Osgood Schlatter

Aka: Osgood Schlatter, Osgood-Schlatter, Tibial Apophysitis

1. Epidemiology
   1. Common in physically active children near Puberty (age range 10-14 years old)
      1. Boys (more common): Age 13-14 years old
      2. Girls: Age 10-11 years old
   2. More common in Running and cutting sports
      1. Soccer
      2. Basketball
      3. Gymnastics
      4. Volleyball
2. Pathophysiology
   1. Repetitive traction of Patellar tendon on tibial tubercle ossification center (apophysis)
   2. Cartilage detachment from tibial tuberosity
   3. Acute stress
      1. Recent increase in athletic activity
      2. Recent growth spurt
3. Symptoms
   1. Waxing and waning anterior Knee Pain for months
   2. Bilateral in up to one third of patients
   3. Knee Pain aggravated by
      1. Running
      2. Jumping or hurdling
      3. Going up and down stairs
      4. Direct pressure wwith kneeling
      5. Squatting
4. Signs
   1. Localized tenderness and swelling at tibial tuberosity (tibial tubercle)
   2. Provocative maneuvers
      1. Knee extension against resistance
      2. Passive knee hyperflexion
5. Differential Diagnosis
   1. See anterior Knee Pain
   2. Tibial apophysis avulsion Fracture
   3. Slipped capitalfemoral epiphysis with radiating pain
6. Imaging
   1. Knee XRay
      1. Rules-out Fracture, tumor or Osteomyelitis
      2. May show tibial tubercle fragmentation and overlying soft tissue swelling
7. Management
   1. Reduce Physical Activity
   2. Consider infrapatellar strap
   3. Knee immobilizer splint may occasionally be useful
   4. Quadriceps strengthening
   5. Surgical excision of ossicle may ultimately be needed if persistently painful
   6. Protect the area from direct trauma
   7. Analgesics as needed (Acetaminophen, NSAIDs)
   8. Avoid local Corticosteroid Injections
      1. Weakens Patellar ligament
      2. Thins and depigments skin
   9. Orthopedic consultation if persistent pain despite mature skeleton
8. Course
   1. Self limited, resolves over months
   2. Resolves when tibial tubercle fuses to diaphysis
9. References
   1. Atanda (2011) Am Fam Physician 83(3): 285-91
   2. Dunn (1990) Am Fam Physician 41:173-6