Osgood Schlatter's Disease
Why does it occur?
Osgood Schlatter’s Disease (OSD) is a condition of the growing teenager that causes swelling and pain on the front of the knee just distal to the kneecap. Adolescent knees have open growth plates which are a potential weak part of the bone. There is a growth plate at the Tibial Tubercle, which serves as the attachment point for the patellar tendon (i.e. tendon originating from your kneecap), which is an extension of the Quadriceps tendon. Therefore, excessive and repetitive running or jumping places excessive force on the Tibial Tubercle via the Patella Tendon. This force then pulls on the growth plate, initially causing inflammation around the area of the Patella tendon attachment point to the tibial tubercle.. Adolescents especially during their growth spurts who are heavily involved in activities that involve significant running and jumping, are prone to excessive and repetitive forces at the tibial tubercle growth plate. OSD is more common in boys and can occur in both knees at the same time in some patients.
Symptoms:
Adolescent patients most commonly present with pain in the front of the knee that is worsened by running and jumping. The tibial tubercle itself will usually also be enlarged given the inflammation.
Diagnostic Testing:
An x-ray is usually ordered to further evaluate the growth plate. Comparison Xrays with the opposite knee are often also obtained. Dr. Lee is mainly looking for evidence of a more serious condition, called a tibial tubercle avulsion fracture. Ruling out this condition is an important component of the diagnostic process. An MRI may be ordered to rule out other soft tissue and internal knee derangement issues should they be suspected.
Treatment Options:
Nonoperative treatment is the mainstay of treatment for OSD. Physical Therapy and knee strapping may also be advised. NSAIDs such as Advil or Aleve (if not contraindicated for the patient) may be considered to decrease pain and swelling. For severe cases, a knee immobilizer/brace may be prescribed. In those patients who do not follow these non-operative instructions by continuing to run and jump, it is not uncommon for the tibial tubercle to eventually break off and displace, requiring surgery with screw fixation. This condition is typically self limited, and should go away when the patient has stopped growing, but the swelling most often lingers.
Surgical Treatment:
Surgery is advised for patients who have significantly displaced their Tibial Tubercle or have failed nonoperative treatment. Surgery will either involve placing a screw across the tibial tubercle to fuse the growth plate OR excising the ossicle and then reattaching the patellar tendon down to the bone.
Dr. Steven Lee is part of the teaching faculty for the Lenox Hill Sports Medicine Fellowship (which is the oldest sports medicine fellowship in the country), and is currently the Associate Director at NISMAT, which is the first institute in the country dedicated to sports medicine research. He routinely advises and sees various sports medicine injuries including in the pediatric and adolescent age groups.
Recovery Expectations:
Adolescent patients who undergo surgery will be placed into a knee immobilizer for 4-6 weeks, during which time full weight-bearing will be allowed while wearing the brace. Physical therapy will focus on increasing range of motion and strength thereafter. Adolescent patients can expect to return to sports 4-6 months after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.