Patients may complain of mild pain or tenderness in one or both knees during activities that put a strain on the knees. Pain may be mild to moderate, to sometimes very severe and debilitating in some cases. In many cases, pain may be accompanied with a swelling on, around or slightly below the knee.
OSD commonly occurs in just one knee. However, it is bilateral in 25-50% cases, although the involvement is typically assymetric .
Other signs, particularly in young children, may include the child not showing interest in sports, slow and dull behaviour, limping after any physical activity, etc.
Entire Body System
Soft Tissue Swelling
In the sub-acute stage, soft tissue swelling resolves, but the bony ossicle remains. In the chronic stage, the bone fragment may fuse with the tibial tuberosity which can appear normal. [ncbi.nlm.nih.gov]
X-ray is normal or may show a soft tissue swelling. In MRI, tibial tuberosity is normal, but it shows the fluid collection in the infrapatellar region. [doi.org]
Plain radiograph Soft tissue swelling with loss of the sharp margins of the patellar tendon are the earliest signs in the acute phase; thus, a compatible history is also essential in making the diagnosis. [radiopaedia.org]
Knee pain associated with systemic symptoms Septic arthritis. Juvenile idiopathic arthritis. Knee pain associated with an abnormal examination of the hip Perthes' disease. Slipped proximal femoral epiphysis. Transient synovitis. [patient.info]
CONCLUSIONS: Closing-wedge osteotomy of the tibial tubercle effectively reduced the bony prominence after Osgood-Schlatter disease and consecutively improved the outcome in terms of knee pain and function. [ncbi.nlm.nih.gov]
Copyright 2015 American Academy of Orthopaedic Surgeons Osgood-Schlatter Disease (Knee Pain) Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. [web.archive.org]
Also, see eMedicineHealth's patient education article Knee Pain. [emedicine.com]
Anterior Knee Pain
Preoperative and postoperative tubercular prominence, Caton-Deschamps index for patellar height, the Kujala Anterior Knee Pain Scale, Lysholm Knee Score as well as visual analog scale score and Tegner activity scores were recorded. [ncbi.nlm.nih.gov]
pain at other sites, should be investigated urgently or the child should be referred. [patient.info]
With Osgood-Schlatter, you may experience: Gradually worsening pain below your knee, at the top of the shin bone. Pain that worsens with exercise. Swelling and tenderness at the top of the shin. A boney growth at the top of the shin. [riverdalesportspt.com]
pain or inflammation. magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. blood tests Treatment for [childrenshospital.org]
Osteochondritis dissecans (OCD), osteochondritis deformans (Perthes disease) and tibial tubercle avulsion fracture were described as part of the symptom complex in some heritable bone disorders [ 15 – 20 ]. [ped-rheum.biomedcentral.com]
Surgical excision of the ossicles has been suggested for unresolved sequelae of Osgood-Schlatter disease in adults resistant to conservative measures. [ncbi.nlm.nih.gov]
As a last resort, your child’s doctor may suggest surgery. Living with Osgood-Schlatter disease Osgood-Schlatter disease usually goes away on its own. [familydoctor.org]
The mean angular impulse of the 2 types of runs was small at all the indicators. [ncbi.nlm.nih.gov]
Work up includes a detailed history and physical exam.
Laboratory tests are rarely conducted. Some may include:
- Blood work to rule out juvenile idiopathic arthritis
- Electrolytes (Ca, Na, K)
- X-ray to rule out fracture, irregular ossification, fragmentation, etc
- No diagnostic test is available for OSD. Diagnosis is made clinically .
Treatment is conventional and includes bed rest, use of ice packs and compressions to reduce swelling and elevation of the limb involved.
Arthroscopy has been used with good results . Surgical repair is generally not needed and undergone only if the swelling is interfering with walking or other physical activity. This may occur in chronic disease due to formation of bony or cartilaginous ossicles. An orthopaedic cast is also seldom used.
Most symptoms will completely disappear with completion of the adolescent growth spurt, around age 14 for girls and age 16 for boys . OSD is a self-limiting disease so prognosis is excellent. With conventional treatment and the use of analgesics, if needed, OSD will go away without any lasting effects.
