Knee Injuries

Osgood Schlatters

Jun 23, 2022

What is Osgood-Schlatters?  

Osgood-schlatter disease (OSD) is swelling and irritation of the growth plate at the top of shin bone. A growth plate is a layer of cartilage near the end of a bone where most of the bone’s growth happens.It is weaker and more at risk for injury than the rest of the bone.

If we define it more technically so this disease  is “traction apophysitis at the level of Tibial tubercle due to repetitive strain o the secondary ossification center of Tibial tuberosity “Causes of repetitive strain can be strong pull of quadriceps muscle produced during sporting activities. Tibial avulsion is another cause which may occur in the preossification phase. Once the bone or cartilage is pulled away it continues to grow, ossify and enlarge. This enlarged area may become fibrous, creating a separate persistent ossicle or may show complete bony union with some enlargement of Tibial tuberosity. Traction apophysitis is one of the most encountered overuse injuries in children and adolescents.

If we see anatomy researches show that Tibial tubercle is a large elevation on the proximal anterior aspect of tibia, just distal to anterior surfaces of medial and lateral Tibial condyles. It gives attachment to patellar tendon. Stress at this musculo-tendonous junction can cause pain and swelling. The Osgood-Schlatter disease is localized at the Tibial tubercle, distal and anterior to the knee.

What are the signs & symptoms ?

If we talk about sign and symptoms of osgood-schlattter disease pain is a leading symptom in this disease and it aggravates during physical activities such as running, jumping , kneeling, cycling, walking up and down the stairs and kicking a ball. In sports  like basketball, volleyball, soccer and in tennis pain increases.  Swelling and hypertrophy of the tubercle can be occur.  In quadriceps muscle tightness is a significant symptom.

  • Painful palpation of the tibial tuberosity.
  • Pain at the tibial tuberosity that worsens with physical activity or sport.
  • Increased pain at the tibial tuberosity with squatting, stairs or jumping.
  • In some cases increased bony protuberance at the tibial tuberosity.

Some differential diagnosis can be:

  • Jumper’s knee (patellar tendinitis) or Sinding- Larsen-Johanssen syndrome
  • Hoffa’s syndrome
  • Synovial plica injury
  • Tibial tubercle fracture

Do I need investigations?

For diagnosis purpose X-RAY  may be utilized to visualize the musculo-tendonous junction. Radiographic examinations of both knees should always be performed, in both the anterior-posterior and lateral projections, to rule out the possibility of tumors, fractures, ruptures or infections. The lateral radiograph generally shows the characteristic picture of prominent tibial tubercle with irregularly ossific nucleus, or free bony fragment proximal to the tubercle. Imaging is also useful to exclude tuberosity epiphysiolysis or tumors.

In some cases sonographic examination can also be used. The ultrasound can be directed to demonstrate the appearance of the cartilage and bony surface, the patellar tendon, soft-tissue swelling anterior to the tibial tuberosity, and fragmentation of the tibial tuberostings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

Can a diagnosis be confirmed with a physical examination?

YES! A diagnosis can be made through a thorough history and examination. Tenderness to palpation over the tibial tuberosity that worsens with weight-bearing squat or jumping is fairly indicative of this disease.

Physical examination reveals pain during palpation of the tibial tubercle.

Resisted extension of the knee from 90° flexed position will usually reproduce pain, but resisted straight leg raised test is usually painless.

Ely’s test, which proves excessive tightness of the quadriceps femoris muscle, is positive in all cases.

A diagnosis can be made through history and examination. Tenderness and swelling over tibial tuberosity that worsen with weigh bearing activity is a clear indication of this disease.

  • If we palpate tibial tubercle pain produce.
  • If we ask the patient to do resisted extension from flexion position of knee reproduces pain but important point is that straight leg raise is painless.
  • Ely’s test that proves excessive tightness of quadriceps muscle is positive in all cases.

What can I do to help the condition?

Treatment begins with rest, activity modification and sometimes drugs are helpful that are NSAIDS (Non-steroidal anti-inflammatory drugs). Physiotherapy can play a significant role that improves the flexibility and strengthen the surrounding musculature. In this mainly muscles are quadriceps, hamstrings, iliotibial band and gastrocnemius muscle. High intensity

The physiotherapist can focus on exercises to improve the flexibility and strenghten the surrounding musculature. This includes the quadriceps, hamstring, iliotibial band and the gastrocnemius muscle. High-intensity quadriceps-strengthening exercises increase stress across the tibial tuberosity and are initially avoided. Stretching should initially be performed statically at a low intensity to prevent pain before progressing to dynamic or PNF stretching. Duration of at least thirty seconds with three repetitions is recommended at least once a day to increase the range of motion. Low-intensity quadriceps-strengthening exercises, such as isometric multiple- angle quadriceps exercises, are therefore instituted earlier in the conditioning program. High-intensity quadriceps exercises and hamstring stretching are introduced gradually and have been proven effective with high evidence rating. Other treatments are shock wave, activity limitation and tapping.

In some cases surgery is indicated surgical procedures should be avoided until the child has grown up and the bone growth has been completed to avoid growth-plate arrest and the development of recurvatum and or valgus of the knee. Surgical treatment, we identified different surgical procedures such as drilling of the tibial tubercle, excision of the tibial tubercle (decreasing the size), longitudinal incision in the patellar tendon, excision of the ununited ossicle and free cartilaginous pieces (tibial sequesstrectomy), insertion of bone pegs and/or a combination of any of these procedures.


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