Medicine & Shoulder Surgery
Sports Medicine & Shoulder Surgery Patient Guides
Patient Guide to Osgood-Schlatter Disease
WHAT IS OSGOOD-SCHLATTER DISEASE?
Osgood-Schlatter Disease is a common cause of knee pain in young children and adolescents who are still growing. In this condition there is pain and swelling below the knee joint on a prominence on the leg bone (tibia) called the tibial tuberosity (FIGURE I & II). There may also be inflammation of the tendon that stretches over the knee cap and attaches to the top of the shin bone. This tendon is known as the patellar tendon.
I: Front view of the knee
WHAT CAUSES OSGOOD-SCHLATTER DISEASE?
It is not known why some individuals get Osgood-Schlatter’s and some do not. Also, while most children get it in only one knee, some get it in both knees. The condition most commonly affects athletic young people, particularly boys between the ages of 10 and 15, who play games or sports that include frequent running and jumping.
Osgood-Schlatter’s occurs when there is irritation of the bone growth plate in the area of the tibial tuberosity. Bones generally do not grow in the middle but at the ends near the joint at an area called the growth plate. These areas of growth are made of cartilage and not bone (FIGURE IV). The cartilage is never as strong as the bone, so high levels of stress can cause the growth plate to begin to hurt and swell.
In Osgood-Schlatter’s the tendon from the kneecap (patella) attaches to the growth plate in the front of the leg bone (tibia) (FIGURE I & II). The thigh muscles (quadriceps) attach to the patella and when they pull on the patella, there is a pull on the patellar tendon. The patellar tendon then pulls on the tibia in the area of the growth plate. Any movements that cause repetitive extension of the leg can result in tenderness at the point where the patellar tendon attaches to the top of the tibia. Activities which put stress on the knee, especially squatting, bending, or running up hill (or stadium steps) cause the tissue around the growth plate to hurt and swell. It also hurts to hit or bump the tender area. Kneeling can be very painful.
HOW IS IT DIAGNOSED?
This condition is characterized by swelling and tenderness where the patellar tendon attaches. It is typically swollen only in the front, so swelling all over the knee may be something else. The diagnosis is confirmed by X-ray which shows that the growth plate is wider than usual. The X-ray may show small bones in the growth plate (FIGURE V) which have not fused or become solid due to the stress. Other studies such as MRIs, CAT scans or blood tests are not usually needed to make the diagnosis of Osgood-Schlatter’s.
III: X-ray of a normal knee from side. Yellow arrow
points to bony outgrowth where patellar tendon attaches
to top of shin bone, just below knee joint.
IV: X-ray of normal knees from front. Growth plate
is seen at top of shin bone.
HOW IS IT TREATED?
Treatment for Osgood-Schlatter Disease consists of decreasing the activity that makes it worse, icing the painful area, use of knee pads, and anti-inflammatory medication. Osgood-Schlatter’s usually goes away with time and rest. Sports activities that require running, jumping, or other deep knee bending should be limited until the tenderness and swelling subside. Knee pads are recommended for athletes who wish to continue participating in sports where the knee might make contact with the playing surface or other players. Ice packs after activity are helpful and ice can be applied 2 to 3 times a day, 20 to 30 minutes at a time, if necessary (See Patient Guide to Ice Techniques). The appropriate time to return to sports will be based on the athlete's pain tolerance. An athlete will not be "damaging" their knee by playing with some pain.
Medicine such as Tylenol or non-steriodal anti-imflammatory drugs (NSAIDs) (such as ibuprofen, Aleve, Advil) are usually not recommended if the athlete is competing. It is best not to hide pain with medication, and the best treatment is rest from the activity.
IS SURGERY EVER NEEDED?
In almost every case surgery is not needed. The reason for this is that the cartilage growth plate eventually stops its growth and fills in with bone. Once this happens, the bone is seeing the stress and not the cartilage. The pain and swelling go away because there is no new growth plate to be injured. If one waits until the adolescent is done growing, the pain almost always goes away.
Rarely, the pain persists after the growth of the bones has stopped. Surgery is indicated only if there are bone fragments that did not heal (FIGURE V). Surgery is never done on a growing athlete since the growth plate can be damaged. If surgery on an adult is needed, it is usually successful at relieving pain.
If pain and swelling persist despite treatment then the athlete should be periodically re-examined by the doctor (See Patient Guide to Good Pain / Bad Pain). If the swelling continues to get bigger and bigger then the patient should be re-evaluated.
V. More serious case of Osgood-Schlatter disease
where bone fragment is seen separating away from tibia.