Osgood Schlatter disease

background

• Common cause knee pain - esecially adolescents
• Painful overuse of the tibial tuberosity
• Gradual onset
• Max after sport, especially jumping (basketball)
• Early Teens (growth spurts), M>>F
• 30% bilateral
• Repeated pull off (quads ligament) microfractures at epiphyseal plate

Examination

• Tibial tuberosity prominnce ± tenderness
• Pain triggered by resisted knee extension
• Clinical Dx - no need for x-ray

Management

• Conservative
• Reduce (usually no need to avoid completely) triggering activity but maintain activity (change sport etc)
• 90% will have symptom resolution by end of teens growth spurt
  • ROUGH etsimates e.g. compare with mean parental height, siblings height, menarche
• Local ice therapy or NSAIDs PRN
• Later physiotherapy to stretch hamstrings and iliotibial band
• No steroids

Consider

• Other DDx
• Hx trauma
• Constitutional symptoms
  • T °, ↓wt, malaise, arthralgia
  • Night pain, rest pain
• Beware hip exam