Osgood Schlatter Disease

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OSGOOD
SCHLATTER
DISEASE

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Definition
Osgood–Schlatter disease or syndrome (OSD) is an
irritation of the patellar ligament at the tibial
tuberosity.

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It was named after two physicians in 1903, Dr. Robert Osgood and
Dr. Carl Schlatter.
Osgood Schlatters disease is a very common cause of knee pain in
children and young athletes.
It occurs during the period of rapid growth, due to a combined
high level of sporting activity.
It occurs more frequently in boys than in girls, with reports of a
male-to-female ratio ranging from 3:1 to as high as 7:1.
[1]
[1]. Kujala et al. "Osgood-Schlatter's disease in adolescent athletes. Retrospective
study of incidence and duration“. 1985. Am J Sports Med 13 (4): 236–41.

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Other names for
Osgood-Schlatter Disease
Osteochondrosis
Tibial Aponphysitis.
Tibial tubercle apophyseal traction injury
Morbus Osgood-Schlatter
Rugby knee

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Causes
OSD is thought to be caused by small injuries due to
repeated overuse before the area has finished growing.
Some studies report that up to 50% of patients relates a
history of precipitating trauma.
It is common in adolescents who play soccer, basketball,
and volleyball, and who participate in gymnastics.
Osgood-Schlatter disease affects more boys than girls.

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Pathomechanics

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Key Structures Involved in OSD
Key areas involving OSD
Quadriceps Femoris
Muscle- Tendon Unit
Patella
Tibial Tuberosity

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Following an adolescent growth spurt, repeated stress from contraction
of the quadriceps is transmitted through the patellar tendon to the
immature tibial tuberosity.
This can cause multiple sub-acute avulsion fractures along with
inflammation of the tendon, leading to excess bone growth in the
tuberosity and producing a visible lump which can be very painful
when hit.
Activities such as kneeling may irritate the tendon further.

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Who Gets OSD?
•Most often seen in teenage boys and young men.
–Age range: Boys ~ 12 to 15 ; Girls ~ 8 or 12 years.
–Most times it is seen after the boy or girl has had a growth
spurt and the symptoms gradually come on.

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Who Gets OSD?
New research shows that athletes with limited dorsiflexion could be at
great risk for OSD.
It is thought that a decrease in dorsiflexion in the ankle leads to
compensation in the leg with increased knee flexion, tibial inversion
and foot pronation during the stance phase of running.
These three compensations may lead to greater stress placed on the
patellar tendon which could lead to OSD.
Zoran Šar evi . Limited ankle dorsiflexion: a predisposing factor to Morbus Osgood Schlatter?
č ć
Knee Surgery, Sports Traumatology, Arthroscopy. 2008. Volume 16, Issue 8 , pp 726-728.

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Who Gets OSD?
If the patellar tendon attaches more proximally and in a
broader area to the tibia, this might probably cause OSD.
Burak Demirag.The pathophysiology of Osgood-Schlatter disease: a magnetic resonance
investigation. J Pediatr Orthop B. 2004 Nov ;13 (6):379-82.

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What Makes OSD Worse?
osquatting
orunning
owalking up or down stairs
ocycling
oforceful contractions of the quadriceps muscle
ojumping (basketball, volleyball)
okneeling
orepetitive hard landings
Anything that puts excessive stress on the insertion of the patellar
tendon

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Symptoms
oMain symptom - painful swelling over a bump on the tibia
oSymptoms occur on one or both legs.
oPain:
oPain is mild and intermittent initially.
oLater stages- the pain is severe and continuous in nature.
oPalpation: The area is tender to pressure, and swelling
ranges from mild to very severe.
oFunction: The pain is worse with acute knee impact.

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Painful
swelling

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Calcification
at the tibial
tuberosity

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oThe pain can be reproduced by extending the knee against resistance, stressing
the quadriceps, or striking the knee.
oBilateral symptoms are observed in 20–30% of patients.
oThe symptoms usually resolve with treatment but may recur for 12–24 months
before complete resolution at skeletal maturity, when the tibial epiphysis fuses.

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CLASSIFICATION
oPresentation of Osgood-Schlatter Disease was classified into two
groups according to X-ray examination, those with and without
fragmentation of the tibial tuberosity.
oLater Woolfrey and Chandler (1960) classified the radiological
changes associated with Osgood-Schlatter disease into 3 types.

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Woolfrey and Chandler, 1960
oType I, where the tibial tubercle is prominent and irregular
oType II, where there is additional small fragments of bone adjacent
to the anterior and superior aspects
oType III, where the tubercle is normal, but there is free bone
particles in similar distribution.

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Diagnosis
•Radiographic imaging (x-ray)
•Ultrasonography
•Magnetic Resonance Imaging (MRI)

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Radiographs
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Differential Diagnosis
•Sinding–Larsen–Johansson syndrome
•Patellar subluxation or dislocation
•Patellofemoral pain syndrome 
•Jumper’s knee
•Housemaid’s knee
•Tibial tubercle fracture

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Prevention
•The small injuries that may cause this disorder are usually
unnoticed, so prevention may not be possible.
•Regular stretching, both before and after exercise and athletics,
can help prevent injury.

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Conservative Management
oIbuprofen or other nonsteroidal anti inflammatory drugs (NSAIDs),
or acetaminophen (Tylenol).
oRest (3 days) and decreasing activity (1-2 weeks)
oIce - over the painful area, 2 to 3 times a day, 20 to 30 minutes at a
time,
oBracing, Orthopedic casting
oInfra patellar strap – 6 to 8 weeks

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Surgical Management
•Excision of intra-tendon ossicles
•Tibial sequestrectomy

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Physiotherapy Management:
Stretching
•Hamstrings
•Quadriceps
•Calf muscles
Strengthening
•SLR
•Prone Hip extension
•Knee stabilisation
•Quadriceps strength training,
with terminal range movement

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Kaiser Permanente, Exercises for OSD:
•SLR to the front•SLR to the front Short Arc
Quadriceps

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•Half-squat with knees and feet turned
out to the side

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•Step- up and Step down

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•Terminal Knee extension

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Interesting Facts About OSD:
•15% of teenage suicides occur due to depression
caused by OSD during the game seasons
•OSD has been proved to occur in dogs!
(though a new system of classification of the disease is required)

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THANK YOU