1. Osgood-Schlatter DiseaseOsgood-Schlatter Disease
Raymond G Buick FRCS

2. Osgood-Schlatter disease
1903
Robert Bayley Osgood
Carl B Schlatter

3. Osgood-Schlatter disease
most frequent cause of knee pain in children
aged 10-15 years
gradual onset of pain
– tibial tuberosity
– after repetitive activity

4. Osgood-Schlatter disease
M>F 3:1 7:1
Age 8 to 16 years
Peak age
• boys about 12 to 15 years
• girls about 10 to 12 years.
• bilateral symptoms 30%

5. pathogenesis
definitely linked with the growth spurt

6. pathogenesis
caused by forceful contractions of the
quadriceps muscles transmitted through the
patellar tendon to the tibial tuberosity
leading to pathological changes at the at the
proximal tibial apophysis insertion

7. pathogenesis
caused by forceful contractions of the
quadriceps muscles transmitted through the
patellar tendon to the tibial tuberosity
leading to pathological changes at the at the
proximal tibial apophysis insertion
apophysis
an outgrowth,
projection or
protuberance,
especially of bone

8. pathogenesis
patellar tendon
tibial tuberosity

9. pathogenesis
The tibial tubercle apophysis appears in children
aged 7-9 years.
mismatch between the force of the quadriceps
contraction and the maturity of the patellar
tendon - tibial junction

10. pathogenesis
leading to
•multiple small avulsion fractures
•distal patellar tendinitis
•osteochondritis

11. aetiology
• activity (during or after football,
ballet, gymnastics,
• running or jumping sports, or
kneeling,

12. diagnosis - clinical presentation
• age and activity
• pain inferior to the patella at the insertion of
the patellar tendon
– aggravated by exercise and relieved by rest
• tenderness
• swelling
• limp

13. examination
• prominence and soft-tissue swelling over the tibial
tubercle
• tenderness over tibial tuberosity and patellar
tendon
• pain on knee extension
• pain on resisted knee extension
• pain on flexion
• remainder of the knee examination usually is
normal.
• Tight hamstrings and/or quadriceps may also be
noted when compared with the uninvolved side.

14. differential diagnosis
• trauma
• referred from hip
• systemic symptoms (including fever, weight
• loss, or general malaise)
• bone or joint pain elsewhere
• Sinding–Larsen–Johansson syndrome - an
analogous condition involving the patellar tendon
and the lower margin of the patella

15. diagnosis
• history
• clinical examination
• x-ray

16. diagnosis
• history
• clinical examination
• x-ray
Author James Heilman MD

17. treatment
• explanation
• reassurance
• reduction in activity

18. treatment
• explanation
• reassurance
• reduction in activity
• pain management
– Paracetamol
– non-steroidal anti-inflammatory
– application of ice (10–15 minutes, up to three times a
day)

19. treatment
• explanation
• reassurance
• reduction in activity
• pain management
– Paracetamol
– non-steroidal anti-inflammatory
– application of ice (10–15 minutes, up to three times a
day)
• Physiotherapy – stretching & strengthening (reducing
muscle imbalance of the quadriceps, hamstrings, calf
muscles, and iliotibial band)

20. treatment
NOT recommended
• Corticosteroid injections
• Surgery
• In adults
– a large ossicle and an overlying bursa
– may cause pain with kneeling
– treatment consists of excision of the bursa, ossicle, and
any prominence

21. prognosis
NOT recommended
• Corticosteroid injections
• Surgery
• In adults
– a large ossicle and an overlying bursa
– may cause pain with kneeling
– treatment consists of excision of the bursa, ossicle, and
any prominence

22. prognosis
it is usually self limiting
90% of patients treated with conservative care were
relieved of all of their symptoms approximately 1
year after onset of symptom
After skeletal maturity, patients may continue to have
problems kneeling or may have tenderness over an
unfused tibial tubercle ossicle or a bursa that may
require resection
rarely a cause of permanent impairment or disability.

23. The EndThe End
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