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 [7].
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.

• Severe Pain

  Treatment of Osgood-Schlatter disease The only treatment required for most cases of Osgood-Schlatter disease is to reduce the amount of painful activity. Your child can continue at a reduced level of activity as long as the pain isn't too severe. [mydr.com.au]

  The athlete's activities may need to be modified, based on symptoms; if severe pain and limping occur, the child should stop activities until the pain decreases. [runnersworld.com]

  For some sufferers, the pain is mild and periodic and occurs after athletic activity. For others, the pain can be severe and constant. Usually, only one knee is affected, although for a small percentage of people, both knees become painful. [encyclopedia.com]

  OSD typically causes pain and swelling below the kneecap. The pain usually gets worse with running, jumping, going up stairs, and walking up hills. Severe pain may lead to limping. OSD can happen in one or both knees. [kidshealth.org]

• Knee Pain

  Patient will complain of anterior knee pain that increases gradually over time. Pain starts as an ache and can progress to pain that causes limping or impairs activity. [pedclerk.bsd.uchicago.edu]

  Pain is provoked by knee extension against resistance or by hyperflexing the knee with the person lying prone. Hip examination is important because some childhood hip conditions (eg, slipped capital femoral epiphysis) can refer pain to the knee. [patient.info]

  Seek medical attention if the knee is swollen and red, or if the knee pain is associated with fever, locking or instability of the knee joint. [mayoclinic.org]

  This article describes the use of acupuncture in the management of knee pain in Osgood-Schlatter disease. Manual and electroacupuncture were used. The patient responded well to acupuncture and found it effective in relieving his knee pain. [ncbi.nlm.nih.gov]

• Fracture

  Type III: Complete fracture (through articular surface) including high chance of meniscal damage. This type of fracture usually requires surgery. [en.wikipedia.org]

  Radiographic evaluation demonstrated an avulsion fracture of the tibial tuberosity Type III according to the classification of Watson-Jones. [ncbi.nlm.nih.gov]

  But they may be required to rule out tumors, and acute tibial apophyseal fracture, and infection. Xrays of most of the cases are normal. [boneandspine.com]

  In some cases, bone may become partially dislodged (partial avulsion fracture). The body repairs the fractures by laying down extra bone tissue. The result is a larger than normal bump at the tibial tuberosity. [betterhealth.vic.gov.au]

• Osteoporosis

  For excellent patient education resources, visit eMedicineHealth's Osteoporosis Center. Also, see eMedicineHealth's patient education article Knee Pain. [emedicine.medscape.com]

  […] typically, symptoms disappear within 12 to 14 months, soon after the end of the growth spurt experienced by many adolescents (generally around the age of 14 for girls and 16 for boys). see also Bone mineralization patterns ; Bone, ligaments, tendons ; Osteoporosis [encyclopedia.com]

• Muscular Atrophy

  As far as the sportsman is concerned, this entails only brief loss of training and the possibility to avoid muscular atrophy of the affected leg by means of physiotherapeutic exercise. [ncbi.nlm.nih.gov]

• Bone Disorder

  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]

• Confusion

  To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. [uofmhealth.org]

  Stickler syndrome, however, can manifest a wide range of variable and confusing phenotypic features, vary from dwarfism/marfanoid habitus to phenotypically normal individuals [ 1, 2 ]. [ped-rheum.biomedcentral.com]

Work up includes a detailed history and physical exam.

Laboratory Tests

Laboratory tests are rarely conducted. Some may include:

• Blood work to rule out juvenile idiopathic arthritis
• Electrolytes (Ca, Na, K)

Imaging Studies

• X-ray to rule out fracture, irregular ossification, fragmentation, etc

Test Results

• No diagnostic test is available for OSD. Diagnosis is made clinically [8].

Treatment is conventional and includes bed rest, use of ice packs and compressions to reduce swelling and elevation of the limb involved.

Medications

Analgesics such as ibuprofen and paracetamol may be given when and as needed. Corticosteroid injections are not recommended, potential complications include subcutaneous atrophy [9].

Other

Arthroscopy has been used with good results [10]. 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 [6]. 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

Complications of OSD are rare. They may include:

• Chronic pain
• Small lump or bony projection persisting even after treatment.
• Ossicle formation even after surgical repair.

Osgood-Schlatter disease is thought to be caused by small injuries due to repeated overuse before the knee area has finished growing [4]. 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.

Incidence

It occurs approximately 20% in adolescents who are active in sports compared with 5% of non-athletes [2].

Age

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.

Sex

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 [3].

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 [4] [5]. 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 [1]. 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.

1. Nowinski RJ, Mehlman CT 1998. Hyphenated History:Osgood-Schlatter disease. Am J Orthop 27(8): 585-5 
2. 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
3. Duri ZA, Patel DV, Aichroth PM. The Immature Athlete. Clin Sports Med 2002: 21:461
4. Nelson Textbook of Pediatrics. 19th ed. Philadelphia. Pa: Saunders Elsevier;2011 Chap 669.4
5. Wells L, Sehgal K. Osgood-Schlatter disease. In:Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.
6. Osgood-Schlatter Disease (knee pain). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00411 Accessed on 29/08/2014
7. Stanitski CL. Knee overuse disorders in the paediatric and adolescent athlete. Instr Course Lecture;1993 42;483
8. Cassas KJ, Cassettari-Wayhs A, 2006. Childhood and Adolescent Sports-Related Overuse Injuries. Am Fam Physician 73(6): 1014-22 
9. 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
10. Deberardino TM, Branstetter JG, Owens BD; Arthroscopic treatment of unresolved osgood-Schlatter lesions. Arthroscopy 2007. Oct;23(10)1127.e1-3 ePub 2007