Osgood-Schlatter disease of the knee

Osgood-Schlatter disease is an irritation of the patellar tendon that inserts onto the tibial tuberosity (boney protrusion on the front of the lower leg just below the knee cap). The condition is due to stress on the patellar tendon, which attaches to the quadriceps muscle at the front of the thigh to the tibial tuberosity. Repeated stress from contraction of the quadriceps muscle transmitted through the patellar tendon to the tibial tuberosity can cause small avulsion fractures of the tuberosity along with inflammation of the tendon. This results in excessive bone growth of the tuberosity that produces a visible "bump" on the tuberosity causing pain. Robert Bayley Osgood, an American orthopedic surgeon, and Carl B. Schlatter, a Swiss surgeon, described the condition independently in 1903.

Photo: Contributed

Incidence has been reported as high as 21% among teenage athletes compared to 4.5% of non-athletes. Osgood-Schlatter disease is also common among specific sports such as soccer (30%), football (17%) and male figure skating (14.2%). Children and adolescents specializing in a specific sport, pressure to perform, and decreased time between seasons of a sport can contribute to this overuse injury. Overall boys are more affected by this disease than girls, affecting boys aged 12-15 and girls 8-12 years of age. In 20-30% of cases both knees are affected.

The diagnosis of this condition requires a history and examination of the affected knee. Often, the following findings are evident in the diagnosis of Osgood-Schlatter disease:

1. Enlarged and/or swollen tibial tuberosity
2. Pain localized to the tibial tuberosity when palpated
3. Pain to the tibial tuberosity when running, kneeling, or stair climbing
4. Poor quadriceps flexibility
5. Pain to the tibial tuberosity with resisted knee extension (testing the strength of the quadriceps muscle)

Interventions for this condition include the RICE principle: Rest, Ice, Compression, and Elevation. Research also indicates that hamstring and quadriceps stretching be performed to improve flexibility. In addition, current research (2014) indicates that a strengthening program that consists of 3 specific quadriceps exercises may also be implemented. These exercises include: 1. Isometric quadriceps sets (lie on your back, keeping your knee straight, push the back of your knee into the bed, contracting your thigh muscle), 2. Straight leg raises (with a straight leg, lift your leg 5-10 inches off of the bed), 3. Quads over Roll exercises (place a rolled up towel behind your knee and lift the lower leg to straighten the knee, ensuring that the back of the knee stays on the roll). All of these exercises should be performed free of pain. Finally, because Osgood-Schlatter disease is an overuse or repetitive strain injury, decreasing the frequency and intensity of the activities that aggravate the pain will help to improve the condition.

Please consult with your health care provider to establish a diagnosis for your knee pain and determine an appropriate treatment plan.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.