Description
Osgood-Schlatter syndrome is characterized by inflammation of the growth plate of the leg just below the knee at the tibial tubercle, a prominence just below the kneecap. The tibial tubercle is the bony attachment on the large bone of the lower leg (tibia) of the big, powerful thigh muscle (quadriceps). The growth plate is an area of relative weakness, and injury to it occurs due to repeated stress or vigorous exercise. It is a temporary condition of the tibial tubercle that is uncommon after age 16.
Common Signs and Symptoms
- A slightly swollen, warm, and tender bump below the knee
- Pain with activity, especially straightening the leg against force (stair climbing, jumping, deep knee bends, or weight-lifting) or following an extended period of vigorous exercise in an adolescent. In more severe cases, pain occurs during less vigorous activity.
Osgood-Schlatter disease results from stress or injury to the tibial tubercle growth plate (which is still developing during adolescence), causing a flare-up. Repeated stress or injury interferes with development, causing inflammation.
Risk Increases With
- Overzealous conditioning routines, such as running, jumping, or jogging
- Being overweight
- Boys between 11 and 18
- Rapid skeletal growth
- Poor physical conditioning (strength and flexibility)
- Lose weight or maintain ideal body weight.
- Appropriately warm up and stretch before practice or competition.
- Maintain appropriate conditioning:
- Muscle strength
- Flexibility and endurance
- Cardiovascular fitness
- Exercise moderately, avoiding extremes.
- Use proper technique.
Mild cases can be resolved with a slight reduction of activity level, whereas moderate to severe cases may require significantly reduced activity and, occasionally, immobilization for 3 to 4 months.
Possible Complications
- Bone infection
- Recurrence of the condition in adulthood, with symptomatic bone fragments below the affected knee (ossicle)
- Persisting prominence (bump) below the kneecap
Initial treatment consists of medications and ice to relieve pain, stretching and strengthening exercises (particularly of the quadriceps and hamstrings), and modification of activities. Specifically, kneeling, jumping, squatting, stair climbing, and running on the affected knee should be avoided. The exercises can all be carried out at home for acute cases. Chronic cases often require a referral to a physical therapist or athletic trainer for further evaluation or treatment. Uncommonly, the affected leg may be immobilized for 6 to 8 weeks with a reinforced elastic knee support, casting, or a splint. A patellar band (a brace between kneecap and tibial tubercle on top of the patellar tendon) may help relieve symptoms. Surgery is recommended in the growing patient in the rare situation of failed conservative treatment. Surgery is occasionally necessary after skeletal maturity if the ossicle becomes painful.
From Miller MD, Cooper DE, Warner JJP: Review of Sports Medicine and Arthroscopy. Philadelphia, WB Saunders, 1995, p. 61.
Medication
- Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.
- Cortisone injections are rarely, if ever, indicated.
- Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.
- Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.
- Symptoms get worse or do not improve in 4 weeks despite treatment
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