Osgood-Schlatter disease, also called tibial tuberosity apophysitis, is a disorder that causes temporary pain, tenderness, and swelling of the knee. In most cases, pain and swelling occurs at the lower front of the knee under the kneecap, called the tibial tuberosity. This is where a large tendon, called the patellar tendon, attaches to the shinbone (called the tibia). One or both knees may be affected.
Many experts believe that overuse of the knee may cause the disorder. Physical activities that involve running or jumping, (e.g. soccer, gymnastics, or basketball) may lead to Osgood-Schlater disease because they put a lot of stress on the knees.
Osgood-Schlatter disease only occurs in adolescents because their bones are still growing. The frequency of Osgood-Schlatter disease in the United States is unknown, but it is considered uncommon. In general, boys ages 13-14 and girls ages 11-12 are most likely to be affected. It is more common in boys than girls. It is also more common among athletes than non-athletes.
Although Osgood-Schlatter may be painful, it is temporary and only lasts about four to six weeks. Until the condition goes away on its own, people may be encouraged to limit exercises that worsen symptoms. Pain relievers and anti-inflammatories may also help reduce symptoms. Symptoms may also come back from time to time until the person has stopped growing.
Most doctors believe that Osgood-Schlatter disease occurs when the knee is overused and exposed to physical stress. Osgood-Schlatter disease only occurs in adolescents because their bones are still growing. New bone develops from a cartilage growth plate, called an epiphysis. This growth plate is located at either end of the long bones in the legs. Because cartilage is weaker than bone, the growth plate may become swollen and painful if stress is placed on it. As a result, the child feels knee pain.
Physical activities that involve frequent bending of the knees, such as running, football, basketball, soccer, gymnastics, and volleyball, put repeated stress on the top of the tibia, called the tibial tuberosity. The tendon of the kneecap (called the patellar tendon) attaches the kneecap to the shinbone, or tibia. Such activities pull on the thigh muscles (called quadriceps) and may put tension on the patellar tendon. As the patellar tendon is stretched, it may start to pull away from the tibial tuberosity, causing pain, swelling, and redness of the knee.
SIGNS AND SYMPTOMS
Common symptoms: People with Osgood-Schlatter disease typically experience pain, swelling, and tenderness at part of the tibial bone, called the tibial tuberosity. The tibial tuberosity is located on the upper shinbone, just below the kneecap. Swelling and pain may extend to part of the shin. The severity of pain varies among patients. In most cases, only one knee is affected. However, it is possible for symptoms to develop in both knees. The surrounding muscles, especially the quadriceps (thigh muscles), may also be sore and tight.
Duration: Symptoms typically worsen when the person participates in activities that involve running and jumping. Symptoms improve when the knee is rested. Symptoms go away on their own in weeks to months. Symptoms may also come back from time to time until the person has stopped growing. Osgood-Schlatter is rarely a problem after the bones have stopped growing. After symptoms are gone, some people may have a small bump on the tibia. However, this is not a cause for concern.
General: Osgood-Schlatter disease is diagnosed after a physical examination of the affected knee(s). A doctor checks for swelling and redness at the tibial tuberosity, which is located on the upper shinbone, just below the kneecap.
Imaging studies: X-rays may also be taken to examine the bones of the knee and leg. A magnetic resonance imaging (MRI) scan may also be used to attain detailed images of the leg bones.
Complications of Osgood-Schlatter disease are rare. In severe cases, the patellar tendon may stretch so far that it detaches from the top of the shinbone (called the tibia). In such cases, a small piece of bone may break off. Normally, this does not cause long-term problems. In rare cases, surgery may be needed if there are small pieces of bone that did not heal on their own.
General: Although Osgood-Schlatter may be painful, it is temporary and only lasts about four to six weeks. Until the condition goes away on its own, people may be encouraged to limit certain types of exercises. Pain relievers, anti-inflammatories, and other self-care techniques may help reduce symptoms. In rare cases, surgery may be needed if fragmented ends of the bones do not heal by the time the bones have stopped growing.
