Osgood-Schlatter disease
What is Osgood-Schlatter disease?
Osgood-Schlatter disease is a condition that can cause pain in the knees of children and adolescents. It is often associated with a growth spurt and usually gets better with simple treatment.
The condition most often affects children aged 9-14 years. It is more common in children who are very physically active, particularly when activities involve a lot of running and jumping, such as football, gymnastics, cricket, basketball and ballet.
While the affected knee can be painful and may require a temporary slowdown of sporting pursuits, the good news is that children with Osgood-Schlatter disease can generally continue to be active, as the condition will gradually settle with time, when the bones stop growing.
Causes
The patellar tendon is important in movement of the knee. The tendon connects the quadriceps muscle in the front of the thigh to the tibia (shinbone) at a point just below the kneecap. This attachment point normally forms a small lump or protuberance that is known as the tibial tuberosity.
When the quadriceps muscle contracts, the knee straightens. If the patellar tendon becomes too tight, it can pull on the tibial tuberosity. This can cause:
- Pain and inflammation at the point where the tendon attaches to the bone, and;
- Tiny micro-fractures in the bone, which can lead to growth of new bone tissue and enlargement of the tuberosity.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
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Tendon
Dense bands of connective tissue that attach muscles to bones.
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Tibial tuberosity
The bony protrusion at the top of the lower leg bone where the patella tendon attaches.
Risk factors
The tendon can be more likely to pull on the tibial tuberosity if:
- During a growth spurt, the growth of the patellar tendon does not keep up with that of the lower leg, causing the tendon to be tight;
- A child participates in sports or activities that put tension on the tendon, particularly those with a lot of running and jumping, and;
- There are misalignments of the legs, such as being knock-kneed or flat-footed, which can put extra tension on the tendon.
Boys have historically been more likely to experience symptoms; however, this may be because they have tended to be more physically active than girls. Because the growth spurt that coincides with puberty tends to happen a little earlier in girls, they are more likely to have symptoms at a slightly younger age (around 11-12 years of age) compared to boys (around 13-14).
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Tendon
Dense bands of connective tissue that attach muscles to bones.
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Tibial tuberosity
The bony protrusion at the top of the lower leg bone where the patella tendon attaches.
Signs and symptoms
Osgood-Schlatter disease may affect one knee or both. When both knees are involved, one is often worse than the other.
Osgood-Schlatter disease is suspected when pain in the knee tends to:
- Occur when the knee is straightened, such as in kicking;
- Occur with squatting or kneeling;
- Occur when running, climbing, jumping or going up or down stairs, and;
- Reduce with rest.
Other symptoms include:
- A swollen bump on the front of the shinbone (tibia) just below the kneecap, and;
- Redness and inflammation of the skin over the affected area.
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Inflammation
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
Methods for diagnosis
Osgood-Schlatter disease can usually be diagnosed by a doctor from a physical examination.
They will examine the affected knee and look for tenderness and may ask the child to move, squat, or straighten the knee against resistance, to see if this causes pain.
X-rays may be recommended, but are often not necessary to diagnose Osgood-Schlatter disease. Other tests may be recommended if the cause of the symptoms is unclear and other conditions need to be ruled out.
Types of treatment
In general, symptoms will disappear once the growth of the bone stops. This can take months to a year or two.
To manage the symptoms, the following can be helpful:
- Mild pain-relief medications such as ibuprofen and acetaminophen;
- Icepacks on the knee to reduce swelling and pain;
- Physiotherapy - stretches and exercises that help to lengthen and strengthen the quadriceps, hamstrings and calf muscles may help to reduce tension on the patellar tendon;
- Reducing the amount of high-impact sports that trigger the pain - complete rest is generally not recommended, but if a certain sport makes the symptoms worse, trying other activities may be helpful, and;
- Using pads or supportive strapping to protect the knee during activities that may irritate the knee.
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Physiotherapy
A healthcare profession that treats bodily weaknesses or defects with physical remedies, such as massage or exercise.
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Tendon
Dense bands of connective tissue that attach muscles to bones.
