Osgood-Schlatter disease is a condition that causes swelling and tenderness at the bony point (tibial tuberosity) just below the knee. It appears most often in children engaged in athletic activities that place stress on the muscles and other tissues surrounding this area of the leg.

Experts believe that Osgood-Schlatter disease is a result of contraction of the quadriceps, the large muscles in front of the thigh. These muscles are connected to the patellar tendons that run through the knee and attach to the shin bone (tibia). When the quadriceps contract, the patellar tendons pull back from the tibial tuberosity. If this occurs too frequently, it may inflame bone, cartilage or tendon at the top of the tibia.

Pain just below the knee is the most common sign of Osgood-Schlatter disease. The pain may range from mild to severe and is often worse during certain forms of exercise, including running, jumping and using stairs. Kneeling also may cause pain. In some cases, the pain is more constant.

A physician will review a medical history and perform a physical examination when diagnosing Osgood-Schlatter disease. In some cases, the physician may want to take x-rays of the child’s knee.

Short-term pain associated with Osgood-Schlatter can be eased by applying ice (cryotherapy) and taking pain relievers. Long-term treatment consists of resting the leg, physical therapy and refraining from certain activities until the leg heals. Crutches, casting of the leg or surgery may be necessary in more severe cases.

Osgood-Schlatter disease is an overuse condition that causes swelling and tenderness at the bony prominence (tibial tuberosity) just below the knee. It is among the common sources of knee pain in young athletes and tends to affect children during the growth spurt of their pre-teen or teenage years. The frequency of the condition is not known.

It is named after two physicians, Dr. Robert Osgood and Dr. Carl Schlatter, who defined the disease in 1903. It is also known as osteochondrosis.

Parents and children should not ignore symptoms related to Osgood-Schlatter disease. Trying to play through the pain will likely make the condition even worse. For most children, Osgood-Schlatter disease disappears over a period of between six months to 24 months, although it can take longer and symptoms tend to come and go. Once a child stops growing, the tibial growth plate fuses and patellar tendons strengthen and the pain permanently disappears.

After repeated trauma, new bone grows back during the healing process, causing a permanent, painless bump below the knee. In other cases, a painful bony growth below the kneecap may develop that must be surgically removed. A majority of children with Osgood-Schlatter disease will experience some discomfort as adults while kneeling.

Despite its name, Osgood-Schlatter is less a disease and more of an injury caused by overuse. Experts believe that Osgood-Schlatter disease is a result of contraction of the quadriceps, the large muscles in front of the thigh. These muscles are connected to the patellar tendons that run through the knee and attach to the shin bone (tibia), the big bone in the lower leg. The quadriceps connects to the bone at a fairly small area, and rapidly lengthening bones cause muscles and associated tendons to become tight and inflexible, creating overuse stress on the bone or cartilage in this area and resulting in trauma.

When the quadriceps contract, the patellar tendons pull back from the tibial tuberosity. If this occurs too frequently, it may cause inflammation of the bone, cartilage and/or tendon at the top of the shin bone. The result is pain, which can be intense. In severe cases, the tendon may stretch so much that it detaches from the tibia. When this happens, it may cause the dislodging of a knee bone fragment.

Young athletes are especially prone to Osgood-Schlatter disease, including those who take part in football, soccer, basketball, tennis, figure skating, volleyball, gymnastics and ballet. The reason may be their repative use of quadriceps muscles.

Osgood-Schlatter tends to strike during a child’s growth spurt. Both growth and injury can play a role. The growth spurt is the two-year period when children grow most rapidly. It usually occurs between ages 8 and 13 for girls, and 10 and 15 for boys.

Traditionally, boys have been more likely to be affected by Osgood-Schlatter, but this is changing as girls have become more involved in athletics. The ratio of boys to girls for this disorder is generally 3:2.

Pain in the bony prominence (tibial tuberosity) just below the knee is the most common sign of Osgood-Schlatter disease. Pain may occur in both legs, but is limited to just one leg in about 75 percent of cases. The affected leg is usually the dominant leg used in jumping, kicking or running. In some cases, the knee pain or leg pain is mild. In other cases, it is more severe.

Pain is often felt when the patient extends (straightens) the knee against resistance, stresses the quadriceps or squats with the knee fully bent. Pain may become worse with certain forms of exercise, including running, jumping, and going up and down stairs. Kneeling also may cause pain. In other cases, pain is more constant. In most cases, the knee’s range of motion remains unaffected.

Continued swelling (edema) over the tibial tuberosity may cause a bony callus to form. As this callus grows larger, it may become extremely painful when touched. This enlargement of the tibial tuberosity is likely to remain large throughout the child’s lifetime, even after the child has recovered from Osgood-Schlatter disease and pain has subsided. 

Other symptoms associated with Osgood-Schlatter disease include:

• Limping after exercise or other gait disturbance
• Swelling or tenderness under the knee and over the shin
• Tightness of muscles surrounding the knee

A physician will review a medical history and perform a physical examination when diagnosing Osgood-Schlatter disease. The physician will check the child’s range of motion at the knee and hip.

In some cases, the physician may want to take x-rays of the child’s knee to get a closer look at the area where the patellar tendon inserts into the shin bone (tibia) and to rule out other conditions that may be causing the pain. A pain assessment may be performed

Once a child has recovered from Osgood-Schlatter disease, certain steps can be taken to help prevent the condition from occurring again. Exercises such as straight-leg raises, leg curls and quadriceps contractions can strengthen the quadriceps and hamstrings and support the knee. Parents are urged to consult with their child’s physician before having their child try these exercises.

Parents are advised to encourage their child to stretch before and after exercise. This will help loosen the quadriceps, which in turn will make them less likely to tug on the patellar tendon. Children should be urged to avoid deep knee bending. Parents are also encouraged to speak with their child’s coach or trainer to ensure the child is modifying activity levels appropriately.

Preparing questions in advance can help patients or parents have more meaningful discussions with their physicians regarding their conditions. Parents may wish to ask their doctor the following questions about Osgood-Schlatter disease:

1. What signs should I look for that might indicate the presence of Osgood-Schlatter disease?
   
   
2. Can I give my child pain relievers for this condition? Which medications should be avoided?
   
   
3. How will you diagnose my child’s condition?
   
   
4. Should I request that my child stop participating in certain activities?
   
   
5. What other sports or activities should my child avoid?
   
   
6. What are my child’s treatment options?
   
   
7. What are the chances my child will need crutches, braces or surgery?
   
   
8. Will physical therapy be needed? If so, can you recommend a good therapist or therapy center for us?
   
   
9. What are the dangers of leaving Osgood-Schlatter disease untreated?
   
   
10. My child really loves certain activities. Is there another treatment option besides refraining from these activities?
    
    
11. How long will it be before my child can participate in certain activities again?
    
    
12. Why is this condition called a disease - will my child be permanently disabled as a result?