Osgood Schlatter disease (OSD, or as it called Lannelongue’s disease) is an osteochondrosis, or fatigue failure, of the tibial tubercle apophysis that is characterized by pain over the tibial tubercle in a growing child.

Regular sport activity and tightening of the rectus femoris, as judged by passive knee flexion in hip extension, are associated with tibial tubercle apophysitis.

  • It’s mostly occurs in the second decade of life (10 to 15 years in boys and 8-12 years in girls).
  • Male > females
  • Bilateral in 20-30% of cases.

The first descriptions were by Osgood in 1903 and by Schlatter the same year1.

Anatomy

Tibial tubercle forms the proximal front side of the tibia, it serves as an insertion for the patellar tendon (function as extensor mechanism of the knee joint).

Tibial tubercle apophysis is a secondary ossification center that appears as following:

  • At the age < 11 years, the tibial tubercle is cartilaginous, the apophysis forms between the age of 11-14 years.
  • The apophysis fuses with tibial epiphysis at the age 14-18 years.
  • The epiphysis (and apophysis) is fused to rest of tibia after the age of 18 years.
tibial tubercle anatomy

Symptoms and Signs

The symptoms of Osgood Schlatter Disease include:

  1. Pain directly over the tibial tubercle: The pain is aggravated by activities but usually persists even when activities have been curtailed.
  2. Swelling over the tubercle.
  3. There is often enlargement of the tubercle, which is firm on palpation.

The examination reveals point tenderness directly over the tibial tubercle and the distal portion of the patellar tendon., pain in the area is produced by resisted knee extension.

The natural history is one of persistence for months to years during adolescence, with subsequent gradual resolution.

Occasionally symptoms will persist after skeletal maturity, particularly an inability to kneel comfortably. Fragmentation of the tibial tubercle on radiographs has been associated with prominence of the tubercle and continued symptoms at follow-up.

Osgood Schlatter Disease symptoms
Enlargement of the tibial tubercle

Radiographic Findings

Plain AP and lateral radiographs are usually the only diagnostic studies necessary to evaluate the osgood schlatter disease.

  • The lateral radiograph may show fragmentary ossification of the tibial tubercle, which is often a normal variant. In late cases ossicles may form on the undersurface of the patellar tendon just as it reaches the tubercle.

One prospective study has shown an association of patella alta with Osgood-Schlatter disease2.

Osgood Schlatter Disease radiology
Fragmentary ossification of the tibial tubercle

Osgood Schlatter Disease Treatment

Non-operative treatment:

The treatment of Osgood-Schlatter disease should be conservative and expectant.

  1. Reassurance is important because some parents fear that the swollen tubercle may be a sign of malignancy.
  2. Activity limitations should be left up to the child and family, with the understanding that this is not a progressive or crippling disorder. Thus, activity that can be done with tolerable discomfort should be recommended.
  3. NSAIDs may be helpful.
  4. knee immobilizer may be used for a few weeks in severe cases.
  5. Quadriceps stretching may be recommended for symptomatic improvement as tightening of the rectus femoris has been shown to be associated with the condition.

Osgood Schlatter Disease Exercise program:

Straight leg raise is the most common exercise used in rehabilitation program for Osgood Schlatter Disease.

In this exercise, the patient is asked to straight elevate the limb without flexing the knee to a height of about 12 inches from the ground. This is done for 10 to 15 repetitions in the set of 2. The repetition and sets can be increased accordingly.

Few other exercises are also recommended like: short arc quadriceps for quadriceps release, wall slides or quarter squats for strengthening the hamstrings and gastrocnemius muscle.

Osgood Schlatter Disease excercises
Osgood Schlatter Disease excercises

Operative Treatment:

Removal of ossicles from the tubercle may occasionally be necessary in patients with persistent, disabling symptoms.

Prominence of the tubercle has been the major complication after surgical management.

Combined ossicle excision and anterior prominence tubercle plasty through a patellar tendon splitting incision at maturity has been reported with good results.

While uncommon, closure of the tibial tubercle with severe genu recurvatum has been reported with untreated OsgoodSchlatter disease.

Osgood Schlatter Disease ossicles removal
Ossicles removal

Questions & Answers:

How do you pronounce Osgood-Schlatter?

OZgood SHLAWter, that’s how you pronounce it.

Can Osgood Schlatter Disease cause problems later in life?

This condition heals spontaneously when the child’s growth is complete and the epiphysis of the bone fuses. In some cases (10 % of patients), a persistent pain may remain at the site of the tibial tuberosity due to a piece of osteochondral residual from the epiphysis, and we may have to remove it.

Is Osgood Schlatter disease hereditary?

No, it’s not. This condition is an inflammatory disease that is caused due to traction on the apphysis of the tibial tubercle. Some researcher said that it could be familial disease.

What is another names for Osgood Schlatter disease?

1. Lannelongue’s disease.
2. Apophysitis of the tibial tubercle.
3. Osteochondrosis of the tibial tubercle

Reference

  1. Osgood R: Lesions of the tibial tubercle occurring during adolescence, Boston Med Surg J 148:114, 1903. Link
  2. Aparicio G, Abril JC, Calvo E, et al: Radiologic study of patellar height in Osgood-Schlatter disease, J Pediatr Orthop 17:63, 1997. PMID: 8989704
  3. Tachdjian Pediatric Orthopaedics 5th edition book.
  4. Millers Review of Orthopaedics, 7th Edition Book.
  5. Campbel’s Operative Orthopaedics 13th edition book.