Osgood-Schlatter Syndrome

Other Names

• Tibial Tuberosity Apophysitis
• Osteochondrosis
• Traction apophysitis of the tibial tubercle

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Background

• Overuse injury in adolescent athletes (skeletally immature)
• Atraumatic, insidious onset of anterior knee pain, at the tibial tuberosity where patellar tendon inserts
• Self-limited condition
• Caused by repetitive strain and microtrauma from extensor forces applied by the patellar tendon onto the apophysis of the tibial tubercle
  • Results in irritation and severe cases cause partial avulsion of the tibial tubercle apophysis
• Prevalence of Osgood Schlatter disease is 9.8% in adolescents ages 12 to 15
• Bilateral symptoms in 20% to 30% of patients

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Pathophysiology

• Tibial tubercle develops as a secondary ossification center that provides attachment for the patellar tendon
• Bone growth exceeds the ability of the muscle-tendon unit to stretch sufficiently to maintain previous flexibility
  • Leads to increased tension across the apophysis
• Physis is the weakest point in the muscle-tendon-bone-attachment and is at risk of injury from repetitive stress
• Repeated contraction of the extensor mechanism softening and partial avulsion of the apophyseal ossification center occurs resulting in osteochondritis

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Risk Factors

• Poor flexibility of quadriceps and hamstrings
• Extensor mechanism misalignment

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Clinical Features

• Pain on anterior aspect of knee, exacerbated by kneeling
• Enlarged tibial tubercle
• Tenderness over tibial tubercle
• Pain on resisted knee extension

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Differential Diagnosis

• Sinding-Larsen-Johansson syndrome
• Osteochondroma of the proximal tibia
• Tibial tubercle fracture
• Jumpers knee
• Hoffa's syndrome
• Synovial plica injury

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Evaluation

• X-rays
  • lateral radiograph of the knee will show irregularity and fragmentation of the tibial tubercle

• MRI
  • not essential for diagnosis as diagnosis is made on history, physical exam and radiographs
  • will show soft tissue swelling, thickening and edema of inferior patellar tendon, fragmentation and irregularity of ossification center

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Management

• Condition is self-limited (may persist for years until apophysis fuses)
• Modify activity to prevent continuous contraction of extensor mechanism as guided by level of pain
• No evidence that rest speeds up recovery though activity restriction reduces pain
• May continue with sports as long as pain resolves with rest and does not limit activity
• Ice
• NSAIDs
• Knee pad may be worn to protect from direct trauma
• Stretching of hamstrings and quadriceps
• Physical therapy if conservative measures not effective
• No evidence to recommend injection therapy or surgical intervention
• Ossicle excision may be performed in skeletally mature patients with persistent symptoms

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Return to Play

• May continue with sports as long as pain resolves with rest and does not limit activity

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See Also

• Apophyseal And Epiphyseal Injuries (Main)

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References

• Dold A. Osgood Schlatter's Disease (Tibial Tubercle Apophysitis). Orthobullets. https://www.orthobullets.com/knee-and-sports/3029/osgood-schlatters-disease-tibial-tubercle-apophysitis?expandLeftMenu=true. Accessed March 23, 2020.
• Smith JM. Osgood Schlatter's Disease (Tibial Tubercle Apophysitis). StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK441995/. Published May 5, 2019. Accessed March 23, 2020.
• Surgery aDof PO. Osgood Schlatter syndrome : Current Opinion in Pediatrics. LWW. https://journals.lww.com/co-pediatrics/Fulltext/2007/02000/Osgood_Schlatter_syndrome.8.aspx. Accessed March 23, 2020.