What Is Osgood Schlatter Disease?

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Overview 

Osgood Schlatter Disease, also known as osteochondrosis or traction apophysitis, is a condition that causes pain and swelling of the knee.1 Typically, this pain and swelling occurs below the knee joint, usually located towards the top of the shin bone.2 Osgood Schlatter Disease is most common amongst young athletes who engage in sports that require lots of jumping and running, such as basketball.2 To better understand this condition, this article will look at the causes, symptoms and signs of the disease, and diagnosis and treatment plans involved with its management. 

Defining Osgood Schlatter Disease

As discussed, Osgood Schlatter Disease most commonly affects younger athletic individuals with knee pain as defining characteristic. Importantly, it is also a common cause of knee pain in growing children.3 The symptoms of Osgood Schlatter Disease tend to be pain localized to an area of bone at the front of the knee known as the ‘tibial tubercle’. The tibial tubercle sits at the top of the shin bone (otherwise known as the tibia) and is the area where the patellar tendon attaches. The patellar tendon is the tendon responsible for connecting the shin bone with the patella (the knee cap). 

The pain that characterizes Osgood Schlatter Disease arises from the pulling of the tendon on the bone and the growth plate that is beneath it.3 Growth plates are defined as regions of bone (typically at the ends of the bone) that are actively contributing to bone growth. As such, Osgood Schlatter Disease tends to commonly occur during periods of growth spurts whereby muscles, bones and tendons are undergoing significant changes.3 Through participation in athletic sports involving lots of running and jumping, additional strain is placed on these structures. Because of this, Osgood Schlatter Disease most commonly occurs amongst young athletic children. In adolescents aged 12-15, the prevalence of Osgood Schlatter Disease is estimated to be 9.8%.1 

Causes and risk factors in Osgood Schlatter Disease

As we have discussed, Osgood Schlatter Disease is attributed to excessive strain of the patella and tibial bones and the tendon that joins them. When exercising, the quadriceps muscle pulls on the patellar tendon which then pulls on the tibial tubercle. This repetitive action generates significant traction on the tubercle, which can lead to inflammation of the underlying growth plate. As children and adolescents have not yet finished developing their bones, they are more predisposed to the development of this disease due to weaknesses in their bone structure.1 

Despite this, the patellar tendon remains strong in those affected by Osgood Schlatter Disease.3 Its attachment to the growth plate, however, is what weakens. This can cause the patellar tendon and growth plate to slowly separate with excessive strain, with extra bone potentially growing in the healing process.3 

There are numerous sporting activities that can predispose patients to the development of Osgood Schlatter Disease, including:1

  • Basketball 
  • Sprinting 
  • Gymnastics 
  • Football 
  • Squatting 
  • Bending 
  • Uphill running

Any injury to the knee is also associated with the development of Osgood Schlatter Disease. For example, twisting of the knee during a game of football can predispose to the instability that characterizes Osgood Schlatter Disease. 

Signs and symptoms of Osgood Schlatter Disease

The predominant symptom associated with Osgood Schlatter Disease is the presence of pain located at the front of the knee. This pain typically starts as a dull ache over the area of the tibial tubercle.1 The following symptoms are also associated:1 

  • Swelling
    • Swelling will typically be limited to the front of the knee at the region between the patella (knee cap) and tip of the shin bone (tibia). 
  • Pain that intensifies with continued exercise and activity.
    • This pain typically improves with rest and will dissipate within minutes to hours after stopping the activity or exercise. 
    • This pain is especially pronounced when jumping, running, kneeling and squatting.
  • A ‘bump’ or ‘bony presence’ may be found at the region towards the tip of the shin bone. This is due to the new growth of bone that typically occurs with Osgood Schlatter Disease. 
  • Poor ability to bend the leg. 
  • Both knees or just one may be affected. 

Diagnosing Osgood Schlatter Disease

Osgood Schlatter Disease is typically defined as a ‘clinical diagnosis’, meaning that assessment in the clinic is often all that is necessary for the diagnosis.1 Tests, such as blood tests and imaging tests, are therefore often not necessary. Imaging tests, such as X-rays, are often only used if additional complications such as fractures or breaks to the bones are suspected. 

