Osgood-Schlatter Disease (Tibial Apophysitis)



  • 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; almost equal to boys in the United States


  • A common apophysitis in childhood and adolescence affecting athletes more frequently than nonathletes (1)
  • Up to 60% of patients will remain symptomatic into adulthood (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 apophysis leading to tendinosis and apophysitis. Some data suggest that avulsion microfractures occur at the tibial tuberosity.

  • Basic etiology incompletely understood, multifactorial but likely secondary to repetitive microtrauma leading to tendinosis and multiple microfractures
    • 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 (1)[B].

Risk Factors

  • Affects children and adolescents most commonly from the ages of 8 to 18 years
    • Girls 8 to 13 years
    • Boys 10 to 15 years
  • OSD is slightly more common in boys than girls but likely equally common with similar sports participation.
  • Rapid skeletal growth
  • Weak core stabilizers muscles
  • Increased weight/BMI/height
  • Patellofemoral malalignment
  • Overload training volume
  • Quadriceps tightness and/or shortening
  • 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.
  • 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

There's more to see -- the rest of this topic is available only to subscribers.