Next up in our series of child and adolescent musculoskeletal conditions is Osgood-Schlatter disease, a common cause of knee pain found in growing adolescents.
Osgood-Schlatter is the common name for tibial tubercle apophysitis. The tibial tubercle sits at the top of the tibia (shin bone) where the patella tendon attaches. This tendon attaches the kneecap (patella) to the tibia. Osgood-Schlatter disease is an inflammation of the bone at this attachment site. It is an overuse injury rather than a traumatic injury.
What is Osgood-Schlatter Disease?
The knee is a hinge joint, located between the thigh bone (femur) and shin bones (tibia and fibula). Contraction of the muscles on the front of the thigh (quadriceps) straightens the knee, while contraction of the muscles on the back of the thigh (the hamstrings) bends the knee.
The quadriceps muscle attaches to the shin bone below the knee cap (patella) via the patella tendon. The point of attachment of the patella tendon to the shin bone is the bony bump (tibial tuberosity) just below the knee.
The bones of children and adolescents have a special area where the bone is growing, known as the growth plate. Growth plates are areas of cartilage located near the ends of bones. When a child is fully grown, the growth plates harden into solid bone.
Some growth plates serve as attachment sites for tendons, the strong tissues that connect muscles to bones. A bony bump called the tibial tubercle covers the growth plate at the end of the tibia. Repetitive traction on the tubercle in children and adolescents can lead to inflammation of the growth plate which can then result in pain and swelling.
Osgood-Schlatter disease often occurs during a growth spurt and is associated with activities such as running and jumping.
Symptoms of Osgood-Schlatter disease include pain and swelling. Pain typically increases with activity and decreases with rest. Symptoms will depend on the severity of the condition, but may include:
- knee pain and tenderness at the tibial tubercle
- pain when straightening the knee joint or full squatting
- pain on running, or going up and down stairs
- pain that eases with rest
- a swollen tibial tuberosity
- red and inflamed skin over the tibial tuberosity
- quadriceps muscles that can sometimes lose strength and bulk
Some common causes of Osgood-Schlatter disease include:
- recent growth spurt
- exercise – active children, particularly those engaged in athletics and sports are at increased risk
- gender – boys are more susceptible than girls, but this is possibly because boys typically play more vigorous sports
- prior injury – around half of all children with the condition report a prior knee injury
Osgood-Schlatter disease can usually be diagnosed on clinical presentation without the need for further investigation, such as x-rays or ultrasound. However, occasionally these may be performed to rule out other possible causes of the symptoms.
During the appointment, your doctor or physiotherapist will discuss your child’s symptoms and conduct a thorough examination of the knee to determine the cause of pain. This will include applying pressure to the tibial tubercle, which will be tender or painful on a child with Osgood-Schlatter disease, as well as asking your child to walk, run, jump or kneel to see if the movements bring on painful symptoms.
Osgood-Schlatter disease usually resolves by itself within 12 months, with a period of activity modification, stretches and pain relief, however the knee may remain uncomfortable until growing finishes.
Treatment for Osgood-Schlatter may include:
- activity modification and rest from painful activities (followed by a gradual return to activity)
- ice to reduce local pain and swelling
- stretching, massage and foam rollers for the quadriceps, hamstring and calf muscles
- strengthening of the quadriceps, hamstring and calf muscles
- medications (including pain killers and anti-inflammatory drugs)
- the use of tape or a brace
- correction of foot biomechanics
Osgood-Schlatter disease is a self-limiting condition and complete recovery can be expected as the tibial growth plate closes and the child stops growing, however the bump on the knee may be permanent. Discomfort in kneeling may occur in the long-term with patients who have enlarged lumps as a result of the apophysitis.
Although symptoms of Osgood-Schlatter disease may linger for months, few patients have poor outcomes with conservative treatment, and surgical intervention is rarely necessary.
For more information and for a thorough assessment, call us today to arrange your appointment.