Despite this, your healthcare provider will complete a  health assessment to ensure their diagnosis of Osgood Schlatter Disease. This will first involve asking a series of questions whereby they will try to discern the levels, types, and frequency of exercise you engage with. They may also ask you or a family member questions about your development during childhood so that they can rule out other conditions. Importantly, your healthcare provider will also examine the knee, or knees, affected. During this examination they will assess the area affected and will search for signs such as tenderness, warmth and the presence of bony prominences. Additionally, they may also ask you to perform some movements with your legs so that they may assess how well the knee is functioning and if any aspects of leg movements are restricted. 

Treatment and management of Osgood Schlatter Disease

As Osgood Schlatter Disease is associated with sports such as running, jumping and squatting, your healthcare provider may advise you to temporarily refrain from further exercise. By doing this, patients often notice complete resolution of the symptoms such as swelling and tenderness. Whilst it may not speed the rate of total recovery, rest will have significant improvements on the levels of pain experienced.1 Importantly, you may even be able to participate in sports, providing the pain subsides with rest.1 In addition to this, the following treatment options are advised: 

  • Rest, Ice, Compression and Elevation (RICE) 
    • One of the most common treatments to help symptoms is through use of the ‘RICE’ technique. Ice packs can be applied two to three times a day, 20 to 30 minutes at a time.2 
  • Ibuprofen/Naproxen
    • These medications will be typically used to reduce the symptoms of swelling and inflammation. 
  • Stretching Exercises:3
    • The Quadriceps Stretch: this will involve laying on your tummy with your knees together. You should then take hold of your foot and bring the heel of your foot to your bottom.
      • This should not be painful, with only a stretch felt. This should be held for thirty seconds and repeated three times. 
  • Use of knee pads2
    • Knee pads may be given to athletes who play sports where their knee comes into contact with surfaces or other players. Some athletes find that wearing a patellar tendon strap can help decrease the pull on the tibial tubercle. 

If these methods of management fail to be effective, then physiotherapy is advised.  In prolonged and severe cases, your healthcare provider may suggest knee immobilization for a certain period of time.1 Importantly, surgery is rarely, if ever, used in the treatment of Osgood Schlatter Disease.1 

Summary

Osgood Schlatter Disease is a disease common amongst athletic adolescents. Caused by excessive pulling of the patellar tendon on an area of the shin bone (tibia) known as the tibial tubercle, patients can expect to experience symptoms of pain within this region. Damage to the growth plate results from excessive pulling of the patellar tendon through the use of the quadriceps muscle in frequent exercise. Pain that arises is often of an aching nature, starting low and worsening with more frequent exercise. In cases where the bone tries to repair itself, a small bony lump may appear at this region in the front of the knee. To confirm the diagnosis of Osgood Schlatter Disease, your healthcare provider will often ask a series of questions before examining the knee or knees affected. They may also ask you to perform some movements to assess the severity of the condition. X-rays and other imaging tools are used infrequently and are only used to assess for the presence of other complications such as fractures and breaks. Treatment is largely reliant on periods of rest and reduced frequencies of exercise. Some patients benefit from the use of knee pads and patellar tendon straps. These symptoms are largely self-limiting, often disappearing following sufficient periods of rest. For this reason, surgery is rarely indicated. 

References

  1. Smith JM, Varacallo M. Osgood-Schlatter Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441995/.
  2. Osgood-Schlatter Disease [Internet]. 2022 [cited 2023 Nov 24]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/osgoodschlatter-disease.
  3. York and Scarborough Teaching Hospitals NHS Foundation Trust - Osgood-Schlatter’s disease [Internet]. [cited 2023 Nov 24]. Available from: https://www.yorkhospitals.nhs.uk/childrens-centre/your-childs-hospital-journey/therapy-services/physiotherapy/osgood-schlatters-disease/.

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Morgan Keogh

MBBS, Medicine, King's College London, UK

I am a fourth year Medical Student at Kings College London, currently intercalating in a BSc in Cardiovascular Medicine. I have a strong interest in Cardiology, Acute Internal Medicine and Critical Care. I have also undertaken a research project within the field of Cardiology whereby I explored the efficacy of a novel therapeutic test at detecting correlations between established clinical characteristics and salt-sensitive hypertension. I have broad experience with both the clinical and theoretical aspects of medicine, having engaged with a wide array of medical specialities throughout my training. I am currently acting as a radiology representative within the Breast Medicine Society and have experience with tutoring at both GCSE and A-level. I am also working closely alongside medical education platforms to ensure the delivery of content applicable to the learning of future doctors.

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