Osgood-Schlatter Disease (OSD)

Key Points

Traction apophysitis of the tibial tubercle
Common in adolescents during growth spurts
More frequent in athletic teenagers
Boys typically affected age 13-14
Girls typically affected age 11-12

Overview

Osgood-Schlatter Disease is a common cause of anterior knee pain in growing adolescents, particularly those involved in sports requiring running, jumping, and quick directional changes. It represents inflammation of the patellar tendon insertion at the tibial tubercle apophysis during periods of rapid growth.

Pathophysiology

Anatomical Considerations:

Biomechanical factors:
- Repetitive quadriceps contraction
- Traction force on tibial tubercle
- Microavulsion at tendon insertion
Growth-related factors:
- Rapid skeletal growth
- Apophyseal vulnerability
- Muscle-tendon imbalance

Risk Factors:

Sports participation:
- Basketball
- Volleyball
- Soccer
- Gymnastics
- Dance
Anatomic factors:
- Tight quadriceps
- Tight hamstrings
- Patella alta
Growth-related:
- Adolescent growth spurt
- High activity level during growth

Clinical Presentation

History:

Symptoms:
- Anterior knee pain
- Pain worse with activity
- Pain with direct pressure
- Bilateral in 20-30% of cases
Aggravating activities:
- Running
- Jumping
- Stairs
- Kneeling
Timing:
- Gradual onset
- During growth spurts
- Athletic seasons

Physical Examination:

Inspection:
- Tibial tubercle prominence
- Soft tissue swelling
- Local tenderness
Palpation:
- Point tenderness over tubercle
- Soft tissue swelling
- Warmth possible
Special tests:
- Pain with resisted knee extension
- Pain with jumping
- Flexibility assessment

Diagnosis & Assessment

Imaging Studies:

Radiographs:
- Lateral knee view primary
- Findings:
  - Fragmentation of tibial tubercle
  - Soft tissue swelling
  - Irregular ossification
Ultrasound:
- Cartilage swelling
- Tendon thickening
- Bursal inflammation
MRI:
- Rarely necessary
- Used to rule out other pathology
- Shows edema and inflammation

Differential Diagnosis:

Sinding-Larsen-Johansson syndrome
Patellar tendonitis
Tibial tubercle fracture
Patellar subluxation
Soft tissue tumor
Infection

Management

Conservative Treatment:

Activity modification:
- Relative rest
- Sport modification
- Avoid aggravating activities
Physical therapy:
- Stretching exercises:
  - Quadriceps
  - Hamstrings
  - Hip flexors
- Strengthening:
  - Core stability
  - Hip muscles
  - VMO exercises
Pain management:
- Ice after activity
- NSAIDs as needed
- Patellar strap

Return to Activity Protocol:

Phase 1: Pain control
Phase 2: Flexibility
Phase 3: Strengthening
Phase 4: Sport-specific training
Phase 5: Return to full activity

Surgical Management:

Rarely indicated
Indications:
- Persistent symptoms after skeletal maturity
- Large painful ossicles
- Failed conservative treatment
Procedures:
- Ossicle excision
- Tubercle recontouring

Prognosis & Complications

Expected Course:

Natural History:
- Self-limiting condition
- Resolves with skeletal maturity
- Duration: 12-24 months
Recovery Phases:
- Acute: 2-3 weeks
- Rehabilitation: 6-8 weeks
- Return to sport: 2-3 months

Potential Complications:

Short-term:
- Persistent pain
- Activity limitation
- Tibial tubercle avulsion (rare)
Long-term:
- Persistent tubercle prominence
- Painful ossicles
- Anterior knee pain

Prevention Strategies:

Pre-season conditioning
Proper warm-up
Flexibility maintenance
Load management
Proper equipment

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.

Osgood-Schlatter Disease (OSD)