Complications of OSD are rare. They may include:
Osgood-Schlatter disease is thought to be caused by small injuries due to repeated overuse before the knee area has finished growing . Children who are very active in sports often get injured in the knee and this onslaught of small injuries in the still-developing area may lead to a painful swelling.
It occurs approximately 20% in adolescents who are active in sports compared with 5% of non-athletes .
OSD occurs in children who have grown enough to be able to actively participate in sports activities yet still remain in the 'growing' stage. So the Osgood-Schlatter disease occurs most commonly in children between 9 and 16 years of age.
OSD is significantly more common in boys because of their more active part in sports and sports activities, with a male-to-female ratio ranging from 3:1 to even 7:1. However it is becoming more common in girls as their sports participation increases .
The quadriceps muscle, present in the anterior compartment of the leg, helps in straightening the knee and plays a primary role in performing movements like running, jumping, crouching, climbing, etc.
When the quadriceps muscle is used a lot in sports activities during a child's growth spurt, this area becomes irritated or swollen and causes pain  . As the child is growing, so are bones and muscles. But this growth does not proceed at the same rate.
Therefore, higher than sustainable strain may appear on the growing bones, such as forceful contractions of the quadriceps muscles may cause traction of the patellar ligament on the tibial tuberosity, leading to tiny avulsion fractures within the apophysis. These tiny fractures may also heal and grow, leading to pain and swelling of the joint, and thus the development of OSD.
In some cases, the forceful contractions of the quadriceps muscles may create a gap which the body may try to fill up with a new (and abnormal) bone growth. This will result in formation of a hard lump or bony prominence, which is also a presentation of OSD.
Regular physical activity can not be stopped in children so of course, prevention is not totally possible. However, regular stretching of limbs can help and so can ultrasonography for early detection of any ossicles or fragments, if any.
Skeletal diseases in youngsters are seldom found, but one such disease is relatively common in children and teenagers. This disease is apophisitis occurring in the tibial tubercle, and is more commonly known as the Osgood-Schlatter disease (OSD).
Osgood-Schlatter disease is an inflammation of the patellar ligament at the tibial tuberosity . The point of contact between the patellar ligament or tendon and the tibial tuberosity may swell up and become painful, resulting in OSD.
Osgood-Schlatter disease is a relatively mild and self-limiting disease that may occur in growing children, especially in ones that are very active in sports. If your child complains of pain and/or swelling in one or both knees after physical activity, which may get better with rest, he/she may be suffering form OSD. But there is no cause of worry because this disease goes away on its own once the child is fully grown. It should be noted that if the symptoms do not go away even after rest, or if the pain is severe, an orthopaedic surgeon must be contacted immediately.
- Nowinski RJ, Mehlman CT 1998. Hyphenated History:Osgood-Schlatter disease. Am J Orthop 27(8): 585-5
- Kujala UM, Kvist M, Heinonen O. Osgood-Schlatter disease is adolescent athletes. Retrospective study of Incidence and duration. Am J Sports Med 1985; 13:236
- Duri ZA, Patel DV, Aichroth PM. The Immature Athlete. Clin Sports Med 2002: 21:461
- Nelson Textbook of Pediatrics. 19th ed. Philadelphia. Pa: Saunders Elsevier;2011 Chap 669.4
- Wells L, Sehgal K. Osgood-Schlatter disease. In:Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.
- Osgood-Schlatter Disease (knee pain). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00411 Accessed on 29/08/2014
- Stanitski CL. Knee overuse disorders in the paediatric and adolescent athlete. Instr Course Lecture;1993 42;483
- Cassas KJ, Cassettari-Wayhs A, 2006. Childhood and Adolescent Sports-Related Overuse Injuries. Am Fam Physician 73(6): 1014-22
- Bloom OJ, Mackler L, Barbee J. Clinical Inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam Pract 2004 Feb;53(2):153-6
- Deberardino TM, Branstetter JG, Owens BD; Arthroscopic treatment of unresolved osgood-Schlatter lesions. Arthroscopy 2007. Oct;23(10)1127.e1-3 ePub 2007