Osgood Schlatter Disease: It’s a Pain In The Knee

“Osgood-Schlatter disease?” the athletic teen asked me, turning pale, “What is that, some sort of cancer? Is it something I’m going to have for the rest of my life?”

Alas, medicine is full of conditions named for their long-dead discoverers. Some of them sound misleadingly but downright jolly–e.g. Chvostek’s sign (a term for the lockjaw of tetany). Others sound obscure, like McBurney’s point (the point on the lower right abdomen known for tenderness during appendicitis). And then there’s Osgood-Schlatter.  It has enough syllables to sound life-ending, or perhaps describing some sort of Bavarian side dish. No, on both counts.

Rather, Osgood Schlatter disease (OSD) is the most common cause of knee pain in adolescents. In one survey, Osgood Schlatter was found in about 1 in 5 teen athletes (versus less than in 5% of a comparable group of non-athletic kids). Oh, and it isn’t cancer either.

Most often, the stories go a little something like this: An eighth grade basketball player comes into my office about 8 weeks into the season. He complains it feels like some little leprechaun has run up and bashed upon upon his knees with a ball peen hammer at the end of every practice or game. And, wouldn’t you know it? Our hero walks without a limp, but has telltale swelling on the upper aspects of both shin bones that are tender to the touch. These areas ache when he goes down stairs, squats, or kneels. The pain comes and goes, in general, but is usually always worse after a workout.  For the few severely affected kids, the pain may render them unable to play.

Fortunately for my panicked patient in clinic that day, and for the vast majority of those I see with it, OSD causes a mild to moderate amount of discomfort, and responds well to proper treatment and a tincture of time.  What is it, exactly? Take a knee, I’ll explain.

The growing knee of early adolescence is a busy place. Roll up your pant legs and play along as I go. Osgood Schlatter disease can be explained by age, growth, and teen lifestyle. As the old song says, the knee bone (aka, patella) is connected to the shinbone (or tibia). The  workhorse muscle of the thigh, the quadriceps, slings across the kneecap and inserts onto the upper aspect of the tibia via the patellar tendon. For a girl aged 8-12, or for boys around 12-15, the upper aspect of the shinbone where the patellar tendon anchors is a growth plate, and is especially vulnerable to stress and inflammation.

And here we have the setup. Middle school and high school athletes who have rapid periods of growth, and frequently, who engage in high impact sports with prolonged sessions of running and jumping are those who are most vulnerable to developing Osgood Schlatter discomfort.

Over time, tension placed on the patellar ligament by growing bones and the increased stress of athletics can cause microtrauma to the insertion point of the patellar tendon at the bump under the knee, called the tibial tubercle.  In some cases, the cycle of injury and re-healed bone can lead to prominent little goose eggs (see photo above) on one or both of these areas (about 3/4 of all cases are one-sided) that hurt when doctors or parents poke them.

For the treating primary care provider, Osgood Schlatter disease tops our list of diagnoses when we have a so-called classic case, such as a tennis, basketball player, or runner of cross country with sore, bumpy knees. However, before we ever rush to a conclusion, it remains a part of our job to go over parts of each story, and consider and eliminate other possibilities.

Consider: Hip pain can be referred to the knee, oddly enough, and it is key to ensure there is no problem with that big joint, or any other muscles, bones or tendons (anyone for jumper’s knee?). A clinician will perform a leg and knee exam, looking for suspicious rashes, swelling, fluid in the joint, tenderness or limits in strength or movement. To assist in this process, parents or teens who may suspect they have a case of OSD, should be clear about the timing of the onset of pain, triggers for its recurrence, and activities or positions that offer relief of any symptoms.  Most often, a good history combined with a physical exam clinches the diagnosis.

Most teens with Osgood Schlatter disease may continue their sports activity with proper care and treatment. Indeed, whether I meet kids with OSD who’ve undertaken a sport to address their obesity issues or to perform at the elite level, my approach is to keep them playing and to minimize downtime. Kids and parents should discuss with the child’s primary care provider if they would benefit from patellar tendon straps or knee pads.

Customarily, applying ice to painful shins post-workout for 20 min every 2-3 hours after  a workout can suppress swelling and inflammation. Pain relievers, such as Ibuprofen or other non-steroidal anti-inflammatory medications, may take the edge off the owie, but do not tend to shorten the overall course of the problem. Some teens may benefit from some certain stretches to promote quadricep and hamstring flexibility. For those so inclined, acupuncture may also help with pain and inflammation. Happily, the prognosis is excellent for over 90% of kids with Osgood Schlatter disease, and the knee pain typically resolves within a year or when their growth spurts ends–whichever comes first.

For those who encounter more profound pain or disruption of their performance, a respite from play (up to a couple of months!) may be recommended.  For tougher cases, I’d recommend a consultation with a specialist in orthopedics or sports medicine.

So, the next time a 14 year old talks about a leprechaun whacking his knees with hammer after practice, take heed! You need not believe in the wee people part, to be sure, but knee pain? growing kid? athlete? Consider if you might have a case of Osgood Schlatter disease…and getting it checked out for good measure.

Photo #1 by Berg/Worzala,from this nice article; Photo 2 by bonecareatrbjcc

Cartoon below by me.

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