Osgood-Schlatter disease (OSD) is a common cause of knee pain in growing adolescents. It is an inflammation of the tendon where the kneecap (patellar tendon) attaches to the shinbone (tibia).
This condition most often occurs during growth spurts, when these structures are changing rapidly. Because physical activity puts additional stress on bones and muscles, adolescents who participate in athletics, especially running and jumping sports, are at an increased risk.
In most cases of OSD, simple measures like rest, over-the-counter medications, heat and stretching and strengthening exercises will relieve pain and allow a return to daily activities.
The bones of children and adolescents have an area where the bone is growing called the growth plate. Growth plates are areas of cartilage located near the ends of bones. When a child is fully grown, the growth plates close and harden into solid bone. Closure of this tibial growth plate is the definitive remedy for OSD, but the pain that some adolescents experience until that happens can be long-lasting and considerably limiting in sports and lifestyle.
Some growth plates serve as attachment sites for tendons, the tibial tubercle is one of those areas and covers the growth plate at the upper tibia or shin bone. The group of muscles in the front of the thigh (the quadriceps) attach to the tibial tubercle.
With activity, the quadriceps muscles pull on the patellar tendon and then on the tibial tubercle. In some kids, these forces on the tubercle leads to irritation and inflammation of the growth plate. The “bump” of the tibial tubercle may become very pronounced and painful.
In some cases, both knees have symptoms, although one knee may be worse than the other.
Physical Examination findings will usually show knee pain and marked swelling and tenderness to palpation at the tibial tubercle. Many times, we will also find very tight muscles in the front and/or back of the thigh.
Treatment for Osgood-Schlatter emphasizes reducing swelling and pain. This typically requires limiting exercise activity, participation in a structured physical therapy program to work on muscle imbalances and non-steroidal anti-inflammatory medications (NSAIDs).
Surgery is rarely recommended. However, the prominence of the tubercle will persist and in some cases, pain may persist even after the growth plate closure.
In cases of persistent symptoms and limiting pain despite PT and other treatments, we have utilized dextrose prolotherapy injections into and around the tibial tubercle and tendinous attachment. Studies have shown that these treatments may be helpful in relieving symptoms with improved return to sports/activity outcomes. Usually, 3-5 sessions approximately 4-6 weeks apart are sufficient to relieve symptoms. Although still considered investigational/experimental, dextrose prolotherapy injections have been shown to be safe and effective when used for the treatment of tendon and ligamentous disorders.
Yours in health,
Eduardo R Elizondo, MD, CLCP
Fellow, American College of Sports Medicine