Osgood-Schlatter disease

In 1903, Osgood and Schlatter separately described a painful overuse condition affecting the tibial tuberosity. Osgood-Schlatter disease is a common cause of knee pain in children, associated with growth spurts, peaking in boys at about 12 to 15 years and girls at about 10 to 12 years. It is more common in boys than girls and up to 30% of children present with bilateral symptoms. Cadaveric and radiological studies have led to the theory that Osgood-Schlatter disease may be caused by forceful contractions of the quadriceps muscles at the proximal tibial apophysis insertion leading to multiple small avulsion fractures. This may lead to a firm enlargement of the tibial tubercle over time. The age of onset may be caused by the relative imbalance of strengthening quadriceps muscles compared with the growing bone. It is also associated with a shortened biceps femoris hamstring. Diagnosis is clinical and based on history and examination. Patients usually present with a gradual onset of pain localising at the tibial tuberosity, relieved by rest and aggravated by exercise, especially sports involving running and jumping. Patients can be reassured that the syndrome can be effectively self managed, but will often not fully resolve until the end of the growth spurt. However, up to 10% of patients experience persistent symptoms into adulthood, despite conservative measures.