Osgood Schlatter Disease

Teens with pain and swelling below the knee may be suffering from Osgood-Schlatter disease (also called Osgood-Schlatter condition or syndrome), a common overuse condition causing inflammation of the tibial tuberosity. The tibial tuberosity is the small bony bump on the front upper part of the shinbone (tibia), just below the knee, that the patellar tendon attaches to.

Teens or preteens that develop this condition are usually highly active in sports that involve a lot of running and jumping (basketball, volleyball, soccer, gymnastics, etc.). Occasionally, Osgood-Schlatter disease affects kids who are not active in sports. Daily activities such as running up stairs also aggravate the condition.

When running and jumping the front thigh muscle pulls on the patellar tendon, which pulls on the tibial tuberosity. Repeated pulling on the tuberosity causes it to become irritated, causing pain and swelling. The patellar tendon may pull away from the shinbone, sometimes pulling fragments of the tuberosity away with it. As healing occurs, bone is eventually laid in the tendon. This results in a permanent, small visible bump. This bump usually causes no problems.

There may also be inflammation of the patella tendon and surrounding soft tissue where it attaches to the tuberosity. As the injury heals, this swelling will go down. One or both knees can be affected. Often, only one knee is affected.

Why does Osgood-Schlatter disease only occur in growing teens/children? The tibial tuberosity is on a growth plate near the upper end of the shinbone. Before skeletal maturity, the growth plates near the ends of the bones are made of cartilage, which is softer and more vulnerable to injury than bone. Growth plates are replaced by solid bone when growth is finished.

In children the patellar tendon is stronger than the tibial tuberosity. In adults, the tibial tuberosity has turned to bone and is stronger than the tendons. In adults, pain and swelling below the knee may be caused by patellar tendonitis. (More information on tendonitis on Knee Injuries page)

Tight quadriceps may increase the risk of Osgood-Schlatter disease. It is believed that during growth spurts, the muscles and tendons may not always keep up with the growth of the long bones and become tight. Tight quadriceps (and to a lesser extent, tight hamstrings) causes extra tension on the patellar tendon where it attaches to the tibial tuberosity. Stretching exercises for the quads and hamstrings may help, especially before and after running and jumping. Strengthening the quadriceps also may help to stabilize the knee. See Knee Exercises.

Diagnosis is usually based upon the symptoms and a physical examination. An x-ray is sometimes taken. Always get a proper diagnosis from a qualified physician.

Symptoms are pain and swelling over the tibial tuberosity (just below the knee). There may also be an enlargement of the tibial tuberosity itself. The pain increases with activities such as running and jumping. The swelling is tender to the touch. Kneeling on the area is painful. The amount of swelling varies.

Treatment involves taking a break from or limiting activities that aggravate the symptoms; usually this is all that is needed to allow the area to heal. How much time off is needed depends on the severity of the condition. It may be a couple weeks or months, as recommended by your physician. Applying ice wrapped in a cloth to the area (for 15 to 20 minutes every four hours) reduces pain and inflammation. Your physician may recommend anti-inflammatory medications

Once symptoms have subsided, it is usually recommended that the teen or child return to activities involving jumping, running and squatting at a reduced level, increase them slowly and cut back if symptoms recur. Stretching the quadriceps helps reduce tension where the patellar tendon attaches to the tibial tuberosity and may help the condition from reoccurring.

Long Term Consequences of Osgood-Schlatter Disease

Although symptoms usually go away when the bones finish growing, some people who have had Osgood-Schlatter disease during puberty may continue to have pain as an adult. The bony lump below the knee usually doesn't cause major problems but pain when kneeling are common.

Occasionally, the bony lump interferes with function of the knee, which may result in intermittent or chronic pain that is aggravated by activities that involve running or jumping. A loose bone fragment in the patellar tendon may also cause chronic pain. Problems are usually treated conservatively. If conservative treatments such as icing the knee, stretching and strengthening the quadriceps through exercise and taking a break from activities that trigger pain up are not adequate, surgery is an option (after growth is complete).

Arthroscopic excision of an ununited ossicle due to Osgood-Schlatter disease

Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men

Reducing the Risk of Long Term Consequences

The risks of long-term problems may increase when a teen with Osgood-Schlatter disease continues to participate in sports or activities that involve jumping or running against his or her doctors advice. Taking a break from activities that aggravate the condition is needed to allow proper healing.

Osgood-Schlatter disease is a common condition (with a big name) that usually resolves after the bones have finished growing.