Osgood-Schlatter's Disease

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Young teenagers, particularly boys, are the most commonly affected. It is uncommon over the age of 16. It is most common in teenagers who play a lot of sport involving kicking, running, or jumping. These kinds of sports cause repeated and vigorous use of the quadriceps muscles.

What are the symptoms?

The main symptom is pain just below the kneecap (patella). The severity of the pain tends to flare up and down. It is usually worse during, and just after, activity. It tends to ease with rest. Pain typically lasts a few months, but sometimes persists until you have finished growing. The knee joint is not affected, so knee movements are normal.

A small, tender, bony bump may develop a few centimetres below the kneecap. This occurs where the patella ligament attaches to the tibia ('shin bone'). The small bump is permanent, although in time it becomes painless.

No special tests are usually needed as the diagnosis is often clear from the typical symptoms.

Sometimes it develops for no apparent reason. However, overuse of the front thigh muscles (quadriceps) is thought to be a common cause. The quadriceps muscle is used to straighten the knee. This muscle pulls on the patella, which pulls on the patella ligament, which is attached to the upper part of the tibia.

Overuse of the quadriceps muscle can cause repeated stress and strain on the attachment of the patella ligament to the growing tibia. This can cause inflammation and pain at the site of the ligament attachment. In some cases, a small flake of bone is pulled off the tibia by the pulling ligament. Healing bone (callus) then forms which may cause a hard bony bump to develop.

• Pain usually goes within a few months without any treatment. It may help to be reassured that the condition is not serious and is likely to go.
• Paracetamol or similar painkillers may be useful when pain flares up.
• If symptoms persist for 2 years or more, then immobilisation in a plaster to 'force' rest may be advised. A specialist may, rarely, advise an operation on the bony lump if symptoms still do not improve. However, they are more likely to advise patience as a natural easing of symptoms over time nearly always occurs.

Sport or physical activity is not likely to cause any permanent damage, but may make the pain worse. However, it is often sporty teenagers who develop Osgood-Schlatter's disease. Difficult decisions may have to be made about training schedules and sporting commitments. Each case is different, and your doctor will advise. An approach similar to the following may be advised.

• You do not usually need to stop sport. However, easing off strenuous or vigorous sport may be sensible for a while until the pain eases to a tolerable level. Let the pain be your guide. Play sport only to a bearable level of pain. Avoid heavy sport activities if the pain is bad. Consider a complete break from sport for a while if pain remains bad.
• An ice pack applied below the kneecap for about 5 minutes before and after exercise may prevent some inflammation and pain.
• Consider wearing knee pads during sports such as football and rugby to protect the tender area.
• Consider seeing a physiotherapist for advice on exercises to strengthen the quadriceps muscles.

© EMIS and PIP 2006   Updated: June 2006

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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