Background

In 1903, two surgeons, Robert Osgood from the United States and Carl Schlatter from Switzerland, independently described the condition that would later bear their names. Osgood Schlatter disease (OSD) is a common cause of knee pain in physically active adolescents. 

The condition develops due to repetitive pulling of the quadriceps muscle through the patellar tendon at its attachment site on the growing tibial tubercle. This usually occurs during the preadolescent growth phase when the tibial tubercle is more prone to stress. The pain is typically localized over the tibial tubercle and may sometimes extend to the patellar tendon. A similar condition that affects the junction between the patella and the patellar tendon is called Sinding Larsen Johansson syndrome, which is considered the adolescent equivalent of jumper’s knee. 

Epidemiology

Osgood Schlatter disease is among the leading causes of knee pain in growing adolescent athletes. The onset typically aligns with the rapid growth periods of puberty, usually between the ages of 10 and 15 years in boys and 8 and 13 years in girls. The condition is seen more often in males and is particularly prevalent among athletes involved in activities that require frequent running or jumping. In adolescents aged 12 to 15 years, the prevalence of Osgood Schlatter disease is estimated at about 9.8%, affecting 11.4% of males and 8.3% of females. Symptoms appear on both knees in approximately 20% to 30% of cases. 

Anatomy

Pathophysiology

The tibial tubercle forms as a secondary ossification center that serves as the attachment site for the patellar tendon. During periods of rapid growth, bone development can outpace the ability of the muscle-tendon unit to lengthen adequately, resulting in increased tension across the apophysis. In adolescents, the growth plate (physis) represents the weakest part of the muscle-tendon-bone attachment, making it more susceptible to injury from repetitive stress. Continuous contraction of the quadriceps, especially during repeated or forceful knee extension as seen in sports like basketball, football, and gymnastics, can lead to softening and partial separation of the apophyseal ossification center. This process may cause inflammation of the bone and cartilage known as osteochondritis. 

The development and fusion of the tibial tubercle follow a specific sequence: 

The tibial tubercle is completely cartilaginous in children younger than 11 years. 

The apophysis begins to form between 11 and 14 years of age. 

The apophysis then fuses with the proximal tibial epiphysis between 14 and 18 years of age. 

Finally, the proximal tibial epiphysis and tibial tubercle apophysis unite with the rest of the proximal tibia after the age of 18 years. 

Etiology

The patellar tendon attaches to the tibial tubercle, which is initially composed of cartilage. Ossification of this area begins around ages 10 to 12 in girls and 12 to 14 in boys. It is during this phase of bone development that Osgood Schlatter disease most commonly appears. The widely accepted explanation is that repeated traction on the tibial tubercle leads to small tears in the microvasculature, minor fractures, and subsequent inflammation, resulting in pain, swelling, and tenderness at the site. 

Osgood Schlatter disease is classified as an overuse injury that primarily affects physically active adolescents. It develops due to repetitive strain and microtrauma from the powerful pull of the patellar tendon on the still-developing apophysis of the tibial tubercle. This repetitive stress can cause irritation and, in more severe cases, partial avulsion of the apophysis. The risk increases with high levels of physical activity and particularly following rapid growth spurts. In rare cases, direct trauma may cause a complete avulsion fracture. Additional predisposing factors include tightness of the quadriceps and hamstring muscles or misalignment of the extensor mechanism, both of which heighten tension on the tibial tubercle. 

Genetics

Prognostic Factors

The prognosis for Osgood Schlatter disease is generally very good. The condition is self-limiting and typically resolves once skeletal growth is complete, although recovery may take several months. In approximately 10% of cases, symptoms may persist into adulthood, particularly in individuals who do not receive appropriate treatment or fail to follow the recommended management plan. In rare instances, pain and discomfort can continue for several years after the initial onset. 

Clinical History

Age group 

Osgood Schlatter disease most commonly affects adolescents undergoing rapid growth spurts. It typically appears between the ages of 10 and 15 years in boys and 8 and 13 years in girls, coinciding with the period of active bone growth and increased participation in sports or physical activities. The condition is rarely seen in adults, as the tibial tubercle growth plate closes after skeletal maturity. 

