Osgood-Schlatter disease

What is Osgood-Schlatter disease?

Osgood-Schlatter disease is a condition that affects the upper part of the shin bone (tibia). Overuse of the quadriceps muscle (the muscle on the front of the thigh) can cause repeated strain where this muscle attaches via the patellar ligament to the growing tibia. The tibia hasn't finished growing and isn't quite strong enough to withstand the strain on it. This can cause redness and soreness where the ligament attaches. In some cases, a small flake of bone is pulled off the tibia by the pulling ligament. Healing bone (callus) then forms which may cause a hard bony bump to develop.

Osgood-Schlatter disease (also sometimes called Osgood-Schlatter syndrome) is one of the commonest causes of knee pain in active adolescent children. Young teenagers, particularly boys, are the most commonly affected and it is unusual to develop this over the age of 16. Playing sports which involve kicking, running or jumping can make Osgood-Schlatter disease more likely but it can sometimes occur in children who are not sporty.

The main symptom is pain just below the kneecap (patella). The severity of the pain tends to vary. It is usually worse during, and just after, activity and it tends to ease with rest. The pain typically lasts a few months but sometimes persists until the teenager has finished growing. This means that in some cases it can last up to two years.

A small, tender, bony bump may develop just under the kneecap. This is where the patellar ligament attaches to your shin bone (tibia). The bump is permanent although over time it becomes painless. The knee joint itself is not affected so knee movements are normal. Symptoms usually occur on one side but in up to a third of cases it affects both knees.

The diagnosis is made from the typical symptoms and X-rays are unnecessary. An x-ray may be requested if the diagnosis is not clear from the symptoms.

The pain usually goes within a few months without any treatment. When the pain flares up, it may be useful to take a painkiller such as paracetamol or ibuprofen.

Physiotherapy can be of benefit. Osgood-Schlatter exercises are used to strengthen the muscles around the knee joint (principally the quadriceps, hamstrings, and gastrocnemius muscles).

Osgood-Schlatter taping has previously been thought to be helpful but there is little evidence of benefit for most people. An adhesive tape is placed across the part of the bone that is tender and swollen (the tibial tuberosity) while the patient's knee is bent. This offloads the pressure when the joint is straightened, relieving some of the pressure and pain.

Osgood-Schlatter surgery is very rarely required but if the pain persists, a small operation may be performed. This involves removing unhealed areas of flakes of bone or fixing them to the upper part of the shin bone (tibia).

Sport or actividad física is not likely to cause any permanent damage but may make the pain worse. However, since it is often sporty teenagers who develop Osgood-Schlatter disease, if the pain is affecting their ability to take part in their sport, difficult decisions may have to be made about training schedules and sporting commitments.

An approach similar to the following may be advised:

• You do not usually need to stop sport. However, easing off strenuous or vigorous sport may be sensible until the pain eases to a tolerable level. You should aim to reduce the duration, frequency and also intensity of your exercise, especially if this exercise includes running or jumping. Consider a complete break from sport for a while if pain remains bad.

• An ice pack applied below the kneecap (patella) for about five minutes before and after exercise may prevent some inflammation and pain.

• Consider wearing knee pads during sports such as football and rugby, to protect the tender area.

• Some people find an Osgood-Schlatter brace helpful. It works by reducing pressure on the painful bump at the top of the tibia.

• Consider seeing a physiotherapist for advice on exercises to stretch the thigh muscles.

As mentioned, the pain typically only lasts a few weeks or months. However, it can sometimes last up to two years. The pain does not usually fully resolve until the end of the teenage growth spurt. Some people find that the pain can return (recur) when they kneel.