Osgood-Schlatter Disease
Tibial Tubercle Apophysitis
Knee pain is a common complaint in adolescent athletes. Knee injuries can be divided into acute and chronic injuries. Acute injuries are those that occur because of an initial mechanism of injury (dislocation, sprain, fracture, subluxation). Chronic injuries are those that gradually occur over time and cannot be attributed to one specific mechanism of injury.
Defining Osgood-Schlatter Disease
Osgood-Schlatter disease is an inflammation at the tibial tuberosity (boney prominence located on the tibia just below the knee joint). The inflammation is caused by repetitive tension (from the force of the quadriceps through the patellar tendon) at the point of attachment between the patellar tendon and the tibial tuberosity.
Some contributing factors to this include rapid fluctuations in growth spurts in both males and females, pre-existing malalignment conditions including pronated feet (walking on the inside border of the feet), genu valgum ( medially positioned patella), and patella alta (high riding patella caused by a long patellar tendon).
This condition typically develops in females between the ages of 8 and 13 years of age and in males between the ages of 10 and 15 years of age. These are the ages of rapid growth within the long bones of the body. This condition can affect one knee or can be seen bilaterally (in both knees).
According to Anderson, M.K., Parr, G.P., and Hall, S.J. (2009), this condition is estimated to occur in 21% of adolescent athletes as compared to 4.5% of their non-athletic peers (Foundations of Athletic Training). This condition is more commonly seen in males than females, and is seen in athletes who compete in sports that require repetitive loading on the knees such as volleyball and basketball (lots of jumping).
Severity of Osgood-Schlatter Disease
This condition is easily diagnosed because the tibial tuberosity is the direct source of pain. The patient will complain of pain, tenderness, and swelling directly over the tibial tuberosity. The tibial tuberosity itself may appear to be enlarged and more prominent than the uninjured side.
The severity of this condition is differentiated into three grades (Anderson, M.K., Parr, G.P., & Hall, S.J (2009):
- Grade 1 – pain after activity that resolves within 24 hours
- Grade 2 – pain during and after activity that resolves within 24 hours and does not restrict activity
- Grade 3 – continuous pain that restricts activity
Management of Osgood-Schlatter Disease
The standard treatment is non-operative and directly correlates to the severity of the condition. This condition is usually managed with activity modification, ice, and immobilization (in more severe cases). Ice packs can be applied directly to the tender area for twenty minutes after activity. Activity is not restricted unless the pain is inhibitive. Treatment usually lasts between four to six weeks (Frush & Lindenfeld, 2009).
Additional management techniques may include heel pads (cushions compressive loads travelling up the foot to the tibia) placed in the shoes, knee pads (protect tibial tuberosity from impact during activity), and/or a patellar tendon knee strap (to redistribute the tensile load off of the tibial tuberosity and up into the patellar tendon).
The pain related to this condition typically dissipates as the apophysis closes in the long bone of the tibia (athlete stops growing). However, the athlete may be left with a permanent bony growth on the front of the tibia that may continue to be painful into adulthood.
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