Physical Examination

Physical Examination  

Localized Tenderness: Pain and tenderness directly over the tibial tubercle, which may be unilateral or bilateral. 

Swelling or Prominence: The tibial tubercle may appear swollen or enlarged compared to the opposite knee. 

Pain with Activity: Discomfort is reproduced with resisted knee extension, squatting, jumping, or running. 

Tightness of Quadriceps and Hamstrings: Palpable or observable muscle tightness that can increase traction on the tibial tubercle. 

Range of Motion: Usually preserved, though full knee flexion may exacerbate pain. 

Gait Alterations: Mild limp or avoidance of impact activities may be present in symptomatic patients. 

Age group

Associated comorbidity

Associated Comorbidity or Activity: 

Patellar tendinitis (jumper’s knee) 

Sinding Larsen Johansson syndrome (involving the inferior pole of the patella) 

Quadriceps muscle tightness or imbalance 

Hamstring tightness 

Pes planus (flat feet) or other biomechanical misalignments that increase stress on the knee 

Associated activity

Acuity of presentation

Acuity of presentation: 

Osgood Schlatter disease presents with a gradual onset of pain and swelling over the tibial tubercle rather than sudden symptoms. The discomfort typically worsens with physical activity, especially running, jumping, or kneeling, and improves with rest. 

Differential Diagnoses

Infectious apophysitis 

Synovial plica injury 

Perthes disease 

Osteomyelitis of the tibia 

Patella tendonitis 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Osgood Schlatter disease is self-limiting and usually resolves once the tibial tubercle apophysis fuses, which may take up to two years. Management focuses on activity modification, pain control with ice or NSAIDs, and stretching and strengthening of the quadriceps and hamstrings. Protective knee padding may help, and physical therapy is considered if symptoms persist. Surgery or injections are not recommended. Long-term, the tibial tubercle may remain prominent but is usually asymptomatic. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

lifestyle-modifications-in-treating-osgood-schlatter-disease

Activity Adjustment: Limit or modify high-impact sports such as running, jumping, and kneeling while maintaining participation in low-impact activities like swimming or cycling. 

Surface Consideration: Encourage training on softer or shock-absorbing surfaces to reduce repetitive impact on the knees. 

Protective Equipment: Use padded knee supports or cushions during activities that involve kneeling or direct contact with the tibial tubercle. 

Footwear: Ensure properly fitting, supportive shoes to improve lower limb biomechanics and reduce strain on the knee. 

Effectiveness of NSAID’s in treating Osgood-Schlatter Disease

Ibuprofen (Motrin, Advil, Ultraprin)
Ibuprofen is commonly used to manage mild to moderate pain. It works by reducing prostaglandin synthesis, thereby decreasing inflammation and alleviating pain. 

Ketoprofen
Ketoprofen is indicated for mild to moderate pain and inflammation. Lower initial doses are recommended for small-statured or elderly patients, as well as those with liver or kidney impairment. Doses above 75 mg generally do not enhance effectiveness, so higher doses should be used cautiously with careful monitoring of patient response. 

Naproxen (Naprelan, Anaprox, Aleve, Naprosyn)
Naproxen is employed to relieve mild to moderate pain by inhibiting cyclo-oxygenase activity, which lowers prostaglandin production and reduces both pain and inflammation. 

role-of-management-in-treating-osgood-schlatter-disease

Osgood-Schlatter Disease management involves phased care focused on pain control, rehabilitation, and gradual return to activity. In the acute phase, pain and inflammation are addressed through activity modification, ice therapy, NSAIDs if needed, and protective padding. The rehabilitation phase emphasizes stretching of the quadriceps and hamstrings, strengthening of lower limb and core muscles, and low-impact exercise to maintain fitness. Gradual return-to-activity follows, guided by pain resolution, with progressive participation in sports while continuing flexibility and strength exercises. Long-term management includes education, monitoring until skeletal maturity, and preventive measures to avoid recurrence, recognizing that the condition is self-limiting and resolves as the tibial apophysis fuses. 

Medication

Future Trends

Media Gallary

References

Osgood-Schlatter Disease – StatPearls – NCBI Bookshelf