OSGOOD – SCHLATTER DISEASE
What is Osgood-Schlatter disease?
Osgood-Schlatter disease is a condition in which the prominence of the tibial tuberosity, the bony bump on the front of the tibia (shinbone), becomes painful and swollen. This condition commonly occurs in adolescents during the growth spurt of puberty, and it is more prevalent in boys. It is often associated with repetitive activities that involve the quadriceps muscle, such as running and jumping. The quadriceps muscle, the four-headed muscle of the thigh, plays a crucial role in extending the knee. It originates from multiple points on the pelvis and converges into a common tendon that attaches to the upper edge of the patella (kneecap). Through the patella and then down the patellar ligament, the quadriceps transfers its force to the tibia, specifically to the bony prominence on the front side called the tibial tuberosity. In children engaged in repetitive activities that involve stretching and pulling of the patellar ligament from the tibial tuberosity, avascular necrosis and aseptic inflammation can occur. Mechanical traction, causing microtrauma to the still-cartilaginous apophysis of the tibial tuberosity, leads to intense pain and sometimes swelling, resulting in Osgood-Schlatter disease.
How to confirm Osgood-Schlatter disease?
Children with Osgood-Schlatter disease complain of pain on the front side of the knee and often describe the appearance of swelling or a lump on the knee, Figure 1. They usually do not recall a significant injury but experience increased pain after sports activities. Clinical examination may reveal thickening and swelling, and palpation consistently induces intense tenderness over the tibial tuberosity. Some children may complain of pain during kneeling, indicating the presence of a bony outgrowth called an ossicle, Figure 2. In such cases, an ultrasound or a profile X-ray of the knee may be performed to confirm the presence of the ossicle.
Figure 1.
Figure 2.
How to treat Osgood-Schlatter disease?
The treatment of Osgood-Schlatter disease is typically conservative and involves physical therapy. It is essential to modify the child’s sports activities, limit jumping, and initiate stretching exercises for the quadriceps, which are often tight. Consistent stretching is crucial, and the use of a Black roll roller to stretch muscle fascia can be beneficial. In the acute, highly painful phase, cryotherapy with ice massage is recommended, while pain medications are generally not advised. Osgood-Schlatter disease typically resolves with physical therapy. In cases where an ossicle is present, surgery may be considered for some children. However, in situations where activities such as jumping lead to a fracture or avulsion of the tibial tuberosity, with the patellar ligament tearing off a piece of the young bone at its attachment site, surgery is the preferred treatment.
