How should I manage Osgood‑Schlatter disease in an active adolescent boy aged around 13 years?

Management of Osgood-Schlatter Disease in an Active Adolescent Boy

Osgood-Schlatter disease is a self-limiting traction apophysitis of the tibial tubercle that resolves spontaneously in over 90% of cases with conservative management consisting of activity modification, ice application, and quadriceps/hamstring stretching exercises. 1, 2

Diagnosis and Clinical Presentation

• Pain is localized to the anterior proximal tibia over the tibial tuberosity, typically described as a dull ache that worsens with jumping, running, stair climbing, or kneeling. 1

• The condition occurs most commonly in boys aged 12-15 years during periods of rapid skeletal growth, particularly those participating in high-impact sports like basketball, volleyball, and running. 2, 3

• Radiographs may show irregularity of the apophysis with separation from the tibial tuberosity in early stages and fragmentation in later stages, though imaging is not always necessary for diagnosis. 2

• A superficial ossicle in the patellar tendon may be visible on radiological evaluation. 1

Conservative Management (First-Line Treatment)

Conservative treatment successfully manages over 90% of cases and should be implemented immediately. 2, 3

Activity Modification

• Restrict or temporarily cease activities that involve repetitive knee extension, particularly jumping sports (basketball, volleyball) and activities requiring kneeling. 1, 4

• The patient can continue low-impact activities that do not exacerbate symptoms while avoiding complete immobilization. 4

Physical Therapy and Stretching

• Implement daily quadriceps and hamstring stretching exercises, as muscle tightness—particularly shortening of the rectus femoris—substantially alters knee biomechanics and is a key risk factor for OSD. 5, 3

• Stretching has apparent efficacy based on available evidence, though high-quality randomized controlled trials are lacking. 5

• Rehabilitation exercises should focus on improving flexibility of the hamstring muscles and addressing muscle weakness during knee extension. 3

Symptomatic Relief

• Apply ice to the tibial tuberosity after activities to reduce local inflammation and pain. 2

• Analgesics (NSAIDs or acetaminophen) can be used for pain control during symptomatic periods. 4

Expected Course and Prognosis

• Complete recovery is expected with closure of the tibial growth plate, typically within 12-24 months as skeletal maturity is reached. 1, 2

• The condition is self-limiting and generally ceases with skeletal maturity. 1

• Overall prognosis is excellent, though some patients may experience residual discomfort with kneeling or minor activity restrictions. 1, 2

Surgical Intervention (Rare Cases Only)

Surgery is reserved for the small minority (<10%) of skeletally mature patients who remain symptomatic despite adequate conservative treatment. 2

• Surgical indications include disabling symptoms and pain that persist after physeal closure despite at least 6-12 months of conservative management. 1, 3

• Arthroscopic excision of the ossicle and/or free cartilaginous material is the preferred surgical technique over open procedures. 1

• Arthroscopic surgery offers advantages including early postoperative recovery, no anterior incisional scar that causes kneeling discomfort, better cosmetic results, and ability to address concomitant intra-articular pathology. 1

Prevention Strategies

• Quadriceps and hamstring stretching should be implemented in everyday practice routines for all children who participate in regular sports activities, particularly high-impact sports. 3

• Addressing body weight, muscle tightness, and muscle weakness during knee extension can reduce risk of developing OSD. 3

Critical Pitfalls to Avoid

• Do not pursue surgical treatment in patients with open growth plates, as the condition will resolve with skeletal maturity. 1, 2

• Avoid complete activity restriction or immobilization, as this is unnecessary and may lead to deconditioning; instead, modify activities to avoid pain-provoking movements. 4

• Do not overlook the importance of stretching exercises, particularly for the rectus femoris and hamstrings, as muscle tightness is a modifiable risk factor. 5, 3

• Reassure the patient and family that this is a benign, self-limited condition that will resolve with growth plate closure, as unnecessary anxiety may lead to excessive activity restriction. 1, 2