Osgood-Schlatter disease (tibial tuberosity avulsion)
- Andrew J Kienstra, MD
Andrew J Kienstra, MD
- Clinical Assistant Professor of Pediatrics, Section of Pediatric Emergency Medicine
- University of Texas at Austin
- Dell Medical School
- Dell Children's Medical Center
- Charles G Macias, MD, MPH
Charles G Macias, MD, MPH
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- William Phillips, MD
William Phillips, MD
- Section Editor — Pediatric Orthopedics
- Professor of Pediatrics and Orthopedics
- Baylor College of Medicine
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Osgood-Schlatter disease, also known as osteochondritis of the tibial tubercle, was first described in 1903 [1,2]. It is a traction apophysitis of the proximal tibial tubercle at the insertion of the patellar tendon.
The clinical features and management of Osgood-Schlatter disease will be discussed here. Causes of knee pain and the general approach to the diagnosis of knee pain in children and adolescents are discussed separately. (See "Approach to acute knee pain and injury in children and skeletally immature adolescents" and "Approach to chronic knee pain or injury in children or skeletally immature adolescents".)
Osgood-Schlatter disease is characterized by pain and swelling at the tibial tubercle, the point of insertion of the patellar tendon (figure 1 and picture 1). The patellar tendon arises from the inferior pole of the patella, a sesamoid bone within the quadriceps tendon. The quadriceps muscle is involved in knee extension.
Osgood-Schlatter disease generally occurs in children 9 to 14 years of age who have undergone a rapid growth spurt. It occurs in approximately 20 percent of adolescents who are active in sports compared with 5 percent of nonathletes . It is bilateral in 25 to 50 percent of cases, although the involvement is typically asymmetric [3-5].
Osgood-Schlatter has traditionally occurred most commonly in boys. However, it is becoming more common in girls as their sports participation increases . Osgood-Schlatter typically occurs one to two years earlier in girls than in boys, corresponding to the different timing of the pubertal growth spurt. (See "Normal puberty", section on 'Growth spurt'.)
- Osgood, RB. Lesions of the tibial tubercle occurring during adolescence. Boston Med Surg J 1903; 148:114.
- Schlatter, C. Verletzungen des schnabelforminogen fortsatzes der oberen tibiaepiphyse. Beitre Klin Chir Tubing 1903; 38:874.
- 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.
- Krause BL, Williams JP, Catterall A. Natural history of Osgood-Schlatter disease. J Pediatr Orthop 1990; 10:65.
- Stanitski CL. Knee overuse disorders in the pediatric and adolescent athlete. Instr Course Lect 1993; 42:483.
- Duri ZA, Patel DV, Aichroth PM. The immature athlete. Clin Sports Med 2002; 21:461.
- Willis RB. Sports medicine in the growing child. In: Lovell and Winter's Pediatric Orthopaedics, 6th ed, Morrissey RT, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1384.
- Cassas KJ, Cassettari-Wayhs A. Childhood and adolescent sports-related overuse injuries. Am Fam Physician 2006; 73:1014.
- Mital MA, Matza RA, Cohen J. The so-called unresolved Osgood-Schlatter lesion: a concept based on fifteen surgically treated lesions. J Bone Joint Surg Am 1980; 62:732.
- Gholve PA, Scher DM, Khakharia S, et al. Osgood Schlatter syndrome. Curr Opin Pediatr 2007; 19:44.
- Ogden JA, Southwick WO. Osgood-Schlatter's disease and tibial tuberosity development. Clin Orthop Relat Res 1976; :180.
- Hirano A, Fukubayashi T, Ishii T, Ochiai N. Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease. Skeletal Radiol 2002; 31:334.
- Rosenberg ZS, Kawelblum M, Cheung YY, et al. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology 1992; 185:853.
- Demirag B, Ozturk C, Yazici Z, Sarisozen B. The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. J Pediatr Orthop B 2004; 13:379.
- Aparicio G, Abril JC, Calvo E, Alvarez L. Radiologic study of patellar height in Osgood-Schlatter disease. J Pediatr Orthop 1997; 17:63.
- Andrisano A, Mignani G, Mazzetti M. Long term results in Osgood-Schlatters disease. Ital J Orthop Traumatol 1985; 11:483.
- Clark, MC, Iwinski, HJ. The limping child: The challenges of an accurate assessment and diagnosis. Pediatr Emerg Med 1997; 2:123.
- Micheli LJ. Osgood-Schlatter syndrome. In: The Sports Medicine Bible, Harper Perennial, New York 1995. p.137.
- Dunn JF. Osgood-Schlatter disease. Am Fam Physician 1990; 41:173.
- Micheli LJ, Purcell L. Osgood-Schlatter disease. In: The Adolescent Athlete: A Practical Approach, Spring, New York 2007. p.311.
- Osgood-Schlatter Disease. In: Essentials of Musculoskeletal Care, Greene WB. (Ed), American Academy of Orthopedic Surgeons, Rosemont 2001. p.719.
- Stahli LT. Sports. In: Fundamentals of Pediatric Orthopedics, 2nd ed, Lippincott Raven, Philadelphia 1998. p.111.
- Wall EJ. Osgood-schlatter disease: practical treatment for a self-limiting condition. Phys Sportsmed 1998; 26:29.
- De Flaviis L, Nessi R, Scaglione P, et al. Ultrasonic diagnosis of Osgood-Schlatter and Sinding-Larsen-Johansson diseases of the knee. Skeletal Radiol 1989; 18:193.
- Blankstein A, Cohen I, Heim M, et al. Ultrasonography as a diagnostic modality in Osgood-Schlatter disease. A clinical study and review of the literature. Arch Orthop Trauma Surg 2001; 121:536.
