Classic Presentation
Osgood-Schlatter's Disease (Tibial Tuberosity Apophysitis) is specific to pediatric athletes, usually in the age range of 8 to 15 years, with females presenting younger than males. Athletes will usually complain of pain over the front of the knee at the end of a practice or end of a school day. The pain will specifically be at the tibial tuberosity, a growth plate on the lower portion of the knee that appears as a small bump (photo below). Pain typically will resolve with rest. However, more severe cases can be painful enough to cause a limp. Also, the pain can be ongoing for weeks to months prior to seeking care, due to instances where pain resolves with rest. For clarification purposes, Osgood Schlatter's Disease is not a disease in the formal sense of the word, rather an overuse injury that occurs due to pull on the tibial tuberosity growth plate.
Evaluation
Athletes can have a variety of physical presentations of this condition. Some will have notable swelling over the tibial tuberosity as well as a visible "bump" at the anterior knee. On the other hand, some athletes will have no visible signs of injury, yet have significant tenderness over the tibial tuberosity. Keep in mind that mild cases of Osgood-Schlatter's Disease may only cause pain with activity and therefore the physical exam can be normal. Osgood Schlatter's Disease can be confused with patella tendonitis, which is typically more common in older patients. In general, x-rays are not needed, but in the photo below you will see the presence of the tibial tuberosity growth plate that is sometimes confused for a fracture. Of note, fragmentation of the growth plate can be normal, therefore a fragmented growth plate with an asymptomatic patient would not be consistent with the diagnosis of Osgood Schlatter's Disease
X-ray Evaluation
Treatment
In general, Osgood Schlatter's Disease will improve over time, although athletes can see flare-ups depending upon their volume of activity. The flare-ups should subside once the growth plate at the tibial tuberosity has closed. Relative rest and icing is a good first step when in pain. Stretching and improving flexibility of the hamstring and quadriceps muscles can be helpful to prevent return of pain once it is under control. Another option of treatment is a patella strap that can be worn over the patella tendon to relieve stress at the tibial tuberosity. It is very important that the patella tendon strap is not put on top of the tibial tuberosity as this will cause further pain.
Patella Tendon Strap
Return to Play
Mild Osgood Schlatter's Disease does not require restriction from activities, as the athlete can usually participate on an as tolerated basis. Moderate pain may require restriction from activities for several weeks to a month, until the pain is better under control and flexibility of the hamstring and quadriceps muscles have improved. An athlete should consider cross-training and conditioning in a sport with less impact, such as swimming or biking. In rare cases, the athlete may need to be placed in a straight leg knee immobilizer and crutches to completely remove tension from the tibial tuberosity and allow it to heal appropriately.