Osgood Schlatter Disease

Clinical Presentation

• An active 14-year-old boy has anterior knee pain
• Anterior knee pain
  
• Inflamed bump in the localize over the tibial tuberosity

Definition

• Overuse injury caused by excessive tension on the patella tendon, affecting its insertion at the tibial tuberosity.
• Micro-avulsion fractures are caused–> inflammation, pain and a visual bump on the anterior-superior shin.

Most Common

• Males 13 to 15 (mostly males)
  
• Females 10-12

Key Features

• Pain come on in sporting activities
  
• Age is a key diagnostic tool

Risk Factors

• Intrinsic:
  • Rapid growth spurts where bone grows faster than muscle and tendon length
    
  • Excessive genu valgus and/or subtalar pronation
    
  • Suboptimal patella tracking can also predispose this condition
• Extrinsic:
  • Children and adolescents that participate in high levels of sporting activity

Physical Exam

• Tenderness along the patella tendon and at the tibial tuberosty
  
• Knee extension against resistance should reproduce pain
  
• Normal ROM

Differentials

• Patellar Tendinopathy
  
  • There is a large bony prominence with OSD
• Fat Pad Irritation or Impingement
  
  • Patellar inferior pole may be displaced posteriorly in fat pad irritation
    
  • Aggravating when standing for pat pad impingement
• Sinding-Larsen-Johansson Lesion
  • Another overuse injury affecting the patella tendon
  • Palpation at the inferior pole of the patella should reproduce pain
    
  • No prominent bump on the tibial tuberosity

Imaging

• MC: Radiography
  
• Ultrasound
  
• MRI

Treatments

• Rest/ activity modification
  
  • Decreased activity for 2-3 months or until asymptomatic
• Ice
  
• Stretching
  
• Taping
  
• Strengthening exercises
  
• NSAIDS
  
• Orthotics
  • A neoprene brace may provide symptomatic relief.
  • Contraindicated: Knee immobilizers 
• Physiotherapist:
  • Alleviation of symptoms
    
  • Education
• Surgery