- Yanagisawa S, Osawa T, Saito K, et al. Assessment of Osgood-Schlatter Disease and the Skeletal Maturation of the Distal Attachment of the Patellar Tendon in Preadolescent Males. Orthop J Sports Med 2014; 2:2325967114542084.
- Nakase J, Aiba T, Goshima K, et al. Relationship between the skeletal maturation of the distal attachment of the patellar tendon and physical features in preadolescent male football players. Knee Surg Sports Traumatol Arthrosc 2014; 22:195.
- Nakase J, Goshima K, Numata H, et al. Precise risk factors for Osgood-Schlatter disease. Arch Orthop Trauma Surg 2015; 135:1277.
- Suzue N, Matsuura T, Iwame T, et al. State-of-the-art ultrasonographic findings in lower extremity sports injuries. J Med Invest 2015; 62:109.
- Sailly M, Whiteley R, Johnson A. Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation. Br J Sports Med 2013; 47:93.
- Chow SP, Lam JJ, Leong JC. Fracture of the tibial tubercle in the adolescent. J Bone Joint Surg Br 1990; 72:231.
- Bloom RA, Gomori J, Milgrom C. Ossicles anterior to the proximal tibia. Clin Imaging 1993; 17:137.
- Scotti DM, Sadhu VK, Heimberg F, O'Hara AE. Osgood-Schlatter's disease, an emphasis on soft tissue changes in roentgen diagnosis. Skeletal Radiol 1979; 4:21.
- Lee DW, Kim MJ, Kim WJ, et al. Correlation between Magnetic Resonance Imaging Characteristics of the Patellar Tendon and Clinical Scores in Osgood-Schlatter Disease. Knee Surg Relat Res 2016; 28:62.
- Schwend RM, Geiger J. Outpatient pediatric orthopedics. Common and important conditions. Pediatr Clin North Am 1998; 45:943.
- Tachdijan MO. The knee and leg. In: Clinical Pediatric Orthopedics: The Art of Diagnosis and Principles of Management, Appleton and Lange, Stamford 1997. p.107.
- D'Ambrosia RD, MacDonald GL. Pitfalls in the diagnosis of Osgood-Schlatter disease. Clin Orthop Relat Res 1975; :206.
- Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam Pract 2004; 53:153.
- Hussain, A, Hagroo, GA. Osgood-Schlatter disease. Sports Exer Injury 1996; 2:202.
- Beovich, R, Fricker, PA. Osgood-Schlatter's disease. A review of the literature and an Australian series. Aust J Sci Med Sport 1988; 20:11.
- Weiss JM, Jordan SS, Andersen JS, et al. Surgical treatment of unresolved Osgood-Schlatter disease: ossicle resection with tibial tubercleplasty. J Pediatr Orthop 2007; 27:844.
- Stanitski CL. Patellofemoral mechanism. In: DeLee & Drez's Orthopaedic Sports Medicine Principles and Practice, DeLee JC, Drez D, Miller MD. (Eds), Saunders, Philadelphia 2003. p.1814.
- Topol GA, Podesta LA, Reeves KD, et al. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. Pediatrics 2011; 128:e1121.
- Rostron PK, Calver RF. Subcutaneous atrophy following methylprednisolone injection in Osgood-Schlatter epiphysitis. J Bone Joint Surg Am 1979; 61:627.
- Tolo VT. The lower extremity. In: Lovell and Winter's Pediatric Orthopaedics, Morrissey RT, Weinstein SL. (Eds), Lippincott- Raven, Philadelphia 1996. p.1063.
- Neuschwander DC. Peripatellar pathology. In: DeLee & Drez's Orthopaedic Sports Medicine Principles and Practice, 2nd ed, DeLee JC, Drez D, Miller MD (Eds), Saunders, Philadelphia 2003. p.1867.
- Orava S, Malinen L, Karpakka J, et al. Results of surgical treatment of unresolved Osgood-Schlatter lesion. Ann Chir Gynaecol 2000; 89:298.
- Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease. J Pediatr Orthop 1995; 15:292.
- Binazzi R, Felli L, Vaccari V, Borelli P. Surgical treatment of unresolved Osgood-Schlatter lesion. Clin Orthop Relat Res 1993; :202.
- Pihlajamäki HK, Mattila VM, Parviainen M, et al. Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men. J Bone Joint Surg Am 2009; 91:2350.
- Bernhardt DT. Overuse injuries of the knee. In: Care of the Young Athlete, 2nd ed, Harris SS, Anderson SJ (Eds), American Academy of Orthopedic Surgeons, American Academy of Pediatrics, Elk Grove Village, Illinois 2010. p.421.
- Wiss DA, Schilz JL, Zionts L. Type III fractures of the tibial tubercle in adolescents. J Orthop Trauma 1991; 5:475.
- Bolesta MJ, Fitch RD. Tibial tubercle avulsions. J Pediatr Orthop 1986; 6:186.
- Lynch MC, Walsh HP. Tibia recurvatum as a complication of Osgood-Schlatter's disease: a report of two cases. J Pediatr Orthop 1991; 11:543.
- Bellicini C, Khoury JG. Correction of genu recurvatum secondary to Osgood-Schlatter disease: a case report. Iowa Orthop J 2006; 26:130.
- Risk factors
- CLINICAL PRESENTATION
- DIAGNOSTIC EVALUATION
- DIFFERENTIAL DIAGNOSIS
- Nonsurgical treatment
- - Pain control
- - Activity continuation
- - Physical therapy
- - Education
- - Follow-up
- Surgical treatment
- COMPLICATIONS AND SEQUELAE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS