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Osgood-Schlatter disease
Overview
Osgood-Schlatter disease involves pain at the tibial tubercle (aka tibial tuberosity), typically in children 9 to 14 years of age during a rapid growth spurt secondary to patellar tightening from forceful/excess quadriceps contraction.
It typically occurs in children who are active in athletics, so historically, it was more common in males than in females but this is no longer the case. It does, however, tend to occur a couple of years earlier in girls (9 - 12 years old) than in boys (12 to 14 years old) because girls undergo puberty (growth spurts) earlier.
Pathogenesis
Osgood-Schlatter disease results from repetitive, excessive quadriceps activation, which induces forceful patellar tendon tightening that irritates the tibial tubercle (aka tibial tuberosity), especially during a growth spurt.
Risk factors
Athletics, especially involving movements that place stress on the tibial tubercle through rapid, forceful quadriceps contraction, such as:
- Running with rapid directional change
- Jumping
Diagnosis
Clinical examination is sufficient (radiographs are not required).
- Prominence of the tibial tubercle (bony or soft tissue) and associated tenderness to palpation.
- Reproducible pain at the knee with provocative maneuvers.
- Inflammation of the the tibial tubercle (look for osteomyelitis).
- Referred pain to the knee from hip-related pathology (eg, slipped capital femoral epiphysis, Legg-Calvé-Perthes disease).
- Outer knee pain (eg, from iliotibial band syndrome) rather than pain at the tibial tubercle.
- Acute onset of pain (or in the setting of knee injury) can be due to avulsion fracture of the tibial tubercle.
- Nocturnal or rest-related knee pain, especially with systemic symptoms, should raise concerns for another potential process such as infection, or tumor.
Imaging
Lateral radiographic imaging can identify tibial tubercle abnormalities or patellar tendon changes (but is unnecessary to make the diagnosis).
Management
Typically, Osgood-Schlatter disease typically is benign and self-limited - it resolves when the growth plate ultimately ossifies.
Conservative management includes control of pain and swelling and strengthening of the quadriceps and muscle stretching to promote flexibility. Note that inactivity is contraindicated but patient education about what activities exacerbate symptoms is helpful.
Surgical management is reserved for rare instances where patients have persistent symptoms after closure of the proximal tibial growth plate.