Osgood-Schlatter's Disease

• Knee pain is common in athletes.
• The greatest risk factor is frequent sports in adolescent males.
• Osgood-Schlatter disease often is encountered in children 10 to 15 years of age who participate in sports such as football, basketball, gymnastics and volleyball.¹

Symptoms

• Pain and swelling below the knee.
• 20 to 30 percent of patients report bilateral symptoms.²

Signs

• Examination reveals tenderness and swelling at the tibial tubercle.
• Hip examination is important because some childhood hip conditions (e.g. slipped capital femoral epiphysis) can refer pain to the knee.

X-rays may reveal fragmentation and irregular ossification at the tibial tubercle, but are rarely indicated unless there is suspicion of other injuries.¹

• Osteochondritis dissecans
• Patellar or quadriceps tendonitis
• Patellofemoral instability
• Patellofemoral pain syndrome
• Inferior patellar pole traction apophysitis (Sinding-Larsen disease)
• Patellar stress fracture
• Prepatellar or infrapatellar bursitis
• Referred pain

General measures

• Most patients respond to conservative treatment consisting of rest from painful activities and application of ice.
• Immobilisation of the knee may be needed.
• Quadriceps stretching as part of a strengthening program should be encouraged once symptoms are controlled e.g. sliding down a wall flexing knees, to squatting position. Hold for 10 seconds and raise again slowly.
• If conservative measures fail, an infrapatellar strap for six to eight weeks may provide symptomatic relief during activity.² Physiotherapists can facilitate this.

Pharmacological

• Analgesic medications as needed for pain.
• Corticosteroid injection of the tibial tubercle is not recommended because of potential complications such as subcutaneous atrophy.^1,2

Surgical

• Surgery is rarely required.
• There may be an ossicle under the distal patellar tendon as a consequence of the disease.
• Surgical treatment gives good results in these unresolved cases.³ Arthroscopy has been used with good results.⁴

Osgood-Schlatter disease usually is self-limiting, but symptoms may continue for up to one year.⁵ However, some complications can occur:

• Mild discomfort with kneeling.
• Residual bony deformity.
• Painful ossicles in the distal patellar tendon.⁶

Most patients are able to return to full activity within two to three weeks.

1. Wall EJ. Osgood-Schlatter disease: practical treatment for a self-limited condition. Phys Sport Med 1998; 26:29-34.
2. Bloom OJ, Mackler L, Barbee J; Clinical inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam Pract. 2004 Feb;53(2):153-6.
3. Orava S, Malinen L, Karpakka J, et al; Results of surgical treatment of unresolved Osgood-Schlatter lesion. Ann Chir Gynaecol. 2000;89(4):298-302. [abstract]
4. DeBerardino TM, Branstetter JG, Owens BD; Arthroscopic treatment of unresolved Osgood-Schlatter lesions. Arthroscopy. 2007 Oct;23(10):1127.e1-3. Epub 2007 Mar 19. [abstract]
5. Gholve PA, Scher DM, Khakharia S, et al; Osgood Schlatter syndrome. Curr Opin Pediatr. 2007 Feb;19(1):44-50. [abstract]
6. Cassas KJ, Cassettari-Wayhs A; Childhood and adolescent sports-related overuse injuries. Am Fam Physician. 2006 Mar 15;73(6):1014-22. [abstract]

• Osgood-Schlatter's disease, Clinical Knowledge Summaries (January 2010)
• Chang AK, Slabinski MS, Talavera F, Levy DB et al; Osgood-Schlatter disease. eMedicine, July 2008.