Osgood Schlatter

Aka: Osgood Schlatter, Osgood-Schlatter, Tibial Apophysitis, Juvenile Osteochondrosis of Tibial Tubercle, Osgood-Schlatter Disease

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II. Epidemiology

  1. Common in physically active children near Puberty (age range 10 to 14 years old)
    1. Boys (more common): Age 13 to 14 years old
    2. Girls: Age 10 to 11 years old
  2. More common in athletes (21% versus 4.5% for non-athletes), especially in Running and cutting sports
    1. Soccer
    2. Basketball
    3. Gymnastics
    4. Volleyball

III. Pathophysiology

  1. Repetitive traction of Patellar tendon on tibial tubercle Ossification Center (apophysis)
  2. Cartilage detachment from tibial tuberosity
  3. Increased during growth spurts
  4. Acute stress
    1. Recent increase in athletic activity
    2. Recent growth spurt

IV. Symptoms

  1. Waxing and waning Anterior Knee Pain for months
  2. Bilateral in up to one third of patients
  3. Knee Pain at tibial tuberosity aggravated by
    1. Running
    2. Jumping or hurdling
    3. Going up and down stairs
    4. Direct pressure wwith kneeling
    5. Squatting

V. Signs

  1. Localized tenderness and swelling at tibial tuberosity (tibial tubercle)
  2. No overlying erythema
  3. Knee range of motion is intact
  4. Quadriceps and hamstring tightness may be present
  5. Provocative maneuvers
    1. Knee extension against resistance
    2. Passive knee hyperflexion to buttock
      1. Results in exquisite pain at tibial tubercle
      2. Diagnostic for Osgood Schlatter

VI. Differential Diagnosis

  1. See Anterior Knee Pain
  2. Tibial apophysis avulsion Fracture
  3. Slipped capitalfemoral epiphysis with radiating pain

VII. Imaging

  1. Knee XRay
    1. Indicated for significant tenderness or difficult weight bearing
      1. Evaluate for Fracture including Tibial Stress Fracture, Tibial Tuberosity Avulsion Fracture, tumor or Osteomyelitis
    2. May show tibial tubercle fragmentation and overlying soft tissue swelling
  2. Bedside Ultrasound
    1. Tibial tubercle with swelling and fragmentation
    2. Increased Blood Flow over apophysis

VIII. Associated Conditions

  1. Sinding-Larsen Johansson Disease
    1. Small avulsion Fracture of the inferior pole of Patella
    2. Pathophysiology and management are the same as with Osgood-Schlatter

IX. Management

  1. Reduce Physical Activity, but may still participate
  2. Consider Infrapatellar Strap
  3. Knee Immobilizer splint may occasionally be useful
  4. Quadriceps and hamstring strengthening and Stretching
  5. Protect the area from direct Trauma
  6. Analgesics as needed (Acetaminophen, NSAIDs)
  7. Avoid local Corticosteroid Injections
    1. Weakens Patellar ligament
    2. Thins and depigments skin
  8. Orthopedic Consultation if persistent pain despite mature skeleton
    1. Surgical excision of ossicle may ultimately be needed if persistently painful (rarely needed)

X. Course

  1. Self limited, resolves over months
  2. Resolves when tibial tubercle fuses to diaphysis

XI. References

  1. Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]
  2. Atanda (2011) Am Fam Physician 83(3): 285-91 [PubMed]
  3. Dunn (1990) Am Fam Physician 41:173-6 [PubMed]

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