Osgood Schlatter’s Disease
Tibial Tuberosity Apophysitis
What is Osgood Schlatter’s Disease?
Osgood Schlatter’s Disease (OSD) is also known as tibial tuberosity apophysitis. It is the medical name for inflamed bone at the tibial tuberosity growth plate site in adolescents.
Osgood Schlatter’s Disease is an inflammation of the bone at the top of the tibia (shin bone), where the tendon from the patella (kneecap) attaches. It is an overuse knee injury rather than a traumatic injury.
While Osgood Schlatter’s Disease is relatively common, it is a quite debilitating knee injury in young active children/adolescents.
What the Symptoms of Osgood-Schlatter’s Disease?
Osgood Schlatter’s Disease presents in active growing boys and girls as:
- Local pain, swelling, and tenderness over the tibial tuberosity (patella tendon insertion).
- Pain experienced during exercise (e.g., running, jumping) or with direct kneeling contact.
- Stairs, squatting and kneeling may be painful.
- Quadriceps weakness can be present in chronic cases.
- Bilateral symptoms occur in 20-30% of cases.
- The apophysis may enlarge in later stages, which looks like a tender lump in its active phase.
What Causes Osgood-Schlatter’s Disease?
Repetitive quadriceps contractions cause a traction force on the tibial tuberosity, disrupting the immature bone. There is a higher incidence in more active children during the adolescent growth spurt.
As a child grows, bones go through different stages of development:
- The tibial tuberosity is initially cartilaginous (cartilaginous stage).
- It then enters the apophyseal stage when the secondary ossification centre (apophysis) appears.
- The unity of the proximal tibial epiphysis with the tibial apophysis marks the epiphyseal stage.
- Lastly, when the growth plates fuse, the bony stage has been reached.
Children are most susceptible to Osgood-Schlatter’s Disease when their bones are in the (2nd) apophyseal stage.
During this phase, the apophysis is unable to withstand high tensile forces. When presented with robust and repetitive muscle contractions, micro-fractures occur in the immature area—the bone separation results in symptoms typical of Osgood Schlatter’s Disease. Additionally, the irregular bone growth that explains an enlarged tibial tuberosity afterwards.
Another potential cause of Osgood Schlatter’s Disease has been the lack of growth of the quadriceps compared to the femur. During a growth spurt in a child, the lengthening of the muscle is unable to keep up with the lengthening of the rapidly lengthening femur, resulting in an increased tensile force on the tibial tuberosity.
Who Suffers Osgood Schlatter’s Disease?
Osgood Schlatter’s Disease usually strikes adolescents who are active during their growth spurts, which is the two year period where they grow most rapidly. Osgood-Schlatter’s Disease is most common in boys but can affect either gender if the children are active. Tight thigh muscles also predispose you to Osgood Schlatter’s Disease. (de Lucena GL et al. 2011)
The most prevalent groups are Boys: ages 11-15 years – Girls: ages 8-13 years.
Activities involving repetitive, muscular quadriceps contractions, such as jumping, running, volleyball, basketball, soccer, gymnastics, dance, netball and ice skating are most at risk.
Osgood Schlatter’s Disease clinical diagnosis typically occurs without the need for further investigation.
Plain X-rays m rule out other conditions such as a tibial tuberosity fracture, malignancy, or infection. MRIs may confirm the diagnosis.
What is the Symptom Progression?
While a mild case of Osgood Schlatter’s Disease can resolve within days or weeks, severe cases require professional management to avoid growth plate damage. Chronic Osgood Schlatter’s Disease can result in an avulsion fracture of the patella tendon, which can severely affect your ability to walk or run. The pain and swelling symptoms can potentially last for years.
Fortunately, Osgood Schlatter’s Disease responds favourably to well-managed physiotherapy.
Osgood-Schlatter’s Disease Treatment
Physiotherapy assessment and treatment is a proven benefit for Osgood Schlatter’s disease sufferers. About 90% of patients respond well to non-operative physiotherapy treatment, but symptoms may come and go for 12-24 months before complete resolution. (Gholve et al. 2007)
- Immediate cessation or reduction of high impact activities (e.g. jumping and running).
- Use an infrapatellar knee strap to dissipate forces away from the site of Osgood Schlatter’s Disease. An example of an Osgood Schlatter’s Disease brace is a jumpers strap.
- Kinesiology taping may provide both pain relief and load reduction at the site of pain and injury.
- Only on rare occasions, severe Osgood Schlatter’s Disease may require crutches.
Please consult with your physiotherapist for the best advice specific to your knee.
Ice & TENS Machine
Rest is essential in the management of Osgood Schlatter disease and relief of pain.
Whether or not you should continue playing sport is dependent on symptoms. It is best to discuss your exercise workload with your physiotherapist for advice on how to manage your return sport best while respecting your injury.
Stretching, Massage & Foam Rollers
One common reason for developing Osgood Schlatter’s Disease is excessively tight quadriceps muscles, ITB, hamstrings, hip flexors and calf muscles. Your physiotherapist will prescribe specific stretches for you, but in most cases, you’ll experience better results with foam rolling and massage.
Your physiotherapist will commonly prescribe or modify exercises for you that addresses your kneecap control. This strengthening helps to control your symptoms during the active phase of Osgood Schlatter’s Disease.
Foot Arch Control & Orthotics
Your foot biomechanics or arch control may be inadequate for your intensity of the sport. Your physiotherapist can assist both the assessment and corrective exercises for your dynamic foot control.
Active Foot Correction Exercises can be beneficial as both a preventative and corrective strategy—more info: Active foot control exercises.
Occasionally, your foot biomechanics may be predisposing you to torsional stresses that can cause abnormal knee forces, which can cause knee injury. In these instances, foot orthotics may assist. There are mixed views on how effective these are since the foot structure is rapidly changing at this age. Ask your physiotherapist or podiatrist for advice.
The Prognosis for Osgood Schlatter’s Disease
Osgood Schlatter’s Disease is a self-limiting syndrome. Complete recovery occurs with the closure of the tibial growth plate. Discomfort in kneeling may happen in the long-term with patients who have enlarged lumps due to apophysitis. Avoiding permanent bone enlargement is desirable.
Although Osgood Schlatter’s Disease symptoms may linger for months, few patients have poor outcomes with conservative treatment, and surgical intervention is seldom necessary.
Osgood Schlatter sufferers should seek the professional advice of their trusted youth knee physiotherapist for individual treatment advice.