Osgood Schlatter Disease

Osgood Schlatter disease is a common cause of pain in the front of knee in children and adolescents. It results in inflammation of the growth plate at the tibia (shin bone) typically between the ages of 9 to 15 years.

Causes

  • Repetitive stress, increased exercise intensity, jumping sports, change in exercise activity and growth spurts are common contributors to the onset Osgood Schlatter Disease

  • Increased load through the quadriceps muscle can put increased tension on the attachment of the patella tendon on the tibia.

  • During childhood the growth plate of the tibia is not fully fused and therefore the patella tendon can irritate this growth plate resulting in inflammation at the knee.

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Signs & Symptoms

  • Pain and tenderness at the top of the shin bone, just below the knee cap.

  • Palpable bump at the top of the shin bone, below the knee cap.

  • Pain aggravated by weight bearing exercises such as walking, running and jumping

  • Usually occurs during ages of growth between 9-15yrs old

  • More common in males

Differential Diagnosis

  • Sinding-Larsen-Johannson syndrome

  • Referred pain from hip

  • Hoffa’s fat pad irritation

How to Manage

  • Education and advice regarding load management. This will be dependent on the child’s current function and pain levels. Often a period of offloading is required in the early stages if highly irritable.

  • Advice regarding return to activity and load management. Osgood Shlatter disease is a self-limiting injury and will improve when full skeletal maturity  is achieved, however it is important your child is able to stay active whilst managing there injury.

  • If applicable manual therapy to help improve pain, knee range of motion and decrease muscle tightness.

  • Prescription of a home exercise program targeted to impairments contributing to symptoms including lower limb and pelvic stability and control, strength and flexibility.

  • Following assessment of foot biomechanics, if appropriate advice regarding footwear and referral to Sports Podiatrist if necessary for orthotic review.

  • Management may also include referral to a sports doctor for review if any further medical intervention such as imaging, differential diagnosis and assistance with management plan.

References

  1. Cairns G., Owen T., Kluzek S., Thurley N., Holden S., Rathleff M.S., Dean B.J.F. (2018). Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ Open Sport Exerc Med; 4(1).

  2. Rathleff M.S., Winiarski L., Krommes K., Graven-Nielsen T., Holmich P., Olesen J.L., Holden S., Thorborg K. (2020). Activity modification and knee strengthening for Osgood-Schlatter Disease: a prospective cohort study. Orthopaedic Journal of Sports Medicine; 8(4).

PROmotion Assessment and Outcomes Measures

  • Subjective examination including assessment of current and previous activity levels, past injury history, aggravating factors, footwear

  • Assessment of knee and hip range of motion

  • Palpation of knee and surrounding structures

  • Assessment of lower limb muscle, strength, control, flexibility and imbalances

  • Assessment of sporting footwear