Pediatric Injuries

Osgood-Schlatter Disease

Anatomy

The kneecap (patella) connects muscles in the front of the thigh to the shinbone (tibia). As you bend or straighten a leg, the kneecap is pulled up or down. This movement of the kneecap is accommodated by a V-shaped notch (femoral groove) at one end of the thighbone (femur). The medial patella femoral ligament (MPFL)—located on the inside (medial side) of the knee—helps hold the kneecap in place and stop it from sliding/popping off of the outer side (lateral side) of the knee.

The tendon in the front of the knee (patella tendon) connects the kneecap (patella) to the shinbone (tibia). In growing children, the patellar tendon attaches to the growth plate of the kneecap. This growth plate (tibial tubercle) is the bump near the top of the tibia where the patellar tendon attaches to the bone.

Description

In Osgood-Schlatter disease, children have pain at the front of the knee due to inflammation of the growth plate (tibial tubercle) at the upper end of the shinbone (tibia).

Cause

When a child participates in sports or other strenuous activities, the quadriceps muscles of the thigh pull on the patellar tendon which, in turn, pulls on the tibial tubercle. In some children, this repetitive traction on the tubercle leads to the inflammation, swelling and tenderness of an overuse injury. The prominence, or bump, of the tibial tubercle may become very pronounced. Painful symptoms are often brought on by running, jumping, and other sports-related activities.

Nonsurgical Treatment

• Rest—If symptoms are severe enough, the child may need to limit exercise activity until the pain resolves.
• Stretching exercises—Stretches for the front and back of the thigh (quadriceps and hamstring muscles) may help relieve pain and prevent the disease from returning.
• Nonsteroidal anti-inflammatory medication—Drugs like ibuprofen and naproxen may be recommended to help reduce symptoms of pain and swelling.
• Immobilization—If the pain is severe and interferes with walking and normal daily activities, a cast or cast brace may be applied to completely rest the knee area.

Recovery

Most symptoms will completely disappear when a child completes the adolescent growth spurt, around age 14 for girls and age 16 for boys. However, if Osgood-Schlatter disease is not allowed to heal properly, it could result in more severe problems. Continued stress on the tibial tubercle from athletic activity may potentially lead to a break in the tubercle bone. Thankfully, this is not common. If it does occur, though, treatment for this type of fracture requires a cast or possibly surgery, and in order to heal properly, the child will not be allowed to participate in sports for a prolonged period of time.