Chapter 90: Osgood-Schlatter

Patient Story

An adolescent male presents with unilateral knee pain and swelling (Figure 90-1). His pain is worse after athletic participation and with kneeling. On examination, he has point tenderness and edema of the tibial tubercle. He is diagnosed with Osgood-Schlatter disease and treated with rest, ice, and non-steroidal anti-inflammatory medication. His symptoms improve but he continues to have mild flares of pain when he is more active.

Introduction

Osgood Schlatter disease was described in 1903 by Dr. Osgood and Dr. Schlatter as pain and edema of the anterior tibial tubercle.^1,2 These clinical findings result from traction apophysitis at the patellar tendon insertion site on the proximal tibial tubercle.

Synonyms

Osteochondritis of tibial tubercle; tibial tuberosity avulsion.

Epidemiology

• Occurs in adolescents after a rapid growth spurt.

• More common in males than females (Figure 90-2).³

• More common in athletes (21.2%) than nonathletes (4.5%).⁴

Etiology and Pathophysiology

• Overuse injury.

• Repetitive strain leads to chronic avulsion of tibial tubercle apophysis.

• Chronic avulsion results in separation and elevation of the patellar tendon insertion at the tibial tubercle.

• Callous formation during the healing process leads to a pronounced tibial tubercle.

Risk Factors

• Participation in athletic activities that involve repetitive running and jumping.

• Pubertal growth spurt.

• More proximal attachment of the patellar tendon.⁵

• Broad patellar tendon attachment at the tibia.⁵

• High riding patella.⁶

Diagnosis

Clinical Features

• Tenderness and prominence of the tibial tubercle.

Distribution

• Typically unilateral but can have bilateral involvement.⁴

Imaging

• Osgood-Schlatter is often a clinical diagnosis. Imaging is not indicated unless unusual features are present to suggest an alternate diagnosis.

• Plain films may demonstrate a spectrum of findings from normal to fragmentation and irregularity of the tibial tubercle, anterior knee soft tissue swelling, and patellar tendon thickening on the lateral knee x-ray (Figure 90-3). Plain films may not be helpful if tibial tubercle has not yet ossified (often between the ages of 9 and 11 years).

• Computed tomography and magnetic resonance imaging (MRI) are not typically indicated. MRI is, however, the most sensitive form of imaging and will demonstrate ...