Osgood-Schlatters Disease (Tibial Tubercle Apophysitis)

Osgood-Schlatter's, or tibial tubercle apophysitis, is a common cause of knee pain in

patients whose bones are still growing; however, it is not really a disease. This condition
is caused by increased tension on the attachment of the patellar (kneecap) tendon at the
top of the shin bone (tibia).
Osgood-Schlatter's most often occurs in boys aged 11 to 15, but can also affect slightly
younger girls. It is one of the most common causes of knee pain in adolescents.
What causes Osgood-Schlatters?
Osgood-Schlatters is thought to result from repetitive tension and forceful contraction of
the quadriceps (front of the thigh) muscle. The onset of pain is usually associated with a
period of rapid growth combined with activity.
Risk factors include tight quadriceps, tight hamstrings (the muscles on the back of the
thighs), a "high-riding" kneecap, and external rotation of the shin bone.
What are the symptoms of Osgood-Schlatters?
There is usually pain at the front of the knee during activity, especially running, jumping,
squatting, kneeling, and going up and/or down stairs. Typically the pain improves with
rest. The onset of symptoms is usually gradual. Symptoms occur in both knees in 25 to 50
percent of patients. There might also be a bony prominence at the knee and swelling.
How is Osgood-Schlatters diagnosed?
The diagnosis is typically made by physical examination. X-rays and other imaging
studies are not usually necessary, though sometimes x-rays are ordered to rule out other
causes of pain in patients with unusual symptoms, suspicious findings during an
examination, or pain that does not respond to the usual treatment.
How is Osgood-Schlatters treated?
Treatment typically involves modification or even cessation of activities. Ice can also be
quite helpful to reduce pain. An "infrapatellar strap" (a supportive strap worn around the
knee) may help alleviate pain.
Flexibility exercises for the hamstrings and quadriceps can also reduce tension on the
quadriceps and the patellar tendon. Symptoms should gradually improve with time.
References
Anderson SJ and Harris SS, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village,
IL: American Academy of Pediatrics; 2010.
Sarward JF and LaBella CR, eds. Pediatric Orthopaedics and Sports Injuries. Elk Grove
Village, IL: American Academy of Pediatrics; 2010.