Limit certain physical activities: People with Osgood-Schlatter may need to limit or avoid certain physical activities that worsen symptoms. Activities that involve frequent bending of the knee, such as running, soccer, basketball, or other sports, may worsen symptoms. It is important that people stretch the quadriceps muscles before exercising. Having tight quadriceps may put stress on the patellar tendon where it connects to the tibial tuberosity. In order to maintain physical fitness, people can choose other activities that do not involve jumping or running, such as swimming or cycling.
Knee brace or support: Wearing a strap across the front of the kneecap during high-impact physical activities may help reduce stress at the tibial tuberosity. As a result, symptoms of pain and inflammation may be reduced. A knee brace that wraps around the entire knee may also help reduce swelling and provide support during activities.
Ice or cool compress:
Applying ice or a cool compress for 15 minutes to the affected area may help reduce pain and swelling.
Crutches: People with severe pain may need to use crutches for a few weeks. Using crutches limits stress on the knee and allows it to heal.
Pain relievers: Many over-the-counter pain relievers, such as acetaminophen (Tylenol©), can be used to reduce pain caused by Osgood-Schlatter disease. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil© or Motrin©), may reduce both pain and inflammation. However, not all NSAIDs are safe for children. Parents should to talk to their children's doctors or pharmacists to find out what type of medication is best for their children.
Oscon©: A supplement, called Oscon©, has been suggested as a possible treatment for Osgood-Schlatter disease. Oscon© capsules contain organic selenium compounds (SelenoExcell™), Saccharomyces cerevisiae, and the natural form of vitamin E (called RRR-a-tocopherol). Two soft-gel capsules are typically taken daily by mouth. However, if children have difficulty swallowing the capsules, the contents can be mixed with food or water. It has been suggested that this formula may reduce inflammation, accelerate the healing process, and reduce the length of time that symptoms of Osgood-Schlatter disease last. Although there are many individual reports of improved symptoms after taking Oscon©, well-designed human studies are needed to determine if this is a safe and effective treatment for people with Osgood-Schlatter disease. Oscon© may cause an upset stomach if it is not taken with food. No other side effects have currently been reported.
Surgery: In very rare cases, surgery may be needed if the knee still hurts after the bones have stopped growing. Surgery is only required if there are small pieces of bone in the knee that did not heal on their own. During the procedure, called a tibial sequestrum, the small pieces of bone are surgically removed. Surgery is only performed in adults because it can lead to growth plate damage in a growing individual.
Returning to activity: The length of time that a person needs to limit or avoid certain types of physical activities varies among patients. In general, the condition usually improves after a few weeks to months. People should wait until their pain is low before engaging in activities that involve frequent bending of the knees. In most cases, people with Osgood-Schlatter disease can safely participate in physical activities if they only have mild pain. If pain worsens, however, they should stop exercising and allow the knee to rest and heal.
Once the pain has gone away, a doctor may recommend strengthening and/or stretching exercises for the quadriceps. This may help reduce the chance of Osgood-Schlatter disease occurring again before the bones are completely grown.
Physical therapy: Physical therapy may help a person strengthen the quadriceps in order to prevent Osgood-Schlatter disease from recurring. A physical therapist may recommend exercises that will not worsen symptoms of Osgood-Schlatter disease. A therapist may also recommend special braces and straps to help support the knee and reduce symptoms.
Currently, there is a lack of scientific data on the use of integrative therapies for the treatment or prevention of Osgood-Schlatter disease.
There is no way to completely prevent Osgood-Schlatter disease because it is impossible to avoid bending the knees. Stretching the quadriceps muscles, calf muscles, and hamstrings before and after exercising may help reduce the risk of developing the condition. People are also encouraged to do warm-up and cool-down exercises before and after participating in athletic activities. This helps prevent injuries.
If people experience signs and symptoms of Osgood-Schlatter disease, they should visit their doctors to rule out serious injuries. They should also limit or avoid activities that worsen symptoms.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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