Osgood-schlatters disease

Question 1

Osgood-schlatters caused by?
Epidemiology?

Answer 1

Osgood-Schlatter disease is caused by inflammation at the tibial tuberosity where the patella ligament inserts. It is a common cause of anterior knee pain in adolescents.

It typically occurs in patients aged 10 – 15 years, and is more common in males. Osgood-Schlatter disease is usually unilateral, but it can be bilateral.

Question 2

Pathophysiology?

Answer 2

The patella tendon inserts into the tibial tuberosity. The tibial tuberosity is at the epiphyseal plate. Stress from running, jumping and other movements at the same time as growth in the epiphyseal plate result in inflammation on the tibial epiphyseal plate. There are multiple small avulsion fractures, where the patella ligament pulls away tiny pieces of the bone. This leads to growth of the tibial tuberosity, causing a visible lump below the knee. Initially this bump is tender due to the inflammation, but has the bone heals and the inflammation settles it becomes hard and non-tender.

Question 3

Presentation Osgood-schlatter?

Answer 3

Osgood-Schlatter disease presents with a gradual onset of symptoms:

Visible or palpable hard and tender lump at the tibial tuberosity
Pain in the anterior aspect of the knee
The pain is exacerbated by physical activity, kneeling and on extension of the knee

Question 4

Management?

Answer 4

Initial management focuses on reducing the pain and inflammation.

Reduction in physical activity
Ice
NSAIDS (ibuprofen) for symptomatic relief

Once symptoms settle, stretching and physiotherapy can be used to strengthen the joint and improve function.

Question 5

Prognosis?

Answer 5

Symptoms will fully resolve over time. The patient is usually left with a hard boney lump on their knee.

A rare complication is a full avulsion fracture, where the tibial tuberosity is separated from the rest of the tibia. This usually requires surgical intervention.