I see a large number of adolescent athletes in my office that play a wide variety of sports, and many of these athletes come in with knee pain. Most of these patients have conditions that can be treated without surgery, and I can help them get back to their sports fairly quickly. Perhaps one of the most common causes of knee pain that I see in this adolescent age group that most people don’t know a lot about is Osgood-Schlatter disease (or syndrome). The name may sound scary, but it is a very treatable condition and usually has no long-term effects.
Osgood-Schlatter disease is an irritation of the patellar tendon at its attachment on the tibial tubercle, which is the bony bump that can be felt just below the front of the knee. In children, there is a growth center called an apophysis at the tibial tubercle that is composed of cartilage, and this apophysis is not quite as strong as bone. With athletic activity, the traction forces on the patellar tendon can be quite high and can injure the apophysis and slightly pull it apart (a violent injury can pull it completely off, but that is a topic for another day). The inflammation caused by this injury causes pain, and as the body attempts to heal the apophysis, new bone is deposited that can make the tibial tubercle larger. Chronic cases of Osgood-Schlatter can lead to quite large bony bumps below the knee, but these bumps do not affect knee function. This can develop in one knee or in both simultaneously.
This condition is much more common in boys, with ratios reported in some studies as high as 7:1. However, with more girls participating in higher-level sports now than ever before, the ratio seems to be decreasing and in my practice seems to be closer to 2 or 3:1. There is no good anatomic reason why boys should be affected more than girls, and that leads most orthopedists to believe that activity level must be the most important factor. Children who participate in sports that involve a lot of running, jumping, and cutting are most susceptible to developing this problem.
The good news is that this syndrome is self-limiting and will nearly always go away with time. Once a child reaches skeletal maturity and the growth center closes, the symptoms will go away; this usually occurs around age 14 for boys and 16 for girls. In the meantime, symptoms can usually be controlled with a short period (1-4 weeks) of rest and reduced athletic activity, oral anti-inflammatory medications, and occasionally a patellar tendon strap to help offload the forces on the tibial tubercle. Stretching the quadriceps and hamstring muscles is important, as tightness of these muscle groups increases the traction forces through the patellar tendon. In very rare cases, all of these treatments fail and the patient may develop bony fragments around the tubercle that are painful. In these instances, surgery to remove the fragments may be necessary.
There is a similar condition that involves injury and irritation in the patellar tendon at the attachment on the bottom of the patella instead of the tubercle. This sounds even worse since it has three names instead of two, Sinding–Larsen–Johansson syndrome. This condition is much less common than Osgood-Schlatter, but treatment regimens and outcomes are similar.
It seems that people dream of having a syndrome named after them, but no one can ever decide who was the first to describe a condition so they have to share the glory. I imagine an epic rock-paper-scissors battle between Robert Osgood and Carl Schlatter to determine whose name was listed first. Paper covers rock – Osgood wins.