What is it?
Osgood-Schlatter Disease (OSD) is an overuse injury creating a traction apophysitis of the tibial tuberosity. In young developing athletes, this apophysis is biomechanically weak, which predisposes injury during periods of rapid skeletal development. Additionally, when training demands exceed the ability of the muscle-tendon unit to accommodate these stresses, this increased tension results in bony microtrauma and inflammation of the apophysis.
Osgood-Schlatter Disease is most common in athletes between the ages of 10-15. Up to 10% of adolescents are affected by this problem.
Clinical Presentation
Osgood-Schlatter patients often present with a non-traumatic history of progressively increasing pain that is usually over the tibial tuberosity (right below the knee cap). Risk factors for OSD include tightness in the surrounding muscle groups and mechanical factors such as repetitive motion, trauma, and sport. Symptoms usually increase with exercise.
Upon examination, the knee may be swollen or inflamed. In persistent cases, the tuberosity may be more prominent on the involved knee and appear as a bump below the knee cap. Range of motion may be diminished and full passive (self movement) knee flexion is often uncomfortable. Pain typically intensifies when contracting the quadriceps against resistance.
Diagnosis
The diagnosis of OSD is generally based on a history exam and the physical presentation. Radiographs are not always necessary unless there is a suspected bony pathology.
Management
The main focus of treating OSD is to identify the biomechanical factors that produced the disorder. Inflexibility or weakness of the hamstrings, quadriceps, or calves will generate excessive loads during athletic activity.
Some athletes with mild cases may continue activity as long as it does not produce significantly greater pain. Other athletes may require extended periods of rest to properly manage the condition. Most athletes will benefit from some type of cross-training to limit injury from overuse. These activities may include swimming, weight lifting, stationary biking, and upper body exercises.
The spine, sacroiliac, and lower extremity restrictions may be addressed through joint manipulation. Myofascial release techniques should address adhesions and tightness in the hip, thigh, and leg.
Patient education and exercise are key management tools for Osgood-Schlatter. Stretching exercises should be used for the hamstring, calf muscles, IT band, and hip adductors. Clinicians should assess for and correct lower extremity weakness, especially in the hamstrings, hip rotators, calves and quadriceps.
A successful return to play requires addressing load and pain limitations. Return to functional activity begins with jogging and moves into sprinting, cutting, squatting, and jumping.