Overview

Osgood Schlatter disease (OSD) is a knee condition most commonly seen in adolescents and young adults before they are fully grown. However, in about 10% of sufferers, the symptoms can continue into adulthood¹ and further intervention may be needed. Symptoms are similar to those experienced by children including pain and swelling below the knee cap, especially after exercise or sport. Most cases will be managed conservatively but some cases may be caused by bony fragments in the tendon. These can then be surgically removed with positive results. If you feel you may be suffering from Osgood Schlatter disease (OSD) as an adult, please seek a medical opinion. 

What is Osgood-Schlatter Disease (OSD)?

Osgood-Schlatter disease is a common knee condition that is usually seen in children and adolescents as they grow. It presents as anterior knee pain and sometimes swelling around the tibial tuberosity (which is the small bump of bone underneath your kneecap). The pain is often felt going up and down stairs, kneeling or playing sport,² particularly jumping and kicking sports like football. 

Osgood-Schlatter is more common in boys than girls. However, this difference is getting smaller as more girls become involved in sports.³ The condition commonly affects girls between the ages of 8 and 13, and between 10 and 15 years old in boys.² Most people with Osgood-Schlatter will find their symptoms go away once they reach skeletal maturity. However, 10% of people will continue to suffer symptoms into adulthood.¹ These may be people who did not have their condition properly treated as a child or did not follow the advice at the time. It may also be associated with a return to activity in adulthood following a period of rest.⁴ Most often, those who suffer OGS in adulthood will have had the condition as a child.⁴  This is because the cause of OSG is rapid bone growth, which unfortunately is not seen in adults.

Pathophysiology of Osgood-Schlatter Disease

OSD occurs when there is stress and inflammation of the growth plate of the leg bone. Before a child reaches skeletal maturity, their bones grow at growth plates situated at the end of bones. Whilst they are still growing, these areas are made of cartilage rather than bone, which is more susceptible to large forces being applied to it. The patellar tendon is the tendon which attaches the kneecap to the top of the shin bone at a bump called the tibial tuberosity. Repeated load of this area, such as when running and jumping, can lead to irritation of the growth plate, causing pain and inflammation. As a result, the bump may become more enlarged. In some cases, a small fragment may even become avulsed. Symptoms are usually worse during periods of growth or intense activity. Sufferers will often have poor quadricep and hamstring flexibility which may increase their likelihood of developing the disease.¹

Normally, symptoms of OSD will resolve with time as the growth plates fuse.  Adults who have the disease have often had the condition in childhood. In these cases, the pain may continue due to bony fragments left in the patella tendon that avulsed when they were growing.⁵ Sometimes a fall on the knee or sharp twisting movements can dislodge these fragments, causing pain. In some other cases, the condition may be reignited by a return to sport or activity.¹

What are the symptoms of Osgood-Schlatters in Adults?

• Pain over tibial tubercle (bump on top of shin)
• Pain worse with activity, eases with rest
• There may be an enlarged bump of the tibial tubercle 

How do you diagnose Osgood-Schlatter Disease in Adults?

Often the person will have had a history of Osgood-schlatter’s disease as a child.  Your doctor will ask you questions to see if the pain is worse with activity such as running, jumping and kicking. They will then examine your knee. Sufferers of the condition will have pain with pressure on the tibial tubercle. In some people, this bump may also be enlarged.  

In children, diagnosis is made purely on these findings alone and imaging is rarely required. However, in adults, imaging such as an X-ray or MRI scan will often be taken to assess for any bony fragments (called ossicles).⁶ An MRI would also show surrounding patellar tendinitis.  

What are other conditions that are similar to OSD in adults?

• Patellar tendonitis - patellar tendonitis is similar to OSD in many ways. Like OSD, the symptoms include pain localized to below the knee cap, which gets worse when there is increased stress on the knee, such as jumping and squatting.⁷ However, pain associated with patellar tendonitis is slightly higher than in OSD, and there is no enlargement of the tibial tubercle⁵
• Prepatellar bursitis- A bursa is a fluid-filled structure, whose job is to reduce friction between skin, tendons and bone. A bursa can become inflamed from trauma, repeated stress or infection; this is called bursitis. There are many bursae around the knee but the two which may produce symptoms similar to OSD include the prepatellar bursa and infra-patellar bursa.  The prepatellar bursa lies between the kneecap and skin. It can become inflamed by trauma or lots of kneeling and produces pain and swelling over the knee cap.⁸ However, the location of the pain is much higher than in OSD, across the body of the knee cap
• Infrapatellar bursitis - There are both superficial or deep infrapatellar bursae. The superficial infrapatellar bursa is located between the tibial tubercle and the skin. It causes pain and swelling below the knee cap, but sits just in front of the patellar tendon, allowing you to differentiate with OSD. The deep infrapatellar bursa can be found between the back of the patella tendon and the leg bone. It is the one most likely to be confused with OSD. It can be differentiated as OSD has pain and tenderness at the attachment of the patellar tendon onto the tibial tubercle. Imaging, such as an MRI scan, would show inflammation and thickening in the tendon itself which would not be present in the bursitis⁸ 

What are the treatment options for OSD in adults?

Conservative Treatment 

As with children with OSD, the first line of treatment is relative rest, ice and exercises. Relative rest means reducing or modifying the activities that cause the most pain. Whilst this may not speed up the recovery, it does help to relieve the pain. Ice and ibuprofen gel may help to relieve any swelling.⁶ Exercises can be successful in relieving symptoms; in particular quadriceps and hamstring stretches, and quad strengthening exercises. Physiotherapy and bracing may also help to reduce pain.¹

Injections

Evidence suggests that injections for the treatment of OSD in adults are ineffective and should not be used.^1,6  

Surgery

Whilst surgery for OSD in children and adolescents is rarely done due to its self-limiting nature, it is a viable option for adults with OSD that does not resolve due to the presence of bony fragments in the patellar tendon. Surgery is only done when conservative treatment has failed. It involves removing the bony fragments from the tendon through an incision in the skin. Evidence is sparse but suggests that this will improve pain in over 90% of cases.⁹

Summary

Although normally associated with children and adolescents, Osgood-Schlatter's Disease does occur in a small number of adults. Often these are people who have suffered from the condition as a child, but the condition has not resolved or has been re-aggravated by a return to activity. Most cases will resolve with relative rest, ice and exercises. However, some people may have bony fragments in their tendon; these can be surgically removed with good results. If you feel you may be suffering from Osgood Schlatter disease (OSD) as an adult, please seek a medical opinion. 

FAQ

Can adults get Osgood-Schlatter's Disease?

Yes! Whilst the condition is most commonly found in children and adolescents, about 10% of people with OSD will continue to suffer from the condition as an adult.¹ In these cases, the pain may continue due to bony fragments left in the patella tendon that avulsed when they were growing.⁵ Sometimes a fall on the knee or sharp twisting movements can dislodge these fragments, causing pain. In some other cases, the condition may be reignited by a return to sport or activity.¹