Introduction
Background
In 1903, Robert Osgood (1873-1956), a US orthopedic surgeon, and Carl Schlatter (1864-1934), a Swiss surgeon, concurrently described the disease that now bears their names. Osgood-Schlatter disease (OSD) is one of the most common causes of knee pain in active adolescents.
Frequency
United States
OSD affects 20% of athletic adolescents, as compared with the frequency of 4.5% of age-matched nonathletic controls. The disease is bilateral in 20-50% of patients. Boys are affected more commonly than girls, with a male-to-female ratio of 3:1. Boys aged 10-15 years and girls aged 8-13 years typically are affected, coinciding with growth spurts.
Functional Anatomy
In girls younger than 11 years and in boys younger than 13 years, the tibial tubercle consists of cartilaginous tissue. The secondary ossification center or apophysis of the tibial tubercle develops when girls are aged 8-12 years and when boys are aged 9-13 years. During this stage of skeletal development, the Osgood-Schlatter lesion may occur. The most commonly accepted theory is that repeated traction (traction apophysitis) on the anterior portion of this developing ossification center leads to multiple subacute fractures or tendinous inflammation, resulting in a benign self-limited disturbance manifested as pain, swelling, and tenderness.
By the end of the ensuing 2 stages of bony development (eg, epiphyseal and bony stages), the growth plates of the proximal tibia fuse in both males and females (usually when aged 14-18 y) and the OSD usually subsides.
Sport Specific Biomechanics
During running, gymnastics, and other sports requiring repeated contractions of the quadriceps, an extra-articular osteochondral stress fracture or microavulsion occurs. The proximal area of the patellar tendon insertion separates, resulting in elevation of the tibial tubercle. During the reparative phase of this stress fracture, new bone is laid down in the avulsion space, which may result in a deviated and prominent tibial tubercle. When an individual with an injured tibial tubercle continues to participate in sports, more and more microavulsions develop, and the reparative process may result in a markedly pronounced prominence of the tubercle with longer-term cosmetic and functional implications. A separated fragment may develop at the patellar tendon insertion and may lead to chronic nonunion-type pain.
Clinical
History
- Knee pain usually is the presenting symptom. Patients usually report that the knee pain occurs during activities such as running, jumping, squatting, and ascending or descending stairs. Pain often subsides with rest and activity modification.
- Athletes involved in football, soccer, basketball, gymnastics, and ballet are most commonly affected.
- Symptoms often are vague and intermittent in onset.
- Symptoms may develop without trauma or other apparent cause.
- The patients who present with OSD are male and female adolescents, usually aged 12-15 years.
Physical
The physical examination is very specific with point tenderness over the tibial tubercle. Other physical examination findings may include the following:
- Proximal tibial swelling and tenderness
- Enlargement or prominence of the tibial tubercle
- Reproducible and aggravated pain by direct pressure and jumping (quadriceps contraction)
- Pain with resisted knee extension (quadriceps contraction)
- Full range of motion of the knee
- Hamstring tightness
- No effusion or meniscal signs
- Negative drawer test (no knee instability)
- Normal neurovascular examination
- No abnormal findings in the hip and ankle joints
Causes
The cause of OSD is unknown; however, theories suggest that this condition is a result of repeated knee extensor mechanism contraction that causes partial avulsions or microavulsions of the chondrofibroosseous tibial tubercle. OSD usually occurs in those involved in sports that require running and jumping.
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References
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Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease?. J Fam Pract. Feb 2004;53(2):153-6. [Medline].
Demirag B, Ozturk C, Yazici Z, Sarisozen B. The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. J Pediatr Orthop B. Nov 2004;13(6):379-82. [Medline].
Epstein B. Common problems affecting adolescents - Osgood Schlatter disease: A common cause of knee pain. In: Iowa Health Book: Family Practice. Iowa City, Iowa: The University of Iowa; 1995.
Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease. J Pediatr Orthop. May-Jun 1995;15(3):292-7. [Medline].
Meisterling R, Wall E, Meisterling M. Coping with Osgood-Schlatter disease. In: The Physician and Sports Medicine. Vol 26. New York, NY: McGraw-Hill; 1998.
Ross MD, Villard D. Disability levels of college-aged men with a history of Osgood-Schlatter disease. J Strength Cond Res. Nov 2003;17(4):659-63. [Medline].
Staheli L. 2nd ed. Fundamentals of Pediatric Orthopedics. Philadelphia, Pa: Lippincott-Raven; 1998:56, 123.
Tachdjian MO. Clinical Pediatric Orthopedics: The Art of Diagnosis and Principles of Management. Vol 1. Stamford, Conn: Appleton & Lange; 1997:107-108.
Wall E. Osgood-Schlatter disease: Practical treatment for a self-limiting condition. In: The Physician and Sports Medicine. Vol 26. New York, NY: McGraw-Hill; 1998.
Further Reading
Keywords
OSD, tibial tubercle osteochondrosis, traction apophysitis, knee pain
