Osgood-Schlatter Disease (OSD) in Children and Adolescents

Knee pain caused by repetitive activity in active youths

Julia Munn Hale, PA-C, MHS
Senior Clinical Research Coordinator, Pediatric Orthopaedics
Hospital for Special Surgery


Shevaun Mackie Doyle, MD

Shevaun Mackie Doyle, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

What is it?

Osgood-Schlatter disease (also known as OSD) refers to pain isolated to the bump just below the front of the knee in active, growing children (usually aged 9-13 years). This bump is a bony prominence known as the tibial tubercle (or tibial tuberosity), occurring where the patellar tendon meets the upper end of the tibia.

Sketch of a lateral view (from the side) of a child's knee.
(Created by Tonnie Warfield, RN)

The inclusion of the word “disease” in this condition is actually misleading, as it is not a “disease” but rather an overuse syndrome. It is common and temporary, and children usually outgrow it without any residual problems.

Symptoms

Symptoms include pain and swelling over the tibial tubercle that worsens with activity and improves with rest. Usually there is pain with kneeling and any activity (such as running or squatting) that bends or completely extends the knee. In most cases, only one knee is involved.

Image of inflamed bump over the tibial tubercle, just under the front of the knee

Causes

With repetitive activities, the patellar tendon becomes irritated and inflamed at its point of attachment to the tibial tubercle. This repetitive activity, combined with accelerated growth of a child’s bone, causes traction at the tendinous insertion, stimulating the formation of a bony prominence, which can be seen in the larger “bump” below the knee in the image above.

Diagnosis

This condition is best treated by a pediatric orthopaedic specialist who can diagnose and manage the condition. The doctor will want to know the duration of symptoms and what aggravates and alleviates the pain. Sometimes x-rays are necessary.

Treatment

The treatment goal is to keep the child active, but pain free. Sometimes rest is necessary to alleviate symptoms. Partial rest will not always cure the disease and recurrence later in life may be more difficult to treat. Usually Osgood-Schlatter disease resolves within 6-18 months. Surgery is rarely needed. The pediatric orthopedist will help sort out what activities are appropriate.

Recovery

For competitive athletes, modification of training regimens for 2-3 months may be necessary. During the healing phase, Ibuprofen (Motrin or Advil) may help reduce swelling and pain. Ice can help as well, when applied to the painful area after exercise.

If the pain does not go away, sometimes a cast or brace is recommended. Prescribed physical therapy exercises for stretching and strengthening are beneficial as well. Though the boney prominence may persist when the pain is gone, activities may be resumed gradually.

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