings
• Radiological evaluation:
  • Acute stage: Blurred margins of patellar tendon due to soft tissue swelling
  • 3-4 months: Bone fragmentation at the tibial tuberosity
  • Subacute stage: Soft tissue swelling resolves, but bony ossicle remains
  • Chronic stage: Bone fragment may fuse with the tibial tuberosity 2
• MRI: May show inflammation and edema around the tibial tuberosity in early stages 5

Management

Conservative treatment is successful in over 90% of cases and should be the first-line approach. 3

Conservative Management:

1. Activity modification:

   • Limit physical activities that exacerbate symptoms
   • In severe cases, restriction of activities for several months may be necessary 2

2. Physical therapy:

   • Stretching exercises for quadriceps and hamstrings
   • Strengthening of surrounding muscles 4, 3

3. Symptomatic relief:

   • Ice application after activity
   • Anti-inflammatory medications as needed
   • Protective padding over the tibial tuberosity during activities 1

Surgical Management:

• Reserved for persistent cases with continued pain after skeletal maturity
• Indications: Persistent pain with kneeling due to an ossicle that doesn't respond to conservative treatment
• Procedures include:
  • Open excision
  • Bursoscopic technique
  • Arthroscopic removal of ossicle and surrounding bursa 1
  • Arthroscopic approach offers advantages of earlier recovery, better cosmetic results, and ability to address intra-articular pathology 1

Prognosis

• Self-limiting condition: Most cases resolve spontaneously with skeletal maturity 1, 3
• Long-term outcomes: Generally excellent, though some patients may experience:
  • Mild discomfort with kneeling
  • Activity restrictions in a small percentage of cases 1

Prevention Strategies

• Implementation of quadriceps and hamstring stretching exercises in regular practice routines for children involved in sports activities 3
• Proper warm-up before physical activities
• Gradual increase in training intensity, especially during growth spurts

Common Pitfalls

1. Misdiagnosis: May be confused with patellar tendonitis or other causes of anterior knee pain
2. Overtreatment: Remember this is self-limiting; excessive activity restriction may be unnecessary
3. Undertreatment: Continued high-impact activities despite symptoms can prolong recovery
4. Surgical intervention: Should be considered only after skeletal maturity and failure of conservative measures