eMedicine Specialties > Radiology > Pediatrics

Osgood-Schlatter Disease

Author: Aparna Joshi, MD, Assistant Professor, Department of Radiology, Wayne State University School of Medicine
Contributor Information and Disclosures

Updated: Oct 12, 2007

Introduction

Background

The Osgood-Schlatter lesion is a common cause of knee pain in active adolescents. Two authors, Robert Bayley Osgood and Carl Schlatter, working independently, were the first to describe the condition, in 1903. The diagnosis is usually made on the basis of characteristic localized pain at the tibial tuberosity, and radiographs are not needed for diagnosis. However, radiographic results confirm the clinical suspicion of the disease and exclude other causes of knee pain.

For excellent patient education resources, visit eMedicine's Arthritis Center, Osteoporosis and Bone Health Center, and Foot, Ankle, Knee, and Hip Center. Also, see eMedicine's patient education article Knee Pain.

Pathophysiology

Originally, the Osgood-Schlatter lesion was thought to result from an avulsion of bone or cartilage in the tibial tuberosity. However, subsequent findings have indicated that most cases of Osgood-Schlatter disease are caused by microtrauma in the deep fibers of the patellar tendon at its insertion on the tibial tuberosity; even so, avulsion may be present in some cases.

The quadriceps femoris muscle, the largest muscle in the human body, inserts on a relatively small area of the tibial tuberosity. As a consequence, naturally high tension exists at the insertion site. In children, additional stress is placed on the cartilaginous site as a result of vigorous physical activity, leading to traumatic changes at the insertion; this is especially true in the case of activities, such as kicking, that involve particularly high stress at the insertion. (See also the eMedicine article Knee, Extensor Mechanism Injuries [MRI].)

Frequency

United States

The frequency of this condition has not been quantified.

International

A Finnish retrospective questionnaire study revealed a frequency of 13% among adolescent athletes.¹

Mortality/Morbidity

• Reported complications of Osgood-Schlatter disease include the following:
  • Tibia recurvatum - Caused by premature fusion of the anterior aspect of the proximal tibial physis
  • Patella alta
  • Ossicles - Which may be identified within the tendon; these ossicles may fail to unite to the tibia. If painful, surgical relief may be necessary.

• Complete rupture of the patellar tendon is rare.

Sex

The Osgood-Schlatter lesion occurs more frequently in boys than in girls, with a male-to-female ratio as high as 7:1. This difference is probably related to a greater participation in specific risk activities by boys than by girls.

Age

The Osgood-Schlatter lesion typically occurs in children and adolescents aged 10-14 years.

Anatomy

In children, the cartilaginous tibial tuberosity is an inferior extension of the proximal tibial physis. The tuberosity usually ossifies as an inferior extension of the main epiphyseal ossification center. Sometimes, 1 or more secondary ossification centers develop separately in the cartilaginous tuberosity. These eventually unite with the main, proximal tibial epiphyseal ossification center. Hence, the presence of multiple ossific nodules anterior to the tibial metaphysis is, by itself, a normal variant. The patellar tendon extends anterior to the infrapatellar fat pad of Hoffa and inserts into the cartilage of the anterior tibial tuberosity.

Presentation

Pain, focal swelling, heat, and localized tenderness at the tibial tuberosity are typical in Osgood-Schlatter disease and are considered to be diagnostic clinical findings. Treatment is conservative and includes the use of pain-relieving medications (analgesics, nonsteroidal anti-inflammatory drugs [NSAIDs]), the application of ice in the area of pain, and the avoidance of stress on the knee caused by heavy quadriceps loading. Surgical treatment is reserved for patients in whom the disease does not respond to conservative therapy.

The condition is usually self-limited; symptoms resolve with skeletal maturity in over 90% of cases, when the tibial tubercle fuses to the remainder of the tibia.

Regarding other conditions to be considered, soft-tissue edema adjacent to the tibial tuberosity can coexist with an active Osgood-Schlatter lesion, infectious apophysitis, or a soft-tissue malignancy, although the last 2 conditions are exceedingly uncommon.

Preferred Examination

Lateral radiographs of the knee demonstrate pertinent soft-tissue findings in Osgood-Schlatter disease, as well as bony changes, such as ossicle formation. If the tibial tuberosity must be examined in detail, the knee should be slightly rotated internally to obtain a lateral view because the tibial tuberosity lies slightly lateral to the midline of the knee. An anteroposterior (AP) image can be obtained to exclude other pathologic bone conditions.

Computed tomography (CT) scanning and magnetic resonance imaging (MRI) are not routinely performed, but they may be helpful in cases in which additional pathologic conditions are being considered or in rare cases in which a complication may not be detectable with plain radiographs. Examples of the latter situation include the presence of a physeal fusion bar, which may lead to the complication of tibia recurvatum, or the existence of a small, painful, unfused ossicle.

Ultrasonography is not routinely performed in most centers. With an experienced imager, the findings can confirm the diagnosis.

Differential Diagnoses

Other Problems to Be Considered

Infectious apophysitis
Soft-tissue malignancy
Accessory ossification centers
Late changes of a previous Osgood-Schlatter lesion

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