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 classically present with pain and swelling of the anterior tibial tubercle.
- System(s) affected: musculoskeletal
- Synonym(s): tibial tubercle apophysitis
The incidence in girls is rising 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
- 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.
- 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)
- 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)
There's more to see -- the rest of this topic is available only to subscribers.