Osgood-Schlatter disease

Osgood-Schlatter disease is a tibial osteochondritis thought to arise from overuse of the quadriceps muscle during periods of growth. This causes a traction apophysitis at the tibial insertion of the quadriceps tendon. The most common symptom is anterior knee pain that worsens with exercise. A tibial bump may be felt and can often be seen on x-ray. Treatment is usually conservative. Surgical excision is only necessary in severe and treatment-resistant cases.

• Age
  • Adolescents; on average 9–14 years old
  • Commonly develops shortly after growth spurts
• Sex: ♂ > ♀ (3:1)

Epidemiological data refers to the US, unless otherwise specified.

• Overuse (especially sports involving sprinting and jumping) during the ossification period (adolescence) → excessive strain and repeated avulsion of the patellar ligament on the tibial tuberosity → inflammation → traction apophysitis
• Chronic inflammation of the patella ligament can disrupt the secondary ossification of the tibial tuberosity → detachment of the apophysis → subsequent callous formation during the healing process → pronounced tibial tubercle ^[1]

• Progressive anterior knee pain that is worse with activity and is reproducible with extension against resistance
• Proximal tibial swelling

• X-ray
  • Anterior soft tissue swelling
  • Lifting of tubercle from the shaft
  • Irregularity or fragmentation of the tubercle
• Ultrasound: soft tissue swelling ^[2]

• Mostly conservative (rest, ice, NSAIDs; )
• Strengthening and stretching of the quadriceps muscle
• Generally resolves once full bone maturity is reached
• Surgical excision of intratendinous ossicles in severe cases ^[1]