Osgood Schlatter

Osgood Schlatter’s is a traction apophysitis of the tibial tuberosity! … now to explain that in plain English ---

The tibial tuberosity is the bump of bone at the top of the front of the shin bone (tibia), just below the front of the knee. This is where the patellar tendon attaches to the tibia.

In children, the bones grow from various ‘growth plates’. These are areas of cartilage, where new cartilage is formed and which then turns into bone. This cartilage growth plate can be a potential site of weakness.

The forces transmitted from the quads, through the kneecap, along the patellar tendon and to the tibial tuberosity are massive, particularly with activities such as running or jumping. This can cause tiny stress fractures in the tibial tuberosity growth plate in children aged approximately 10 to  16, and this can cause pain at the front of the knee. If the child continues to do too much exercise then the growth plate can become inflamed. In response to this, the growth plate can start laying down increased amounts of bone, and the tibial tuberosity becomes enlarged and prominent, as well as tender. This is then called ‘Osgood Schlatter’s disease’.

The only appropriate treatment for Osgood Schlatter’s is to back off, decrease exercise levels, ‘listen to the knee’, avoid anything that aggravates the joint, and just give things time to settle. Most cases of Osgood Schlatter’s simply settle and resolve fully with rest and with time. The symptoms normally disappear once the growth plate in the tibial tuberosity closes up and fuses – and in most people this normally happens by the age of 15 or 16 or so.

Osgood Schlatter’s does, however, leave people with an enlarged and prominent tibial tuberosity forever (which is not something that could or should be messed around with at all). This can sometimes make kneeling on the front of the knee on hard surfaces a bit uncomfortable. However, normally it doesn’t cause any more trouble than that.

There is, however, a small percentage of people with Osgood Schlatter’s who do continue to suffer ongoing problems – either ongoing symptoms from childhood, which have simply never settled, or sometimes the knee may settle in childhood but then become symptomatic a number of years later. If a patient who has had Osgood Schlatter’s as a child does complain of ongoing pain at the front of the tibial tuberosity then this can sometimes be because of small loose bits of bone (ossicles) which can detach from the front of the tibial tuberosity and sit behind the back of the bottom end of the patellar tendon, irritating the tendon and causing local inflammation.

Loose ossicles can be seen easily on simply plain X-rays. They are also seen clearly on MRI, plus MRI will also show whether there is any localised inflammation. Therefore, any child whose Osgood-Schlatter’s has failed to settle within the normal expected timeframe, or anyone with a prominent tuberosity that has become tender and painful in adulthood, really should have their knee investigated with appropriate proper imaging, to confirm properly the actual diagnosis of their knee pain.

Persistent pain due to ossicles from Osgood-Schlatters can be cured with a  simple small operation to surgically remove the loose ossicles through a small incision.