Osgood-Sclatter’s Disease

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Clinically Relevant Anatomy

Osgood Schlatters disease is a very common cause of knee pain in children and young athletes usually between the ages of 10 and 15. It occurs due to a period of rapid growth, combined with a
high level of sporting activity.

These changes result in a pulling force from the patella tendon, on to the tibial tuberosity (bony protrusion at the top of the shin). This area then becomes inflamed, painful and swollen. This is frequent in younger people due to the remaining softness in their bones (from childhood).

 

Epidemiology/aetiology

The patella tendon inserts at the tibial tuberosity and through overuse can tug away at the bone causing inflammation. It is seen more often in children involved with running and jumping activities which put a much greater strain on the patella tendon. With repeated trauma new bone grows back during the healing which causes a bony lump which is often felt at the tibial tuberosity. It mainly affects boys aged 10 to 15 years old and should clear up when they stop growing and the tendons become stronger, however, it can occasionally persist into adulthood.

 

INTERESTING INFO – Why is it called Osgood Schlatters disease?

It was named after two physicians in 1903, Dr. Robert Osgood and Dr. Carl Schlatter. These Doctors defined the disease.

Characteristics/Clinical presentation

  • Pain at the tibial tuberosity (or bony bit at the top of the shin) just below the knee.
  • The tibial tuberosity may become swollen or inflamed and may even become more prominent than the other side.
  • Tenderness and pain is worse during and after exercise.
  • Pain when contracting the quadriceps against resistance or when contracting the muscles with the leg straight.

Quick Diagnosis

History/Symptoms

  • Pain over tibial tuberosity.
  • occurs in children around puberty.
Objective findings
  • Exotosis causing increased prominence of tibial tuberosity.
  • Tenderness tibial tuberosity.
  • Symptoms ease with rest, increase with activity.
  • Increased pain over the tibial tuberosity with resisted knee extension.

Management

General Advice for a patient:

  • Rest. This injury needs rest if it is to heal properly. Only do as much exercise as it will allow without causing pain. Weight bearing exercise will make it worse. Keep your sessions few and high quality rather than train every day.
  • Apply ice or cold therapy to the knee regularly throughout the day to reduce pain and inflammation and particularly following activity or sport. Ice should be applied at least three times a day for 10 to 15 minutes. Ice massage with an ice cube is a convenient way to apply cold therapy to a specific area such as the patella tendon.
  • Gently stretch the quad muscles if comfortable to do so.
  • Use a knee support or knee strap to help reduce the tension on the knee.
  • See a sports injury professional

 

Health professional and Physiotherapy management:

  • Make a correct diagnosis to confirm the existance of Osgood Schlatters disease and make sure it is not anything else causing the pain.
  • Use sports massage techniques on the quads and patella tendon.
  • Prescribe an exercise programme that will allow you to do as much exercise as possible and get the best results from your training.

In extremely severe cases:

  • X-ray to see exactly how much damage has occurred.
  • Apply a plaster cast for three weeks if pain is severe.
  • Will strengthening exercises help? No, not really – Rehabilitation is not really what you need with this one but rest is! However a good trainer or coach should be able to manage your training to get the best results from what you are able to do. This might mean concentrating more on technique or other aspects of your sport or game to produce improvements rather than physical conditioning. This is an unfortunate injury that you will grow out of as long as you don’t over do it.
What type of knee support might help?

There are a number of different supports and braces on the market that may help with Osgood Schlatters disease.

  • A simple neoprene support will provide compression and support to the knee in general and retain the bodies natural heat. A warm tendon will work much better than a cold one.
  • A patella tendon strap wraps around just below the knee, to put direct pressure on the patella tendon to help reduce the strain on the tibial tuberosity.
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