What is Osgood-Schlatter disease?

What are the causes of Osgood-Schlatter disease?

The pica tendon inserts at the shin bone in an area referred to as the tibial tubercle. At a young age it is made up of soft cartilaginous tissue. This tissue gradually turns into bone at the age of 10-12 in girls and 12-14 in boys. During this period of time of adolescence, Osgood-Schlatter can present, especially as a result of recurrent stretching exercises and recurrent activation of the quadriceps muscle and the pica tendon. This recurrent activity can lead to microscopic tears in the fibers that connect the tendon to the bone, and eventually lead to microscopic bleeds, microscopic fractures and an inflammatory reaction that leads to swelling, tenderness and sometimes local redness.
This means that Osgood-Schlatter is considered an “over use” injury, which develops in athletically active teenagers. The load this area experiences intensifies when there is an increase in weight, increased intensity and lengthening of the limbs during periods of quick growth and less frequently, after a significant trauma.

What will children with Osgood-Schlatter disease complain of?

The most common complaints are those associated with pain that presents gradually in the anterior portion of the knee with tenderness in the area connecting between the pica tendon and the shin bone.
It is usually a unilateral disease even though the symptoms that present in both knees at the same time or intermittently, in about 20-30% of the patients.

Who do we tend to see Osgood-Schlatter disease in?

Risk factors for this condition include: male gender, ages 12-15 in boys and 8-12 in girls, suboptimal flexibility of the quadriceps and gastrocnemius muscle and periods of accelerated growth.
There are a number of different types of sports that are associated with a higher risk including football, basketball, volleyball, light athletics (short distance running) and gymnastics.

How prevalent is Osgood-Schlatter’s disease?

This is certainly one of the more common causes of knee pain in active teenagers.
Research that has been conducted in the field has shown that among teenagers aged 12-15 years, the prevalence of this condition is about 10% (11.4% in boys and 8.3% in girls).

How can Osgood-Schlatter disease be detected?

Usually, the diagnosis is a clinical one and there is no need for any imaging studies. If the presentation is atypical and not clear cut, or if there was a preceding trauma, an x-ray can be performed in order to rule out other pathologies such as fractures, infections, etc.
If an x-ray of the knee has been done, the classic findings include lifting up of the tibial tuberosity, swelling of the soft tissue anterior to the tibial tuberosity, fragmentation of the area that connects to the bone and calcifications deep in the pica tendon.
It is important to know that these findings can present in healthy young individuals as well, without any complaints and therefore it is important to correlate the findings to the clinical presentation.
Keep in mind that if there is a need for knee x-rays it is important to take two views, and of both knees, for proper comparison.

What is the treatment for Osgood-Schlatter disease?

Let’s start with the bottom line. This is a disease that resolves spontaneously. The problem is that sometimes it takes years until there is a complete closure of the growth plates and complete resolution.
So how can the pain be relieved? We can divide the treatment into two. The symptomatic treatment and the preventive treatment.
The symptomatic treatment includes rest, cold compresses, use of non-steroidal anti-inflammatory drugs and sub-pica knee straps that help distribute the load on the entire knee.
The preventative treatment includes change the style of exercise and the frequency of training. Unfortunately, when this does not help, sometimes the type of sports the person practices needs to be changed.
In addition, physiotherapy can help with the relative shortening of the muscles and tendons in the lower limb through stretching exercises of the quadriceps muscle, gastrocnemius, the gluteus and the hamstrings.

Can we inject steroids or surgically treat Osgood-Schlatter?

There is no evidence in the medical literature that treating Osgood-Schlatter with steroid injection will lead to a resolution of the disease, and in fact could even lead to the tearing of the pica tendon.
As for surgery, surgical procedures, are required in very rare cases where there is severe pain for a long period of time during adolescence and if there are appropriate findings, such as calcifications in the pica tendon.

In summary, this is a relatively common medical condition in adolescents that are physically active. It is the bread and butter for pediatric orthopedists who see teenagers with Osgood-Schlatter daily, and the emphasis is on correct diagnosis, avoidance of missing out important diagnoses, and subsequently appropriate medical management with the hope of bringing the teenager back to their regular activity, pain-free.

Good luck!