Treatment of Osgood-Schlatter Disease
Conservative management with activity modification, ice application, and NSAIDs for pain control is the recommended first-line treatment for Osgood-Schlatter disease, as approximately 90% of patients respond well to nonoperative measures and the condition is self-limiting with skeletal maturity. 1
Understanding the Condition
Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle caused by repetitive strain on the secondary ossification center of the tibial tuberosity 1. It predominantly affects growing children during periods of rapid growth—boys aged 12-15 years and girls aged 8-12 years 1. The condition is exacerbated by sporting activities involving jumping (basketball, volleyball, running) or direct contact such as kneeling 1.
Initial Conservative Treatment Approach
The cornerstone of management includes:
- Activity modification and relative rest from aggravating activities, particularly jumping and kneeling movements 1, 2
- Ice application to the affected tibial tuberosity to reduce inflammation 1
- NSAIDs for pain control during symptomatic periods 1
- Rehabilitation exercises, particularly stretching programs, which show apparent efficacy though high-quality RCT evidence is lacking 2
Approximately 90% of patients achieve symptom resolution with this conservative approach 1. The condition typically runs a self-limiting course with complete recovery expected upon closure of the tibial growth plate 1, 3.
Diagnostic Considerations
Clinical diagnosis is typically sufficient, but MRI can be useful when the diagnosis is uncertain 4. Radiographic changes may show irregularity of the apophysis with separation from the tibial tuberosity in early stages and fragmentation in later stages 1.
Management of Refractory Cases
For the minority of patients (approximately 10%) who remain symptomatic despite conservative measures and have reached skeletal maturity 1, 5:
- Surgical excision of the ossicle and/or free cartilaginous material may provide good results in skeletally mature patients who fail conservative treatment 1, 3
- Arthroscopic techniques are preferred over open procedures due to early postoperative recovery, absence of anterior incisional scarring that causes kneeling discomfort, better cosmetic results, and ability to address concomitant intra-articular pathology 3
- One surgical approach involves excision of a portion of the tibial tuberosity surface with multiple perforations using a thin drill point, resulting in complete ossification and fusion with the tibial metaphysis 5
Alternative Therapies for Treatment-Resistant Cases
For patients with treatment-resistant or refractory disease who have not reached skeletal maturity, autologous platelet concentrate (autologous-conditioned plasma) therapy represents an alternative option, though evidence is limited to case reports 6.
Expected Outcomes and Prognosis
The overall prognosis is excellent 1, 3. However, patients should be counseled that:
- Some may experience persistent discomfort with kneeling even after resolution 1, 3
- A small percentage of conservatively treated patients may develop a protruding prominence below the patella with persistent swelling and soreness on kneeling or forceful knee use 5
- Activity restrictions may be necessary in a few cases 1, 3
Critical Pitfall to Avoid
Do not rush to surgical intervention in skeletally immature patients. Surgery should be reserved exclusively for skeletally mature individuals who have failed an adequate trial of conservative management 1, 3. The natural history of the disease favors spontaneous resolution with growth plate closure, making premature surgical intervention unnecessary and potentially harmful 1, 3.