Osgood-Schlatter Disease (Tibial Apophysitis)

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)