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Osgood-Schlatter Disease
Updated: Apr 22, 2009
Introduction
Background
Osgood-Schlatter (OS) disease is one of the most common causes of knee pain in the adolescent. Consisting of pain and edema of the tibial tubercle (and hence this is an extra-articular disease), Osgood-Schlatter disease is generally a benign, self-limited knee condition associated with traction apophysitis of the tibial tubercle due to repetitive strain on the secondary ossification center of the tibial tubercle.
Paget first described the clinical syndrome in 1891. In 1903, Osgood and Schlatter published separate papers on the subject. Because of a lack of a precise definition, differentiating Osgood-Schlatter disease from avulsion fractures of the tibial tubercle is difficult.
Radiograph of a patient who is skeletally mature. Note that the tibial tubercle is enlarged and there is an ossicle. A bursa was overlying this.
Radiograph of a patient who is skeletally immature. The tubercle is elongated and fragmented.
Pathophysiology
Histologic studies suggest a traumatic etiology for Osgood-Schlatter disease. Bone growth is faster than soft tissue growth, which may result in muscle tendon tightness across the joint and loss of flexibility.
During periods of rapid growth, stress from contraction of the quadriceps is transmitted through the patellar tendon onto a small portion of the partially developed tibial tuberosity. This may result in a partial avulsion fracture through the ossification center. Eventually, secondary heterotopic bone formation occurs in the tendon near its insertion, producing a visible lump. Approximately 25% of patients have bilateral lesions.
In an MRI study of 20 patients with Osgood-Schlatter disease, the patellar tendon was noted to attach more proximally and in a broader area to the tibia in patients with Osgood-Schlatter disease.1
Frequency
United States
The frequency of Osgood-Schlatter disease is not known, but the condition is uncommon.
International
One Finnish study found that Osgood-Schlatter disease affected 13% of athletes.
Mortality/Morbidity
Osgood-Schlatter disease is typically a benign and self-limited condition that waxes and wanes but often takes months to years to resolve entirely.
Sex
Osgood-Schlatter disease occurs more frequently in boys, probably because a greater number of boys participate in sports.
Age
- Osgood-Schlatter disease usually is seen in the adolescent years after undergoing a rapid growth spurt the previous year.
- Girls who are affected are typically aged 10-11 years but can range from 8-12 years.
- Boys who are affected are typically aged 13-14 years but can range from 12-15 years.
Clinical
History
- Osgood-Schlatter disease is a clinical diagnosis.
- Pain is the most common presenting complaint.
- The pain may be reproduced by extending the knee against resistance, stressing the quadriceps, or squatting with the knee in full flexion.
- Running, jumping, kneeling, squatting, and ascending/descending stairs exacerbate the pain.
- Relief of symptoms occurs with rest or restriction of activities.
- Pain usually has been present intermittently for several months before the patient seeks medical care.
- The pain is bilateral in 25% of cases.
- Approximately 50% of patients give a history of precipitating trauma.
Physical
- A visible soft tissue edema is present over the proximal tibial tuberosity.
- Tenderness to palpation over the proximal tibial tuberosity at the site of patellar insertion may be present.
- A firm mass may be palpable.
- Pain is reproduced by extension against forced resistance.
- Knee joint examination is normal; Osgood-Schlatter disease is an extra-articular disease.
- Absence of effusion or condylar tenderness is typical.
- Erythema of the tibial tuberosity may be present.
- Some patients may have quadriceps atrophy.
Causes
- The etiology is controversial, but the condition clearly is exacerbated by exercise. In one study of 389 adolescents athletes, 21% reported Osgood-Schlatter disease in those actively participating in sports as compared with only 4.5% of nonparticipants.2
- Approximately 50% of patients relate a history of precipitating trauma.
- Chronic microtrauma to the tibial tuberosity secondary to overuse of the quadriceps muscle is a leading theory of etiology.
- Histologic studies support a traumatic etiology.
- Risk factors
- Age between 8 and 15 years
- Male sex
- Rapid skeletal growth
- Repetitive jumping sports
More on Osgood-Schlatter Disease |
 Overview: Osgood-Schlatter Disease |
| Differential Diagnoses & Workup: Osgood-Schlatter Disease |
| Treatment & Medication: Osgood-Schlatter Disease |
| Follow-up: Osgood-Schlatter Disease |
| Multimedia: Osgood-Schlatter Disease |
| References |
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References
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Kujala UM, Kvist M, Heinonen O. Osgood-Schlatter's disease in adolescent athletes. Retrospective study of incidence and duration. Am J Sports Med. Jul-Aug 1985;13(4):236-41. [Medline].
Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. Feb 2007;19(1):44-50. [Medline].
Orava S, Malinen L, Karpakka J, Kvist M, Leppilahti J, Rantanen J, et al. Results of surgical treatment of unresolved Osgood-Schlatter lesion. Ann Chir Gynaecol. 2000;89(4):298-302. [Medline].
Aparicio G, Abril JC, Calvo E, Alvarez L. Radiologic study of patellar height in Osgood-Schlatter disease. J Pediatr Orthop. Jan-Feb 1997;17(1):63-6. [Medline].
Binazzi R, Felli L, Vaccari V, Borelli P. Surgical treatment of unresolved Osgood-Schlatter lesion. Clin Orthop. Apr 1993;202-4. [Medline].
Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease?. J Fam Pract. Feb 2004;53(2):153-6. [Medline].
Dunn JF. Osgood-Schlatter disease. Am Fam Physician. Jan 1990;41(1):173-6. [Medline].
Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease. J Pediatr Orthop. May-Jun 1995;15(3):292-7. [Medline].
Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. Feb 2007;19(1):44-50. [Medline].
Hussain A, Hagroo GA. Osgood-Schlatter disease. Sports Exer Injury. 1996;2:202-206.
Krause BL, Williams JP, Catterall A. Natural history of Osgood-Schlatter disease. J Pediatr Orthop. Jan-Feb 1990;10(1):65-8. [Medline].
Micheli LJ. The traction apophysitises. Clin Sports Med. Apr 1987;6(2):389-404. [Medline].
Rostron PK, Calver RF. Subcutaneous atrophy following methylprednisolone injection in Osgood-Schlatter epiphysitis. J Bone Joint Surg Am. Jun 1979;61(4):627-8. [Medline].
Smith JB. Knee problems in children. Pediatr Clin North Am. Dec 1986;33(6):1439-56. [Medline].
Further Reading
Keywords
Osgood-Schlatter disease, OS, OS disease, knee pain, knee injury, apophysitis tibialis adolescentium, Schlatter's disease, Schlatter disease, Schlatter-Osgood disease, traction apophysitis, partial avulsion fracture, proximal tibial tuberosity, patellar insertion, extra-articular disease, quadriceps atrophy, exercise, chronic microtrauma, overuse of quadriceps muscle, repetitive jumping sports, rapid skeletal growth
