Osgood-Schlatter Disease

Osgood-Schlatter disease is caused by inflammation at the tibial tuberosity where the patella ligament inserts. It is a common cause of anterior knee pain in adolescents. 

It typically occurs in patients aged 10 – 15 years and is more common in males. Osgood-Schlatter disease is usually unilateral, but it can be bilateral.

 

Pathophysiology

The patella tendon inserts into the tibial tuberosity. In patients with Osgood-Schlatter disease, multiple minor avulsion fractures occur where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially, this lump is tender due to inflammation. As the bone heals and inflammation settles, the lump becomes hard and non-tender. 

A hard, non-tender lump is then permanently present at the tibial tuberosity.

 

Presentation

Osgood-Schlatter disease presents with a gradual onset of symptoms:

  • Visible or palpable hard and tender lump at the tibial tuberosity
  • Pain in the anterior aspect of the knee
  • The pain is exacerbated by physical activity, kneeling and on extension of the knee

 

Management

Initial management focuses on reducing pain and inflammation. 

  • Reduction in physical activity
  • Ice
  • NSAIDS (e.g., ibuprofen) for symptomatic relief

 

Once symptoms settle, stretching and physiotherapy can be used to strengthen the joint and improve function.

 

Prognosis

Symptoms will fully resolve over time. The patient is usually left with a hard bony lump on their knee.

A rare complication is a complete avulsion fracture, where the tibial tuberosity is separated from the rest of the tibia. This requires surgical intervention.

 

Last updated August 2021
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