Osgood-Schlatter Disease (Tibial Apophysitis)

BASICS

DESCRIPTION

  • Osgood-Schlatter disease (OSD) is a syndrome associated with traction apophysitis and patellar tendinosis that is most common in adolescent boys and girls.
  • Patients classically present with pain and swelling of the anterior tibial tubercle.
  • System(s) affected: musculoskeletal
  • Synonym(s): tibial tubercle apophysitis

EPIDEMIOLOGY

Incidence

The incidence in girls is rising with increased participation in organized youth sports; almost equal to boys in the United States

Prevalence

  • A common apophysitis in childhood and adolescence affecting athletes more frequently than nonathletes
  • Estimated point prevalence of 10% in the general population aged 12 to 15 years

ETIOLOGY AND PATHOPHYSIOLOGY

Traction apophysitis of the tibial tubercle due to repetitive strain on the secondary ossification center of the tibial tuberosity; concurrent patellar tendinosis, disruption of the proximal tibial apophysis, and avulsion microfractures at the tibial tuberosity are contributing factors.

  • Jumping and pivoting sports place the highest strain on the tibial tubercle. Repetitive trauma and deceleration with an eccentric load are the most likely inciting factors.
  • Likely biomechanical association with tight iliopsoas, quadriceps, and hamstring muscles; increased quadriceps strength relative to hamstring strength in adolescence contributes.

RISK FACTORS

  • Affects children and adolescents most commonly from the ages of 8 to 18 years
    • Girls 8 to 13 years old
    • Boys 10 to 15 years old
  • OSD is slightly more common in boys than girls but likely equally common with similar sports participation.
  • Early sport specialization increases the risk of OSD by 4-fold.
  • Rapid skeletal growth
  • Weak core stabilizing muscles
  • Increased weight/BMI/height
  • Patellofemoral malalignment
  • Overload training volume
  • Quadriceps tightness and/or shortening
  • Hamstring tightness or relative weakness in ratio to the quadriceps
  • Participation in repetitive-jumping sports and sports with heavy quadriceps activity (football, volleyball, basketball, hockey, soccer, skating, gymnastics)
  • Ballet (2-fold risk compared with nonathletes)

GENERAL PREVENTION

  • Avoid sports with heavy quadriceps loading (especially deceleration activities and eccentric loading).
  • Patients may compete if pain is minimal.
  • Increase hamstring and quadriceps flexibility.
  • Reduce sports specialization.
  • Increase cross-training.

COMMONLY ASSOCIATED CONDITIONS

  • Shortened (tight) rectus femoris found in 75% with OSD
  • Hamstring tightness
  • Possible association with ADD/ADHD; adolescents with ADD/ADHD are at risk for other musculoskeletal injuries.
  • Sinding-Larsen-Johansson apophysitis
  • Calcaneal apophysitis (Sever disease)

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