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Tibial Tuberosity Apophysitis / Osgood-Schlatter Disease

Definition:
During your child's adolescent growth spurt, his or her bones grow rapidly. If your child is involved in a lot of running and jumping activities during this time, he or she is at risk of developing Osgood-Schlatter disease, an overuse syndrome that causes pain, swelling and tenderness over the bony prominence of the upper shinbone (tibial tuberosity) just below the kneecap. The condition is also referred to as tibial tuberosity apophysitis.

Osgood-Schlatter disease occurs more often in athletic kids than in nonathletes, affecting as many as one in five adolescent athletes. The condition commonly occurs in boys ages 13 to 14 and girls ages 11 to 12. Osgood-Schlatter disease is more common in boys.

Having Osgood-Schlatter disease can be frustrating, because your child may need to limit his or her running and jumping activity level for a short time. But Osgood-Schlatter disease is temporary, and as your child's bones finish growing, the pain should go away.

Causes:
New bone forms from a cartilage growth plate (epiphysis) located at either end of the bone. Cartilage isn't as strong as bone, and stress on the growth plate can cause it to become swollen and painful, especially if your child is very active during his or her growth spurt.

Osgood-Schlatter disease is caused by activities that place repeated stress on the top of the tibia, the big bone in the lower leg, where the tendon of the kneecap inserts. During activities that involve a lot of running, jumping and bending — such as football, soccer, basketball, volleyball, gymnastics and ballet — the pull of the quadriceps can place tension on the band of tissue that connects the knee to the tibia (patellar tendon).
The patellar tendon may begin to pull away from the raised area on the tibia where it attaches (tibial tuberosity), resulting in pain and swelling. In severe cases, the tendon stretches to the point where it actually detaches from the tibia, and it may take a bone fragment with it.

When to seek medical advice:

Call your doctor if your child develops symptoms of Osgood-Schlatter disease. Also see your doctor if your child has this condition and the prescribed treatments don't appear to be helping.

Symptoms:
Signs and symptoms of Osgood-Schlatter disease include:
  • Pain, swelling and tenderness at the bony prominence (tibial tuberosity) on the upper shinbone (tibia), just below the kneecap
  • Knee pain that worsens with activity, especially running and jumping, and improves with rest
  • Tightness of the surrounding muscles, especially the thigh muscles (quadriceps)
The pain varies from person to person. Some have only mild pain while performing certain activities, especially running and jumping. For others, the pain is nearly constant and debilitating. Osgood-Schlatter disease usually occurs in just one knee, but sometimes it develops in both knees. The discomfort can last from weeks to months and may recur until your child has stopped growing.

Dignosis:
Your doctor will conduct a physical examination of your child's knee, looking for tenderness, swelling, pain and redness. He or she will also want to check the range of motion in your child's knee and hip. X-rays may be taken to look at the bones of the knee and leg and to more closely examine the area where the patellar tendon inserts into the tibia.

Complications:
Complications of Osgood-Schlatter disease are uncommon. They may include chronic pain or localized swelling, which often can be helped with icing and anti-inflammatory medications. Even after symptoms have resolved, a "bump" on the tibia in the area of the swelling may remain. This bump may persist to some degree throughout your child's life, but it isn't a cause for concern because it won't interfere with knee function, though the affected knee may look a bit different than your child's other knee.

Treatment:
Osgood-Schlatter disease usually gets better without formal treatment. The usual approach consists of self-care actions that you and your child can take on your own at home or when your child is participating in sports.

In the infrequent cases where pain is severe and self-care approaches don't help, your doctor may suggest that your child use crutches until the knee heals — usually about four to six weeks. Rarely, surgery may be needed if fragmented ends of the bones haven't healed by the time the bones have stopped growing.

Prevention:
Osgood-Schlatter disease may not be entirely preventable. However, it may help if your child limits his or her activity level if he or she notices the symptoms of Osgood-Schlatter disease.

Tight quadriceps muscles cause a "tugging" stress on the patellar tendon where it inserts into the tibial tuberosity, so doing stretching exercises for the quadriceps, hamstrings and calf muscles may help prevent this condition. Being properly warmed up before engaging in athletic activities and performing cool-down exercises afterward also may help.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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