Osgood-Schlatter disease is a condition sometimes found in growing adolescents as a result of inflammation of the patellar tendon in the knee. It most commonly affects children going through a growth spurt, with onset usually between the ages of 11 and 12 in girls, and 13-14 in boys.
The patella (kneecap) is attached to the tibia (shinbone) by the patellar tendon, a sheath of fibrous connective tissue. The tendon provides a measure of stability to the joint by preventing it widening too far when the knee is bent. The point of attachment to the tibia is known as the tibial tubercle. The tendon is also attached to the strong muscles of the thigh, the quadriceps. If the patellar tendon becomes inflamed as a result of overuse, it can cause tenderness or pain at the tibial tubercle.
At the end of each long bone in the arms and legs of a growing child are areas of cartilage that will eventually become bone. These areas are called epiphyseal plates, or growth plates and, as they are made of cartilage, they are softer than bone.
When the quadriceps muscles contract, they pull on the patellar tendon at its point of attachment to the tibia, which, in a child, is a growth plate.
Many sports and activities that young people participate in, such as soccer, basketball, ballet, football, volleyball, skating and gymnastics, require repeated contraction of the quadriceps in order to jump, run and quickly change direction. Such contractions can result in inflammation of the patellar tendon as it is repeatedly strained at its point of attachment to the tibia. The tendon can become slightly detached from the tibia, resulting in the symptoms of Osgood-Schlatter disease.
- Pain that is worse with activity and better with rest
- Pain, swelling and tenderness at the tibial tubercle, just below the patella
- Symptoms in one knee only, although occasionally both knees may be affected
- A painful bony lump just below the kneecap: The body sometimes responds to inflammation of the patellar tendon by growing a bone spur on the point of tendon attachment to the tibia
The doctor will perform a physical examination of the knee that will include observation and palpation (touch). Any pain, swelling or tenderness will be noted, and questions asked about the frequency and severity of the symptoms, and what movements make the symptoms better or worse.
X-rays might be required to evaluate the condition of the bones in the leg and knee and to rule out any other possible conditions that might be causing the symptoms.
Osgood-Schlatter disease is only found in children whose long bones are still growing, so in most cases time and rest will result in a cure. Until bone growth has stopped and the patellar tendon has become stronger, time spent playing sports may have to be curtailed. As the severity of the symptoms varies from person to person, your doctor will advise on the recommended level and type of activity for your child. It is important that your child does not ignore symptoms as carrying on with normal activities while suffering from this condition will make it worse and make treatment more difficult.
In order to relieve pain and reduce swelling, the following treatments can be carried out at home:
If these treatments fail to alleviate the symptoms, a knee brace or strap can be worn and, if your doctor recommends it, use crutches when walking.
- Apply ice, crushed in a bag and covered with a towel, to the painful area for 15 minutes at a time, several times a day
- Rest the knee from any activity, such as deep knee bends, that makes the pain worse
- Wear a compression bandage over the knee
- Elevate the knee above heart level, whenever possible
- Use NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil and others), and pain relievers such as acetaminophen (Tylenol) as necessary and according to instructions
A physiotherapist may teach certain exercises targeted to stretch the quadriceps and hamstrings, and also exercises to strengthen the quadriceps, thereby increasing the stability of the knee joint.
Surgery is rarely needed to treat this disease.
As this condition usually disappears with time, the outlook for a full recovery and return to normal activities is excellent. It may, however, take weeks or months for the symptoms to completely disappear and in some cases a non-painful lump may continue to be present.
The best support for a child with Osgood-Schlatter disease is a knee sleeve with a strap. The strap is placed between the patella and tibial tubercle where it provides pressure on the tendon, thereby decreasing its pull on the tibia. The compression provided will also help to reduce inflammation and pain.
When playing sports, a knee sleeve with a contoured pad over the patella can provide some protection for the affected area.
There are many knee supports available; if wearing one is recommended, your doctor or physiotherapist will suggest one, based on your child’s needs.