Osgood-Schlatter Disease
Summary
Osgood-Schlatter disease (OSD) is a common cause of anterior knee pain in active adolescents, caused by traction apophysitis (overuse injury) of the tibial tuberosity. The patellar tendon pulls on the immature tibial tubercle during repeated jumping, running, or kicking activities, causing microfractures and inflammation. It presents with pain and a prominent, tender bump at the tibial tuberosity. The condition is self-limiting and resolves when skeletal maturity is reached and the growth plate closes. Treatment is conservative: activity modification, ice, and analgesia.
Key Facts
- Age: 10-15 years (during growth spurt)
- Sex: M > F (historically; now more equal with girls' sports participation)
- Symptoms: Pain and swelling at tibial tuberosity; worse with activity
- Sign: Prominent, tender tibial tubercle
- Course: Self-limiting; resolves with skeletal maturity
- Treatment: Conservative (rest, ice, analgesia)
Clinical Pearls
"Bump at the Knee": The hallmark is a prominent, tender tibial tubercle. It's often visible on inspection.
"Worse with Activity": Pain is typically aggravated by running, jumping, kneeling, and climbing stairs.
"Self-Limiting": Symptoms resolve when the growth plate fuses (usually by 16-18 years in boys, 14-16 in girls). The bony prominence may persist.
"X-Ray Only If Atypical": Diagnosis is clinical. X-ray only if red flags (night pain, severe swelling) to exclude tumour or infection.
Incidence
- 10-20% of athletic adolescents
- Peak age: 10-15 years
Demographics
- Historically M > F (2-3:1)
- Gap narrowing with increased female sports participation
- Bilateral in 20-30%
Risk Factors
| Factor | Notes |
|---|---|
| Adolescent growth spurt | Apophysis vulnerable |
| Sports participation | Jumping, running, kicking |
| Tight quadriceps | Increases traction |
| Rapid growth | Muscle-tendon unit tightness |
Mechanism
- Patellar tendon inserts onto tibial tubercle (apophysis)
- Repetitive traction during jumping, running, kicking
- Apophysis is cartilaginous and vulnerable during growth
- Microfractures and inflammation occur at tendon-bone junction
- Healing response → Bone formation → Prominent tubercle
Why It's Self-Limiting
- Once the apophysis ossifies and fuses (skeletal maturity), the area becomes stronger
- Symptoms resolve, but the bony prominence often persists
Symptoms
| Feature | Description |
|---|---|
| Pain | Anterior knee, localised to tibial tuberosity |
| Worse with | Running, jumping, kneeling, stairs, squatting |
| Better with | Rest |
| Swelling | Over tibial tubercle |
| Bilateral | 20-30% of cases |
History
Inspection
- Prominent tibial tuberosity (visible)
- Swelling at tibial tubercle
Palpation
- Tenderness directly over tibial tubercle
- Pain reproduced by palpation
Movement
- Full range of motion at knee
- Pain with resisted knee extension
- Pain with squatting/kneeling
Other
- Normal ligament stability
- No effusion (usually)
Clinical Diagnosis
- Diagnosis is clinical based on history and examination
- Investigations usually not needed
When to Image
| Red Flag | Investigation |
|---|---|
| Night pain/rest pain | X-ray (exclude osteosarcoma) |
| Severe swelling | X-ray, bloods (exclude infection) |
| Atypical features | X-ray, +/- MRI |
X-Ray Findings (If Done)
- Prominent tibial tuberosity
- Fragmentation of apophysis (variable)
- Soft tissue swelling
Management Approach
┌──────────────────────────────────────────────────────────┐
│ OSGOOD-SCHLATTER DISEASE MANAGEMENT │
├──────────────────────────────────────────────────────────┤
│ │
│ CONSERVATIVE (Mainstay): │
│ • Activity modification (reduce aggravating activities) │
│ • Ice after activity (15-20 mins) │
│ • Analgesia (NSAIDs, Paracetamol) for pain │
│ • Quadriceps and hamstring stretching │
│ • Strengthening exercises │
│ │
│ PROTECTION: │
│ • Patella strap / Infrapatellar band │
│ • Knee pad for kneeling │
│ │
│ SEVERE CASES: │
│ • Period of rest from sport (2-4 weeks) │
│ • Rarely: Cast immobilisation (extreme cases) │
│ │
│ DON'T: │
│ • Steroid injections (not recommended) │
│ • Routine imaging │
│ • Unnecessary restriction (can usually participate │
│ to tolerance) │
│ │
│ REASSURANCE: │
│ • Self-limiting condition │
│ • Symptoms resolve with skeletal maturity │
│ • Bony lump may persist cosmetically │
│ │
└──────────────────────────────────────────────────────────┘
Of Osgood-Schlatter
- Persistent bony prominence (common; cosmetic only)
- Chronic pain (rare; usually resolves)
- Ossicle formation (bony fragment in tendon)
- Rarely: Avulsion of tibial tubercle (acute injury, usually separate)
Long-Term
- Most have no functional limitation
- May have minor discomfort with prolonged kneeling as adults
Natural History
- Symptoms resolve in 12-24 months (or at skeletal maturity)
- 90%+ have complete resolution
Long-Term
- Excellent functional outcomes
- Bony prominence persists in 60%
- Occasional discomfort with kneeling
Key Guidelines
- NICE CKS: Knee Pain in Children and Adolescents
- AAP: Clinical Report on Overuse Injuries
Key Evidence
Management
- Conservative treatment is universally recommended
- No evidence for surgery in typical cases
What is Osgood-Schlatter Disease?
Osgood-Schlatter disease is a common cause of knee pain in growing teenagers, especially those who play sports. It happens because the tendon below the kneecap (patellar tendon) pulls on the bony bump on the shin bone (tibial tuberosity) where it's still growing.
What Are the Symptoms?
- Pain and swelling just below the kneecap
- A bony bump that may be prominent and tender
- Pain that gets worse with running, jumping, kneeling, or climbing stairs
- Pain that gets better with rest
Who Gets It?
- Usually teenagers (10-15 years old) during their growth spurt
- More common in children who do a lot of sports (especially football, basketball, gymnastics)
How is it Treated?
- Activity modification: Reduce activities that make it worse
- Ice: Apply after activity to reduce pain
- Pain relief: Paracetamol or ibuprofen
- Stretching and strengthening: Exercises for the thigh muscles
- Knee strap: Can help reduce stress on the area
Will it Go Away?
Yes! Osgood-Schlatter usually goes away on its own once your teenager stops growing and the bone hardens. This is usually by age 16-18. The bump may stay, but it's just cosmetic.
Primary Guidelines
- NICE Clinical Knowledge Summaries. Knee Pain - Assessment. cks.nice.org.uk
Key Studies
- Kujala UM, et al. Osgood-Schlatter's disease in adolescent athletes. Am J Sports Med. 1985;13(4):236-241. PMID: 4025675