Osgood-Schlatter disease

Lateral view X-ray of the knee tibial with overlying soft tissue swelling.

Background

• Apophysitis of tibial tubercle resulting from repeated normal stresses or overuse
• Patients are usually 10-15yr old
• More commonly occurs in running or jumping athletes

Clinical Features

• Most cases are bilateral
  • Although symptoms are commonly asymmetric
• Chronic, intermittent pain over the anterior aspect of knee and tibial tuberosity
• Pain aggravated by activity, improves with rest
• Prominence and soft tissue swelling over tibial tubercle

Differential Diagnosis

Knee diagnoses

Acute knee injury

• Knee dislocation
• Knee fractures
  • Patella fracture
  • Segond fracture
  • Tibial plateau fracture
• Meniscus and ligament knee injuries
• Patella dislocation
• Patellar tendonitis
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Arthritis
• Gout and Pseudogout
• Osgood-Schlatter disease
• Patellofemoral syndrome (Runner's Knee)
• Patellar tendonitis (Jumper's knee)
• Pes anserine bursitis
• Popliteal cyst (Bakers cyst)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Septic joint
• DVT

Evaluation

• Imaging is not typically necessary
  • If obtained shows nonspecific irregularities of tibial tubercle
• Indications for knee xrays (to evaluate for avulsion fracture of the tibial epiphysis)
  • Swelling
  • Inability to actively extent the knee
  • decreased strength with knee extension, or inability to walk

Management

• Disease is self-limited
  • Most patients' symptoms respond to rest and temporary avoidance of offending activity
  • Complete avoidance of activity is not essential
• Immobilization is contraindicated
• NSAIDs
• Apply ice after activity

Disposition

Discharge

See Also

• Knee diagnoses