II. Epidemiology

  1. Common in physically active children near Puberty (age range 10-14 years old)
    1. Boys (more common): Age 13-14 years old
    2. Girls: Age 10-11 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

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Juvenile osteochondrosis of tibial tubercle (C0029376)

Concepts Disease or Syndrome (T047)
MSH D055034 , D010007
SnomedCT 79353000, 72047008, 268124001, 156820001, 430642003
English Juvenile osteochondrosis of tibial tubercle, Osgood Schlatter's disease, Osteochondritis of the proximal tibia, Osteochondritis proximal tibia, Tibial tubercle juv. osteoch., Osteochondritis tib tubercle, Osteochondritis of tibial tubercle, Osgood Schlatter disease (diagnosis), OSGOOD SCHLATTER DIS, Osgood-Schlatter Disease, Osgood Schlatter Disease, Osteochondrosis of tibial tubercle, Osgood Schlatter disease, disease osgood schlatters, diseases osgood schlatter, osgood schlatter disease, osgood-schlatter disease, disease osgoods schlatter's, disease osgood schlatters's, Disease;Osgood-Schlatter, disease osgood-schlatter, osgood schlatter's disease, osgood-schlatter's disease, schlatter's disease osgood, disease osgoods schlatters, tibial tubercle osteochondrosis, disease osgood schlatter, osteochondrosis, Osgood Schlatters disease, Osgood schlatter's dis., Osgood Schlatter disease (disorder), Osgood-Schlatter's disease, Tibial tubercle juvenile osteochondritis, Juvenile osteochondrosis of tibial tubercle (disorder), Osgood-Schlatter; osteochondrosis, Osgood-Schlatter, Schlatter-Osgood, osteochondrosis; Osgood-Schlatter, Osgood-Schlatter's Disease, Osteochondrosis of Osgood-Schlatter, Osteochondrosis of proximal tibia, Osgood-Schlatter disease
Dutch ziekte van Osgood-Schalatter, osteochondrose van tibia tuberculum, Osgood-Schlatter; osteochondrose, osteochondrose; Osgood-Schlatter, Osgood-Schlatter, ziekte van
French Ostéochondrose du tubercule tibial, Maladie d'Osgood-Schlatter, Maladie de Schlatter, Apophysite tibiale antérieure de croissance, Maladie d'Osgood, Apophysite tibiale antérieure
German Osteochondrose des Schienbeintuberkulums, Osgood-Schlatter-Krankheit, Schlatter-Osgood-Krankheit
Italian Osteocondrosi del tubercolo tibiale, Malattia di Osgood-Schlatter
Portuguese Osteocondrose da tuberosidade da tíbia, Doença de Osgood-Schlatter
Spanish Osteocondrosis de tubérculo tibial, Enfermedad de Osgood-Schlatter, enfermedad de Osgood - Schlatter, osteocondrosis juvenil del tubérculo tibial, enfermedad de Osgood Schlatter (trastorno), enfermedad de Osgood Schlatter, osteocondrosis juvenil del tubérculo tibial (trastorno)
Japanese オスグッド・シュラッター病, 脛骨粗面の骨端症, ケイコツソメンノコッタンショウ, オスグッドシュラッタービョウ
Czech Morbus Osgood-Schlatter, Osgoodova-Schlatterova nemoc, Osgood-Schlatterova nemoc, Osgoodův-Schlatterův syndrom, Lannelonguova nemoc
Hungarian Osgood-Schlatter-betegség, Tibia-tuberculum osteochondrosisa
Norwegian Osgood-Schlatter-sykdom, Juvenil osteokondrose tuberositas tibia, Osgood-Schlatters sykdom