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
• Pts are usually 10-15yr old
• More commonly occurs in running or jumping athletes
• Most cases are bilateral
  • Although symptoms are commonly asymmetric

Diagnosis

• Chronic, intermittent pain over the anterior aspect of knee and tibial tuberosity
• Pain aggravated by activity, improves w/ rest
• Prominence and soft tissue swelling over tibial tubercle
• Imaging is not necessary
  • If obtained shows nonspecific irregularities of tibial tubercle
  • If initial presentation includes swelling, inability to actively extent the knee, decreased strength with knee extension, or inability to walk, obtain radiograph to evaluate for avulsion fracture of the tibial epiphysis

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

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