Potential complications
Potential complications of Osgood-Schlatter disease include:
- A permanent, painless bump on the knee. It may still be tender when kneeling;
- Bone fragments (called ossicles) developing in the patellar tendon leading to persistent pain, and;
- Genu recurvatum, a condition in which the knee overextends. This occurs when the growth of the shinbone (tibia) is affected and the front part of the bone stops growing prematurely, changing the position of the knee.
Rarely, symptoms may continue to be troublesome after the bone stops growing. Surgery is not commonly recommended, but may be performed to:
- Remove bone fragments from the patellar tendon, or;
- Remove some of the tissue of the enlarged tibial tuberosity.
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Tendon
Dense bands of connective tissue that attach muscles to bones.
X
Tibial tuberosity
The bony protrusion at the top of the lower leg bone where the patella tendon attaches.
Prognosis
For most children with Osgood-Schlatter, symptoms will settle as their bones stop growing. For a few children, some pain may continue, but the condition rarely requires surgery.
Prevention
Because the initial injuries are small, Osgood-Schlatter disease is difficult to prevent. However, following medical advice may help to reduce the risk of the condition becoming worse and doing more damage to the bone.
References
- “A Patient’s Guide to Osgood-Schlatter Lesion of the Knee.” Accessed October 6 2014. link here
- “Osgood-Schlatter Disease.” Accessed October 7 2014. link here
- “Osgood-Schlatter Disease | Health | Patient.co.uk.” Accessed October 6 2014. link here
- “Osgood-Schlatter Disease Definition - Diseases and Conditions - Mayo Clinic.” Accessed October 6 2014. link here
- “Osgood-Schlatter Disease (tibial Tuberosity Avulsion).” Accessed October 6 2014. link here
- “Osgood Schlatter Syndrome | Better Health Channel.” Accessed October 6 2014. link here
10 Most frequently asked questions (FAQs)
What is Osgood-Schlatter disease? Osgood-Schlatter disease is a condition that causes pain in the knees of children and adolescents. It often follows a growth spurt. It occurs because an overly tight patellar tendon pulls on part of the shinbone (tibia), damaging the bone. What are the symptoms of Osgood-Schlatter disease? Osgood-Schlatter disease causes pain in the knee, particularly when straightening the knee, squatting, kneeling, running or jumping. A red, swollen bump may form on the front of the shinbone, just below the kneecap. What causes Osgood-Schlatter disease? Osgood-Schlatter disease most often occurs in children during a growth spurt, when the patellar tendon may be tighter than usual and so pulls on the shinbone (tibia), causing damage to the bone and inflammation. It is more common in children who are very physically active, or who have misalignments of the legs such as flat-footedness or knock-knees. Who gets Osgood-Schlatter disease? Osgood-Schlatter disease generally occurs in children aged 9-14 years. It is most common at the time of the growth spurt associated with puberty. Once the bones stop growing in the mid-teens, Osgood-Schlatter disease can no longer develop. How is Osgood-Schlatter disease diagnosed? Osgood-Schlatter disease is usually diagnosed by a doctor performing a physical examination and asking about symptoms. X-rays may be recommended, but are not usually required for a diagnosis. How is Osgood-Schlatter disease treated? In most cases, simple management such as reducing the amount of physical activity, using mild pain-relief medications and ice packs to reduce pain and doing physiotherapy exercises are all that is needed to treat Osgood-Schlatter disease. In rare cases, when pain continues after the bones have stopped growing, surgery may be required. Is Osgood-Schlatter disease serious? Osgood-Schlatter disease is normally not serious, although it can be painful. In most children with the condition, symptoms will last months or years, but stop once the bones stop growing. In rare cases, the condition may lead to persistent pain that may require surgery. What can make Osgood-Schlatter disease worse? Participating in a lot of sports and activities that involve a lot of running and jumping can aggravate Osgood-Schlatter disease. It is usually not necessary to stop doing sports altogether, but in some cases reducing participation, or choosing lower-impact sports, may be recommended.
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