Osgood-Schlatter Disease (Tibial Apophysitis)

Osgood-Schlatter Disease (Tibial Apophysitis) is a topic covered in the 5-Minute Clinical Consult.

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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 present with pain and swelling of the anterior tibial tubercle.
  • System(s) affected: musculoskeletal
  • Synonym: tibial tubercle apophysitis

Epidemiology

Incidence
Incidence in girls increasing with increased participation in organized youth sports; still more common in boys

Prevalence
  • A common apophysitis in childhood and adolescence affecting athletes (21%) and nonathletes (4.5%) (1)
  • Approximately 10% remain symptomatic as adults (2).
  • 10% of all adolescent knee pain is due to OSD.

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].

Risk Factors

  • 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)

General Prevention

  • 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

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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 present with pain and swelling of the anterior tibial tubercle.
  • System(s) affected: musculoskeletal
  • Synonym: tibial tubercle apophysitis

Epidemiology

Incidence
Incidence in girls increasing with increased participation in organized youth sports; still more common in boys

Prevalence
  • A common apophysitis in childhood and adolescence affecting athletes (21%) and nonathletes (4.5%) (1)
  • Approximately 10% remain symptomatic as adults (2).
  • 10% of all adolescent knee pain is due to OSD.

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].

Risk Factors

  • 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)

General Prevention

  • 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

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