Osgood-Schlatter Disease

Osgood-Schlatter disease - also called osteochon­drosis - causes incomplete separation of the epiphysis of the tibial tubercle from the tibial shaft. A mechanical inefficiency of the extensor mechanism may result, causing tendinitis of the knee. It can affect one or both knees and is most common in active adolescent boys.

Causes

This disease is probably caused by microtrauma (small, usually unnoticed injuries caused by repetitive overuse) that occurs before the complete maturity of the anterior tibial tubercle attachment.

The disorder is typified by a painful swelling just below the knee on the front surface of the lower leg bone. The area is tender to pressure, and swelling ranges from minimal to very severe. Running, jumping, and climbing stairs cause discomfort. Symptoms occur on one or both legs. The disorder is seen most often in active, athletic adolescents, with boys more frequently affected than girls.

Signs and Symptoms

Signs and symptoms of Osgood-Schlatter disease include:

• Pain, swelling and tenderness at the bony prominence (tibial tuberosity) on the upper shinbone (tibia), just below the kneecap
• Knee pain that worsens with activity, especially running and jumping, and improves with rest
• Tightness of the surrounding muscles, especially the thigh muscles (quadriceps)

Diagnostic tests

X-ray findings may be normal or may show epiphyseal separation and soft-tissue swelling for up to 6 months after onset; eventually, they may show bone fragmentation.

Treatment

Treatment initially involves ice application, nonsteroidal anti-inflammatory drugs, and avoidance of exercises that demand quadriceps contraction. In mild cases, restricting predisposing activities (such as bicycling and running) may relieve symptoms. Rehabilitation exercises reduce inflexibility and strengthen weak ankle dorsiflexion.

If the patient doesn't respond to this treatment, the affected leg may be immobilized for 6 to 8 weeks with a reinforced elastic knee support, plaster cast, or splint. The leg isn't fully immobilized unless the pain doesn't respond to more conservative treatment or the patient doesn't comply with treatment. Rarely, conservative measures fail and the patient needs surgery. Such surgery includes removal or fixation of the epiphysis or drilling holes through the tubercle to the main bone to form channels for rapid revascularization.

Prevention

Osgood-Schlatter disease may not be entirely preventable. However, it may help if your child limits his or her activity level if he or she notices the symptoms of Osgood-Schlatter disease. Tight quadriceps muscles cause a "tugging" stress on the patellar tendon where it inserts into the tibial tuberosity, so doing stretching exercises for the quadriceps, hamstrings and calves may help prevent this condition. Being properly warmed up before engaging in athletics and performing cooling down exercises afterward also may help.