Osgood-Schlatter Disease

WHAT IS OSGOOD-SCHLATTER DISEASE?

Osgood-Schlatter Disease (OSD) is one of the most common overuse injuries sustained by adolescents and older children. This disease occurs when the patellar tendon, which is located just below the kneecap (patella) repeatedly pulls on its bony attachment site on the shinbone (tibia). Over time this results in inflammation and pain felt just below the knee, on one or both sides. This is commonly seen in skeletally immature individuals, where the growth plates have not fully fused, in sports and during growth spurts.

OSD is most often seen in active young girls ages 8 and 12 and young boys ages 12 and 15 (Corbi et al 2022) . In many cases OSD will resolve when skeletal maturity is reached.

WHAT ARE THE SYMPTOMS OF OSD?

Symptoms of OSD may include pain that increases when direct pressure is applied to the area such as when kneeling or resisting against knee extension. Pain typically starts gradually and becomes more constant and severe over time. A painful bony bump may be felt just below the kneecap where the patellar tendon attaches to the tibia.

HOW IS OSD DIAGNOSED?

Diagnosis of OSD is based on detailed history, and physical examination. In some cases advanced imaging, including x-ray, magnetic resonance imaging (MRI) or ultrasound may be used to assess the tibia, tendon and surrounding structures and differentiate between similarly presenting pathologies.

HOW IS OSD TREATED?

Initial treatment of OSD includes rest, ice, NSAIDs, physical activity modification to limit jumping and running and increase cross training, bracing/strapping and physical therapy. The use of a knee strap places pressure on the patellar tendon to reduce the tractional load on the bony insertion site. Cross training, such as swimming, allows the individual to remain physically active while reducing tendon load and limiting aggravating movements.

Physical therapy focuses on progressive knee strengthening exercises and improving flexibility of surrounding musculature. Several studies have additionally highlighted the need for inclusion of core stabilization exercises to maintain good knee mechanics while jumping (Sasaki et al 2019) and to reduce peak torque in knee flexion while running (Chaudhari et al 2020).

Shockwave therapy may be used as an adjunctive therapy to treat tendon pain felt with OSD. Shockwave therapy initiates the body’s natural healing process by improving circulation and speeding up healing and tissue regeneration with the aim of reduction in pain and increase in function.

In cases where conservative management of OSD is unsuccessful, surgical intervention may be recommended. There are a variety of surgical techniques that may be utilized to address the structures causing pain in OSD.

REFERENCES

Corbi F, Matas S, Álvarez-Herms J, Sitko S, Baiget E, Reverter-Masia J, López-Laval I. Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare (Basel). 2022 May 30;10(6):1011. doi: 10.3390/healthcare10061011. PMID: 35742062; PMCID: PMC9222654.

Sasaki S., Tsuda E., Yamamoto Y., Maeda S., Kimura Y., Fujita Y., Ishibashi Y. Core-Muscle Training and Neuromuscular Control of the Lower Limb and Trunk. J. Athl. Train. 2019;54:959–969. doi: 10.4085/1062-6050-113-17.

Chaudhari A.M.W., VAN Horn M.R., Monfort S.M., Pan X., Oñate J.A., Best T.M. Reducing Core Stability Influences Lower Extremity Biomechanics in Novice Runners. Med. Sci. Sports Exerc. 2020;52:1347–1353. doi: 10.1249/MSS.0000000000002254.