Osgood–Schlatter Disease in Children

Osgood–Schlatter Disease in ChildrenOsgood–Schlatter disease is a traction apophysitis of the tibial tubercle due to repetitive tensile microtrauma. It occurs between ages 10 and 15 years, with the onset in girls about 2 years before that in boys. OSD is usually unilateral and occurs in 10% of children participating in sports. OSD is associated with patella alta.

Cause

The condition is due to a differential growth rate between bone and soft tissues. Whether this association is a cause or the result of OSD is not known. The tibial tubercle may be enlarged on the asymptomatic side. OSD may be associated with patella alta.

Clinical Findings

Clinical findings will demonstrate swelling and localized tenderness over the tibial tubercle and no other abnormalities. Order a radiograph if the condition is unilateral or atypical. Radiographs usually show soft tissue swelling and fragmention of the anterior apophysis.

Natural history

OSD resolves with time in most children. In about 10% of knees, some residual prominence of the tibial tubercle or persisting pain from an ossicle may cause problems.

Treatment of Osgood–Schlatter Disease in Children

Manage based on severity of discomfort. Modify activities, use NSAIDs, and use a knee pad to control discomfort. If OSD is severe or persists, apply a knee immobilizer for 7–10 days to relieve inflammation. Injection of steroids is not recommended. Quadriceps and hamstring flexibility exercises are the most useful treatment.

Managing the family To reduce apprehension, consider referring to ODS as a disorder or condition rather than a disease when discussing the problems with the patient and family. Make certain that they are aware that resolution is usually slow, often requiring 12–18 months.

Persisting disability from tenderness and tubercle prominence may be sufficient to require excision of the ossicle and prominence.

Complications are rare and include growth arrest with recurvatum deformity and rupture of patellar tendon or avulsion of the tibial tubercle.

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