Osgood-Schlatter Disease (Tibial Apophysitis)
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- Osgood-Schlatter disease (OSD) is a syndrome associated with traction apophysitis and patellar tendinosis that is most common in adolescent boys and girls.
- Patients present with pain and swelling of the anterior tibial tubercle.
- System(s) affected: musculoskeletal
- Synonym: tibial tubercle apophysitis
Incidence in girls increasing with increased participation in organized youth sports; still more common in boys
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, and disruption of the proximal tibial apophysitis
- Basic etiology unknown, exacerbated by exercise
- Jumping and pivoting sports place highest strain on the tibial tubercle. Repetitive trauma is the most likely inciting factor.
- Possible association with tight hip flexors and tight quadriceps; increased quadriceps strength in adolescence relative to hamstring strength
- Early sports specialization increases the risk for OSD 4-fold (3)[B].
- Affects children and adolescents most commonly from the ages of 8 to 18 years
- Girls 8 to 14 years
- Boys 10 to 18 years
- OSD is slightly more common in boys.
- Rapid skeletal growth
- Increased weight
- Quadriceps tightness
- 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)
- Avoid sports with heavy quadriceps loading (especially deceleration activities—eccentric loading).
- Patients may compete if pain is minimal.
- Increase hamstring and quadriceps flexibility.
- Possibly reduce sports specialization
Commonly Associated Conditions
- Shortened (tight) rectus femoris found in 75% with OSD
- Possible association with ADD/ADHD; adolescents with ADD/ADHD are at risk for other musculoskeletal injuries.
- Sinding-Larsen-Johansson apophysitis