Osgood Schlatter’s Disease

Osgood Schaltters

 

Musculoskeletal complaints are common in the pediatric Emergency Department. As I sit here watching March Madness Basketball (for those not in the US, that is our college basketball tournament, during which my wife consistently humiliates me by picking the winner), I was inspired to write this Morsel. We have covered several Orthopaedic topics in the past (ex, Toddler’s Fracture, Plantar Puncture Wounds, Supracondylar Fracture, Clavicular Head Dislocation), but one of the most commonly encountered is Osgood Schlatter’s Disease.

 

Osgood Schlatter’s Disease: Basics

  • Common cause of knee pain in children
    • 20% of children who participate in sports are affected
  • Believed to be an overuse injury
    • Tension at the insertion site of the patellar tendon on the anterior tibial tubercle
    • Repetitive use before the closure of the epiphysis can lead to traction injury and microavulsion of the tubercle
  • Occurs most often during rapid growth phase
    • Boys: 13-15 years of age
      • Boys more commonly affected (Hanada, 2012)
    • Girls: 11-13 years of age
      • Amongst basketball players, females had more overall knee injuries than males, but had lower rates of Osgood Schlatter’s Disease. (Ito, 2015)
      • Patellofemoral Dysfunction is more common than Osgood Schlatter’s Disease in females. (Foss, 2014)
    • Body Mass found to be associated with severity
      • Lower weight and lower BMI had lower severity on radiographs (Hanada, 2012)
    • Self-limited condition
      • On rare occasions can lead to persistent pain
      • Extremely rare to require surgical intervention
    • Can develop associated bursitis

 

Osgood Schlatter’s Disease: Presentation

  • Pain at the anterior tibial tubercle
  • Pain worse with running, jumping, climbing stairs
  • Often associated with basketball, soccer, football, ballet, figure skating, gymnastics
  • Pain improves with rest
  • Has normal range of motion and gait
  • Tenderness over tibial tubercle
  • Ocassional warmth and erythema of this area as well (it is an inflammatory process)

 

Osgood Shlatter’s Disease: Evaluation

  • The diagnosis does not require any specific testing
  • Radiographs are often obtained to rule-out other conditions (ex, malignancy)
  • Lateral x-ray may show:
    • Thickening of the patellar tendon
    • Thin, anterior ossicles / fragment separating from the tibial tubercle

 

Osgood Schlatter’s Disease: Treatment

  • Basic management is conservative.
    • Conservative management does not mean that you “do nothing.”
  • Decreased Activity
    • Not, NO ACTIVITY!
      • Do not recommend just sitting on couch, watching TV (unless it’s during March Madness and there are multiple games to watch).
    • Recommend that they decrease their activities to the point where pain is improved and then begin adding back in activity as it is tolerated.
    • Cross training may help (ex, swimming)
  • Ice
    • I usually tell them to pretend like they are Michael Jordan and need to ice down their knees.
    • Good trick is to fill small paper cups with water and freeze them. Then they can peel the paper and then use that to apply directly over the tibial tubercle.
  • NSAIDs
  • Physical Therapy

 

References

Launay F1. Sports-related overuse injuries in children. Orthop Traumatol Surg Res. 2015 Feb;101(1S):S139-S147. PMID: 25555804. [PubMed] [Read by QxMD]

Ito E1, Iwamoto J1, Azuma K1, Matsumoto H1. Sex-specific differences in injury types among basketball players. Open Access J Sports Med. 2014 Dec 29;6:1-6. PMID: 25565908. [PubMed] [Read by QxMD]

Yen YM1. Assessment and treatment of knee pain in the child and adolescent athlete. Pediatr Clin North Am. 2014 Dec;61(6):1155-73. PMID: 25439017. [PubMed] [Read by QxMD]

Foss KD1, Myer GD2, Magnussen RA3, Hewett TE4. Diagnostic Differences for Anterior Knee Pain between Sexes in Adolescent Basketball Players. J Athl Enhanc. 2014 Jan 10;3(1). PMID: 25362859. [PubMed] [Read by QxMD]

Maher PJ1, Ilgen JS. Osgood-Schlatter disease. BMJ Case Rep. 2013 Feb 27;2013. PMID: 23446046. [PubMed] [Read by QxMD]
Whitmore A1. Osgood-Schlatter disease. JAAPA. 2013 Oct;26(10):51-2. PMID: 24201924. [PubMed] [Read by QxMD]
Hanada M1, Koyama H, Takahashi M, Matsuyama Y. Relationship between the clinical findings and radiographic severity in Osgood-Schlatter disease. Open Access J Sports Med. 2012 Mar 9;3:17-20. PMID: 24198582. [PubMed] [Read by QxMD]

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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1 Response

  1. February 2, 2017

    […] have discussed several overuse and sports related injuries (ex, Little League Shoulder, Osgood Schlatter’s, Patellofemoral Pain) and how children’s immature skeletal structure makes their injuries […]

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