Osgood-Schlatters Disease (OSD)
What is Osgood-Schlatters disease?
Osgood-Schlatters disease (OSD) is a traction apophysitis of the tibial tubercle and is one of the commonest causes of knee pain in young athletes.
In OSD there is repetitive excessive force (pull) on the weak growing area at the top of the shin bone causing pain and swelling.
What causes Osgood-Schlatters disease?
Osgood-Schlatters disease (OSD) is caused by repetitive excessive force to the tibial tubercle, causing injury to this area.
The quadriceps muscle (thigh muscle) is the largest muscle in the human body. It is attached to the patella (kneecap) and this in turn is attached to the tibial tubercle (front of the shin bone) by the patella ligament. In children, the tibial tubercle is a growing area and is made of relatively weak cartilage.
If there is excessive force at this relatively weak point, damage occurs. This excess force can be caused by a number of factors.
During the adolescent growth spurt the bones grow very quickly. The muscles do not lengthen at the same rate as the bone grows, and so can become very tight. The thigh muscles generate huge forces when they are used to straighten the knee (such as kicking a football). This force is transmitted to the tibial tubercle. If the hamstring and calf muscles are tight , the thigh muscles have to work even harder as they “fight ” against them, causing extra force at the growing (weak) tibial tubercle. In active children, who undertake a lot of kicking or running, the repetitive high force at the tibial tubercle causes damage.
If a child has poor biomechanics due to poor lower limb alignment (often caused by flat feet), the muscles of the lower limb have to work excessively hard and this can cause increased force at the tibial tubercle.
What problems does Osgood-Schlatters disease cause?
OSD causes swelling, pain and tenderness over the tibial tubercle.
Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. The swelling increases and is painful when touched or knocked.
It commonly affects boys who are having a growth spurt during their pre-teen or teenage years. One or both knees may be affected.
How is Osgood-Schlatters disease diagnosed?
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations.
The problem usually occurs in boys who are going through or have just gone through a growth spurt; one or both knees may be affected.
Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time.
There may be swelling over the tibial tubercle and this area is painful if touched or knocked.
On examination the patient often has flat feet, very tight legs muscles especially the quadriceps, hamstring and gastrocnemius.
Xrays may be normal or may show some extra bone formation (ossicles) around the tibial tubercle. An MRI scan will show features of inflammation in this area.
How is Osgood-Schlatter disease treated?
The initial treatment is rest, relieve the pain and treat the underlying cause.
The knee should be rested so that the tibial tubercle it is not being continually “injured”. It may be sufficient to stop your child playing sport but some children require a short period of bed or couch rest. Some children find resting very difficult and require the use of braces or plasters to slow them down. Using crutches is often advised.
OSD is usually caused by tight muscles. A stretching program should be followed usually supervised by a physiotherapist. The stretching program may need to be undertaken up to 5 times a day.
If flat feet are a problems orthotics (insoles) should be used.
The pain should be controlled by rest (limiting activity) and ice (icing the painful area 3-4 times a day – making sure the skin is not burnt), Simple pain killers can be used such as paracetamol as well as anti-inflammatory tablets and cream.
Osgood-Schlatters disease usually goes away with time. When your child stops growing, the pain and swelling should go away because the growing (weak) tibial tubercle fuses and becomes solid bone which is very strong.
How long will it take for my child’s knee to get better?
It may take several weeks or months for the pain to completely stop. When the pain is completely gone, your child may slowly return to his or her previous level of activity.
What can my child do to help prevent developing Osgood-Schlatters?
It is important to undertake correct warm ups and warm downs before and after exercise. This should include a stretching routine.
It may be necessary to undertake additional stretching outside of sport, especially during stages of growth.
You should avoid your child only playing one sport.
You should not allow your child to play through pain.