See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/51765898

Osgood-Schlatter disease

Article  in  Praxis · November 2011

DOI: 10.1024/1661-8157/a000715 · Source: PubMed

CITATIONS READS

3 3,496

3 authors, including:

Richard Weiler Roger Wolman

Vrije Universiteit Amsterdam Royal National Orthopaedic Hospital NHS Trust
73 PUBLICATIONS   1,018 CITATIONS    31 PUBLICATIONS   4,249 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Concussion View project

All content following this page was uploaded by Richard Weiler on 10 February 2014.

The user has requested enhancement of the downloaded file.

BMJ 2011;343:d4534 doi: 10.1136/bmj.d4534 Page 1 of 2

Practice

PRACTICE

10-MINUTE CONSULTATION

Osgood-Schlatter disease
Richard Weiler specialist registrar in sport and exercise medicine; locum general practitioner 1,
Michael Ingram general practitioner 2, Roger Wolman consultant in rheumatology and sport and
exercise medicine 3
1
Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK; 2The Red House Group, Radlett, Hertfordshire; 3The
Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK

This is part of a series of occasional articles on common problems in
primary care. The BMJ welcomes contributions from GPs
An active 14 year old boy, accompanied by his father, presents
because of persisting knee pain, which is worse during and after
sports.
What you should cover
In 1903, Osgood and Schlatter separately described a painful
overuse condition affecting the tibial tuberosity.
Osgood-Schlatter disease is a common cause of knee pain in
children, associated with growth spurts, peaking in boys at about
12 to 15 years and girls at about 10 to 12 years. It is more
common in boys than girls and up to 30% of children present
with bilateral symptoms.1 Cadaveric and radiological studies
have led to the theory that Osgood-Schlatter disease may be
caused by forceful contractions of the quadriceps muscles at
the proximal tibial apophysis insertion leading to multiple small
avulsion fractures.2 This may lead to a firm enlargement of the
tibial tubercle over time. The age of onset may be caused by
the relative imbalance of strengthening quadriceps muscles
compared with the growing bone. It is also associated with a
shortened biceps femoris hamstring.1
Diagnosis is clinical and based on history and examination.
Patients usually present with a gradual onset of pain localising
at the tibial tuberosity, relieved by rest and aggravated by
exercise, especially sports involving running and jumping.
Patients can be reassured that the syndrome can be effectively
self managed, but will often not fully resolve until the end of
the growth spurt.2 However, up to 10% of patients experience
persistent symptoms into adulthood, despite conservative
measures.3
History
• Ask about the severity and nature of the pain, seeking a
history of the relationship with activity, such as aggravation
by activity (during or after football, ballet, gymnastics,
running or jumping sports, or kneeling, for example) and
improvement with rest.
• It is helpful when advising prognosis to consider growth
stage (such as using height comparison with parents and
older siblings and, for girls, whether they have started
menstruating), because symptoms typically cease at the
end of a growth spurt.
• Consider, as with any limb pain in children, other
diagnoses, investigation, and urgent referral in the presence
of trauma, systemic symptoms (including fever, weight
loss, or general malaise), bone or joint pain elsewhere,
night pain, pain after rest, or painful examination of the
hip or knee joint.4
What you should do
Examination and treatment
• Pain can be reproduced at the tibial tuberosity with local
palpation and resisted knee extension.
• Reassure patient and parents that sporting activity does not
have to stop completely and that a reduction in activity
may be sufficient to control the pain. Recommend a graded
reduction in exercise duration, frequency, and intensity for
a limited period, sufficient to resolve or tolerate pain. When
pain is tolerable, consider gradual increases in exercise
levels, again guided by and titrated to symptoms, adjusting
levels, and repeating this process as required.
• Paracetamol, non-steroidal anti-inflammatories, and
application of ice (10–15 minutes, up to three times a day,
including after exercise) to the tibial tuberosity can be
offered for pain management.
• Physiotherapy can be helpful by stretching, strengthening,
and reducing muscle imbalance of the quadriceps,
hamstrings, calf muscles, and iliotibial band.

Correspondence to: R Weiler rweiler@doctors.org.uk

Reprints: http://journals.bmj.com/cgi/reprintform Subscribe: http://resources.bmj.com/bmj/subscribers/how-to-subscribe

BMJ 2011;343:d4534 doi: 10.1136/bmj.d4534
• Corticosteroid injections, though sometimes still advocated,
are not appropriate, effective, or recommended.
• Specialist assessment is recommended for severe or
recalcitrant cases and some specialist centres may use short
term immobilisation when other treatment has failed.
• Emphasise the considerable benefits of physical activity
in childhood and throughout life, trying to encourage
maintenance of activity below the threshold that induces
pain.
• For patients who have intolerable symptoms into adulthood,
numerous surgical techniques have been described, with
variable results. Surgical excision of the bony fragment
and/or free cartilaginous material can be considered, where
conservative treatment has failed.5
A patient information leaflet may be a useful source of further
information for both patient and healthcare professional (see
box).
Competing interests: All authors have completed the ICMJE uniform
disclosure form at www.icmje.org/coi_disclosure.pdf (available on
Reprints: http://journals.bmj.com/cgi/reprintform
Page 2 of 2
PRACTICE
request from the corresponding author) and declare: no support from
any organisation for the submitted work; no financial relationships with
any organisations that might have an interest in the submitted work in
the previous three years; no other relationships or activities that could
appear to have influenced the submitted work.
Provenance and peer review: Not commissioned; externally peer
reviewed.
1 de Lucena GL, dos Santos Gomes C, Guerra RO. Prevalence and associated factors of
Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. Am
J Sports Med 2011;39:415-20.
2 Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter
3
syndrome. Curr Opin Pediatr 2007;19:44-50.
Kujala UM, Kvist M, Heinonen O. Osgood-Schlatter’s disease in adolescent athletes.
Retrospective study of incidence and duration. Am J Sports Med 1985;13:236-41.
4 Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management
of acute musculoskeletal pain: a guide for clinicians. Australian Academic Press Pty. Ltd.,
2004.
5 Pihlajamäki HK, Visuri TI. Long-term outcome after surgical treatment of unresolved
osgood-schlatter disease in young men: surgical technique. J Bone Joint Surg Am
2010;92:258-64.
Accepted: 25 June 2011
Cite this as: BMJ 2011;343:d4534
Subscribe: http://resources.bmj.com/bmj/subscribers/how-to-subscribe
 BMJ 2011;343:d4534 doi: 10.1136/bmj.d4534 Page 3 of 2

PRACTICE

Useful reading

For patients
Patient UK information leaflet. www.patient.co.uk/health/Osgood-Schlatter%27s-Disease.htm
East Kent Hospitals University NHS Foundation Trust, quadriceps and hamstring stretches. www.ekhuft.nhs.uk/patients-
and-visitors/information-for-patients/a-z-of-patient-information/a/anterior-knee-pain/#Muscle-tightness

For healthcare professionals

Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam
Pract 2004;53:153-6
Duri ZA, Patel DV, Aichroth PM. The immature athlete. Clin Sports Med 2002;21:461-82, ix
Gholve PA, Scher DM, Khakharia S, Widmann RF, et al. Osgood Schlatter syndrome. Curr Opin Pediatr 2007;19:44-50;
doi: 10.1097/MOP.0b013e328013dbea
NHS Clinical Knowledge Summaries. Osgood Schlatter’s disease.www.cks.nhs.uk/osgood_schlatters_disease/
management/which_scenario

Reprints: http://journals.bmj.com/cgi/reprintform Subscribe: http://resources.bmj.com/bmj/subscribers/how-to-subscribe

View publication stats