Osgood-Schlatter disease is a common cause of anterior knee pain in active adolescents. It was first described in 1903 by surgeons Robert Osgood and Carl Schlatter. It is typically seen in boys ages 10-15 and girls ages 8-13. It affects 20 percent of athletic adolescents, as compared to about 5 percent of non-athletic adolescent groups. Boys are affected three times more than girls. It affects both knees in 20-30 percent of cases. It is most common in basketball, volleyball, soccer, and gymnastics.
What causes Osgood-Schlatter Disease?
Osgood-Schlatter Disease (OSD) is caused by a traction apophysitis of the tibial tubercle. The tibial tubercle is located on the anterior-superior portion of the tibia, just below the knee joint. A secondary ossification center, or apophysis, develops here when children begin puberty. This is also where the distal portion of the patella tendon inserts. Repetitive microtrauma from a contracting patella tendon can lead to subacute avulsions of tibial tubercle or tendinous inflammation, thus causing OSD.
What are the symptoms of Osgood-Schlatter Disease?
Patients usually complain of knee pain during running, jumping, squatting, or kneeling. It is common for patients to have an antalgic gait. A prominence, swelling, and tenderness will be noticeable over the area of the tibial tuberosity. There should be no knee joint effusion or swelling. Pain is often reproduced with resisted extension of the knee while it is at 90 degrees of flexion. Pain is usually not elicited with straight-leg test. Pain often resides with rest and activity modification.
What does OSD look like on imaging?
Imaging studies are not required to make the diagnosis of OSD. When lateral radiographs of the knee are obtained, the knee film is often normal. In more severe cases of OSD, the radiographs may show a prominence of the tibial tubercle or radiodense fragments separated from the tibial tuberosity. CT scan or MRI should not be used to diagnose OSD.
Osgood-Schlatter Disease treatment
Treatment for OSD is mainly reassurance and conservative treatment. Conservative treatments include ice, NSAID medications, quadriceps/hamstrings stretching, padding, cho-pat strap, and activity modification.
It is a self-limited disease that usually takes months to years to completely resolve. Surgery is very rare and only indicated after puberty and closure of the tibial tubercle physis. Most patients respond to conservative treatment and are able to continue playing their sport of choice as long as the pain is mild and tolerable.
Getting a Second Opinion
A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options. It will also provide you with peace of mind. Multiple studies make a case for getting additional medical opinions.
In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.
You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions. Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.
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Adirim, Terry A., Cheng, Tina L. Overview of Injuries in the Young Athlete. Sports Med 2003. 33(1); 75-81.
Soprano, Joyce V. Musculoskeletal Injuries in the Pediatric and Adolescent Athlete. Current Sports Medicine Reports. 2005. 4:329-334.
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