Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis). It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.
Risk factors include overuse, especially sports which involve frequent running or jumping. The underlying mechanism is repeated tension on the growth plate of the upper tibia. Diagnosis is typically based on the symptoms. A plain X-ray may be either normal or show fragmentation in the attachment area.
Pain typically resolves with time. Applying cold to the affected area, rest, stretching, and strengthening exercises may help. NSAIDs such as ibuprofen may be used. Slightly less stressful activities such as swimming or walking may be recommended. Casting the leg for a period of time may help. After growth slows, typically age 16 in boys and 14 in girls, the pain will no longer occur despite a bump potentially remaining.
About 4% of people are affected at some point in time. Males between the ages of 10 and 15 are most often affected. The condition is named after Robert Bayley Osgood (18731956), an American orthopedic surgeon, and Carl B. Schlatter (18641934), a Swiss surgeon, who described the condition independently in 1903.
Signs and symptoms
Osgood–Schlatter disease causes pain in the front lower part of the knee. This is usually at the ligament-bone junction of the patellar ligament and the tibial tuberosity. The tibial tuberosity is a slight elevation of bone on the anterior and proximal portion of the tibia. The patellar tendon attaches the anterior quadriceps muscles to the tibia via the knee cap.
Intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, lifting things, squatting, and especially ascending or descending stairs and during kneeling. The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. Pain is initially mild and intermittent. In the acute phase, the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of people.
Risk factors
Risk factors include overuse, especially sports which involve running or jumping. The underlying mechanism is repeated tension on the growth plate of the upper tibia. It also occurs frequently in male pole vaulters aged 14–22.
Diagnosis
Diagnosis is made based on signs and symptoms.
Ultrasonography
This test can see various warning signs that predict if OSD might occur. Ultrasonography can detect if there is any tissue swelling and cartilage swelling. Ultrasonography's main goal is to identify OSD in the early stage rather than later on. It has unique features such as detection of an increase of swelling within the tibia or the cartilage surrounding the area and can also see if there is any new bone starting to build up around the tibial tuberosity.
Types
OSD may result in an avulsion fracture, with the tibial tuberosity separating from the tibia (usually remaining connected to a tendon or ligament). This injury is uncommon because there are mechanisms that prevent strong muscles from doing damage. The fracture on the tibial tuberosity can be a complete or incomplete break.
Type I: A small fragment is displaced proximally and does not require surgery.
Type II: The articular surface of the tibia remains intact and the fracture occurs at the junction where the secondary center of ossification and the proximal tibial epiphysis come together (may or may not require surgery).
Type III: Complete fracture (through articular surface) including high chance of meniscal damage. This type of fracture usually requires surgery.
Differential diagnosis
Sinding-Larsen and Johansson syndrome, is an analogous condition involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia. Sever's disease is an analogous condition affecting the Achilles tendon attachment to the heel.
Prevention
One of the main ways to prevent OSD is to check the participant's flexibility in their quadriceps and hamstrings. Lack of flexibility in these muscles can be direct risk indicator for OSD. Muscles can shorten, which can cause pain but this is not permanent. Stretches can help reduce shortening of the muscles. The main stretches for prevention of OSD focus on the hamstrings and quadriceps.