Osgood Schlatters Disease Knee Pain in Children

Osgood Schlatters Disease

What is Osgood Schlatters Disease?

Osgood Schlatters, pronounced as “oz-good shlat-ters”, it is not actually a disease but an injury of the bone resulting from excessive stretching of the patellar ligament.

Also known as Osgood Schlatters Syndrome, it is a painful inflammation of tibial tuberosity, a bony prominence present on the upper front part of tibia (shinbone) about 2 cm below the kneecap, where patellar ligament is attached.

In simple terms, it relates to pain and swelling in the area just below the knee joint on the front side of the leg.

What happens with Osgood Schlatters Syndrome?

To understand osgood schlatters disease, it helps to know the normal anatomy of the knee joint. The knee joint comprises of four different bones;

Femur (thighbone) forms the top of the knee joint,

Tibia (inner and major shin bone) and

Fibula (outer shin bone) from below and

Patella (kneecap) at the front of the joint

From above comes the tendon of the anterior thigh muscle (Quadriceps femoris) known as Quadriceps tendon, which attaches to the superior surface of patella and continues down from patella to the tibial tubercle as patellar ligament. A ligament is a fibrous extension connecting bone to bone in a joint. It is the patellar ligament and more importantly its attachment that is the cause of the problem with Osgood schlatters disease. The patellar ligament (so the extension of the quadriceps femoris muscle) attaches directly into the growth plate on the front of the tibia. See the images for further clarification.

Osgood Schlatters disease usually occurs when the Quadriceps femoris muscle (the front thigh muscle that is used for extending the knee), is used extensively such as in activities involving running, jumping and kicking etc. This puts repeated stress over the growing part of tibia where patellar ligament inserts, leading to pain and inflammation at this site. This can often lead to an avulsion fracture, in which the ligament pulls a small piece of bone off the growing tibia. When this fracture heals, it leads to the formation of a permanent bony bump at the site.

Who is more prone to developing Osgood Schlatters Disease?

Osgood schlatters is mostly seen in adolescents in their early teens, especially those involved in sports such as soccer, basketball, gymnastics, ballet etc.

In girls it occurs between 8-13 years of age while in boys it occurs between 10-15 years of age, typically in the beginning of their growth spurt, which is an approximately 2 year long period of extremely fast physical growth.

During growth spurt, bones grow at a faster rate than muscles and tendons, therefore stretching the muscles and tendons; this exacerbates the stresses imposed during exercise and sports.Moreover, part of the tibia or shinbone where the ligament is attached (tibial tubercle) is still under growth, is weak compared to a mature bone and therefore, more prone to injury.

How is Osgood Schlatters Diagnosed?

It is typically diagnosed by its symptoms, which include;

– pain at the front side of the lower leg, a few cm below the kneecap

it usually affects only one leg (75% of cases)

pain gets worse during and after sports or exercise

pain gets better with rest and ice application

there may be a swelling in the area, and the tibial tubercle of the affected side may become more prominent than the other, normal side

the area is tender, especially during and after sport activities

pain increases when the knee joint is extended against resistance or pressure

Tightness in the Quadriceps femoris (front thigh muscle) and hamstring (back thigh muscle).

The main diagnostic consideration is to rule out other conditions that may have similar symptoms. This may require an x-ray or an ultrasound scan.

Other knee conditions that may be confused with Osgood Schlatters Disease:

Anterior Knee Pain Syndrome: common in adolescence, often has no cause, settles with time.

Sinding-Larsen-Johansson disease: it has a similar cause to Osgood Schlatters only that the injury occurs on the point where ligament is attached on the patella rather than where it is attached on the tibia.

Patellar Tendonitis: inflammation of patella and its ligament, however, the pain occurs directly over the kneecap instead of below it as in Osgood Schlatters.

How to treat Osgood Schlatters

It is a benign condition resolves with time. The only treatment necessary is aimed at pain reduction and restoring normal function to the knee.

Treat the pain and swelling : Follow the RICE formula which includes,
Rest: Avoid painful activities and sports
Ice application: for about 15-20 minutes, 2-3 times daily
Compression: compress the inflamed area with an elastic bandage.
Elevation: elevate the leg

Anti-inflammatory painkillers: such as Nurofen or Ansaid (Flurbiprofen) help reduce pain and swelling.

Support the inflamed bone: In some cases, crutches or knee supports may be required. Heat retaining supports such as neoprene support would compress the knee and retain the body’s natural heat keeping the tendon warm, helping it work better.
Similarly, a patella tendon strap is wrapped just below the knee to press directly on the patella tendon and reduce the strain on the inflamed tibial tuberosity.

Isometric exercise program (exercise not involving joint movement) may also help.

Correct any biomechanical abnormalities that can strain the knee. over pronation will destabilize the knee and strain the tibial tuberosity where the patellar ligament attaches.

Surgery: Severe cases, such as the ones involving avulsion fractures may also require surgical correction, fortunately, it does not happen often.

How long does it take to heal?

Depending upon the extent of injury and how prudently the treatment is followed, the recovery may take from a few weeks or months or it may persist longer, about a couple of years till the growth period is over and the bone becomes mature the growth center fuses. The pain resolves in about 9 out of 10 cases once growth phase is complete.

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