Osgood-Schlatter's Disease (Tibial Tubercle Apophysitis)

What is Osgood-Schlatter’s Disease?Osgood-Schlatter's Disease

Osgood-Schlatter's Disease is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia).

Who is at risk? 

Occurs in skeletally immature patients between the ages of 12 and 18.

  •  It is most commonly seen in the 11 to 14 year-old age group. The development of Osgood-Schlatter’s is associated with the time of rapid growth and immature bone maturation in early teen years.
  • Any adolescent is at risk who participates in activity that can exceed the strength of the tibial tubercle by the quadriceps muscle contracting. This can occur in vigorous sports activities that require frequent running, jumping or squatting (ie. basketball, volleyball, baseball, soccer).
  • It presents in both knees in 20-30% of individuals, and young men are affected more frequently than young women.

Symptoms: 

  •  Knee pain and swelling
  • Increase pain with activities, and decreased with rest
  • Specified pain noted at the tibial tuberosity

How do we treat the painful knee with Osgood-Schlatter’s?

The key treatment is RELATIVE REST. This does not mean elimination of athletic activities, rather it means alteration and modification of each individual's activities, this means possibly curtailing all activities up to 6 weeks, with subsequent gradual increase in activities. Other treatments include: 

Polar therapy (heat and cold):

  • Cold Therapy is initiated for the first 48 to 72 hours after activities. This is accomplished with ice in a towel, plastic bag of frozen peas or chemical cold pack. The cold should be applied 15-20 minutes and off for one hour to minimize potential injury to the skin.
  • Heat can be applied not earlier than three days after an exacerbation of the knee pain and can be done with hot packs, hot tub baths or whirlpools.

Nonsteroidal anti–inflammatory:

  •  Anti-Inflammatory products can be used as needed for pain.
  • Ibuprofen, Motrin, Nuprin, Naproxen-Aleve
  • If stomach irritation occurs with the above, then Acetaminophen (Tylenol) can be used.

Immobilization:

  •  Only if SEVERE pain
  • Short course of immobilization (i.e. four weeks)
  • Removable knee immobilizer

Exercises:

  • Range of motion exercises and strengthening of the knee is necessary to prevent stiffness and atrophy.

Osgood-Schlatter's Disease FAQ's

Once knee pain disappears can it reoccur?

Yes, Osgood-Schlatter’s is frequently a cyclical problem corresponding to the individuals activity level. Typically 12-24 months is required for resolution of symptoms (the approach of skeletal maturity).

Is there anything that can be done to prevent the recurrence of knee pain?

  1. Warm ups: adequate pre-activity warm-ups (including stretching) allows the leg function at its maximum.
  2. Knee pads or straps: if the individual participates in activities in which the tibial tubercle may be struck or hit directly, knee pads are recommended to prevent additional injury. Use of a knee strap can help some individuals minimize symptoms, by altering the forces around the tibial tubercle. Stretching exercises (especially of the quadriceps and hamstrings) may be needed if there is tightness of the muscles or of the legs.

Can a strengthening program help?

For some individuals, an organized strengthening regimen can help. Exercises such as leg curls, straight leg raises, sit-ups, and wall sits can sometimes minimize symptoms. One should stay away from deep knee bends, squats with weights and exercises involving sudden jerking of the knee. Exercises such as cycling or swimming are excellent activities to maintain overall aerobic condition.

Will the bump on the front of the knee go away?

This bump will improve slightly as the inflammation and irritation resolves. However, the knee or knees will always looks “knobby” and one may have a difficulty kneeling on the bump in the future.

What is the long-term prognosis?

The good thing about this diagnosis is that it is a self-limited problem that ends at skeletal maturity for over 95% of those afflicted. Occasionally there is a bone island (or ossicles) within the patellar tendon that can cause pain into adulthood. If this bone island is sufficiently symptomatic it can be excised after skeletal maturity (approximately 15 years in women and 17 years in men).

 

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