Osgood-Schlatter disease is a painful condition that affects the upper part of the shin bone (tibia). It most commonly occurs in teenagers who play sport. It causes pain and swelling just below the knee. It is not serious and usually goes away in time.
What is Osgood-Schlatter disease?
Overuse of the quadriceps muscle can cause repeated strain on the attachment of the patellar ligament to the growing tibia. The tibia hasn't finished growing and isn't quite strong enough to withstand the strain on it. This can cause redness and soreness where the ligament attaches. In some cases, a small flake of bone is pulled off the tibia by the pulling ligament. Healing bone (callus) then forms which may cause a hard bony bump to develop.
Who develops Osgood-Schlatter disease?
Osgood-Schlatter disease (also sometimes called Osgood-Schlatter syndrome) is one of the common causes of knee pain in active adolescent children who play sports. However, it is uncommon over the age of 16 years. Young teenagers, particularly boys, are the most commonly affected. It is more common in teenagers who play a lot of sport involving kicking, running or jumping. These kinds of sports cause repeated and vigorous use of the muscles on the front of the thigh - the quadriceps.
It can sometimes occur in children who are not sporty.
What causes Osgood-Schlatter disease?
Overuse of the quadriceps muscles is thought to be a common cause. The quadriceps muscle is used to straighten the knee. This muscle pulls on the kneecap (patella), which pulls on the patellar ligament, which is attached to the upper part of the shin bone (tibia). Sometimes Osgood-Schlatter disease develops for no apparent reason.
What are the symptoms?
The main symptom is pain just below your kneecap (patella). The severity of the pain tends to vary. It is usually worse during, and just after, activity. It tends to ease with rest. The pain typically lasts a few months, but sometimes persists until you have finished growing. This means that in some cases it can last up to two years.
A small, tender, bony bump may develop just under your kneecap. This is where your patellar ligament attaches to your shin bone (tibia). The bump is permanent, although in time it becomes painless. Your actual knee joint is not affected, so knee movements are normal. Symptoms usually occur on one side, but in up to one in three cases it affects both knees.
The diagnosis is often obvious from the typical symptoms. X-rays are usually unnecessary. However, Osgood-Schlatter radiology may be required if the diagnosis is unclear.
How to treat Osgood-Schlatter disease
The pain usually goes within a few months without any treatment. It may help to be reassured that the condition is not serious and is likely to go. When the pain flares up, it may be useful to take a painkiller such as paracetamol or ibuprofen.
Physiotherapy can be of benefit. Osgood-Schlatter exercises are used to strengthen the muscles around the knee joint (principally the quadriceps, hamstrings, and gastrocnemius muscles).
Osgood-Schlatter taping is sometimes helpful. An adhesive tape is placed across the part of the bone that is tender and swollen (the tibial tuberosity) while the patient's knee is bent. This offloads the pressure when the joint is straightened, relieving some of the pressure and pain.
Osgood-Schlatter surgery is rarely required but if the pain persists, a small operation may be performed. This involves removing unhealed areas of flakes of bone or fixing them to the upper part of the shin bone (tibia).
What about playing sport and other activities?
Sport or physical activity is not likely to cause any permanent damage but may make the pain worse. However, it is often sporty teenagers who develop Osgood-Schlatter disease. If the pain is affecting your ability to do your sport, difficult decisions may have to be made about training schedules and sporting commitments.
An approach similar to the following may be advised:
- You do not usually need to stop sport. However, easing off strenuous or vigorous sport may be sensible until the pain eases to a tolerable level. You should aim to reduce the duration, frequency and also intensity of your exercise, especially if this exercise includes running or jumping. Consider a complete break from sport for a while if pain remains bad.
- An ice pack applied below the kneecap (patella) for about five minutes before and after exercise may prevent some inflammation and pain.
- Consider wearing knee pads during sports such as football and rugby, to protect the tender area.
- Some people find an Osgood-Schlatter brace helpful. It works by reducing pressure on the painful bump at the top of the tibia.
- Consider seeing a physiotherapist for advice on exercises to stretch the thigh muscles.
How long does Osgood-Schlatter last?
As mentioned, the pain typically only lasts a few weeks or months. However, it can sometimes last up to two years. The pain does not usually fully resolve until the end of your growth spurt. Some people find that the pain only returns (recurs) when they kneel. If surgery is required, the result is usually excellent.
Further reading and references
Osgood-Schlatter disease; NICE CKS, Feburay 2015 (UK access only)
Weiler R, Ingram M, Wolman R; 10-Minute Consultation. Osgood-Schlatter disease. BMJ. 2011 Aug 1343:d4534. doi: 10.1136/bmj.d4534.
Leibbrandt DC, Louw QA; The use of McConnell taping to correct abnormal biomechanics and muscle activation patterns in subjects with anterior knee pain: a systematic review. J Phys Ther Sci. 2015 Jul27(7):2395-404. doi: 10.1589/jpts.27.2395. Epub 2015 Jul 22.
Itoh G, Ishii H, Kato H, et al; Risk assessment of the onset of Osgood-Schlatter disease using kinetic analysis of various motions in sports. PLoS One. 2018 Jan 813(1):e0190503. doi: 10.1371/journal.pone.0190503. eCollection 2018.
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