Osgood Schlatter Disease

What is an Osgood Schlatter Disease

Osgood Schlatter Disease is an inflammation of the tibial tubercle, which is an area below your kneecap (patella). The inflammation causes pain and tenderness in this area.

It is most often seen in children and adolescents during the time of growth spurts. The muscles and cord-like structures that attach muscle to bone (tendons) tighten as the bones become longer.

Osgood Schlatter disease is a common cause of knee pain in adolescence (11 to 14 years old) that is thought to result from repetitive traction through the patellar tendon onto the developing tibial tubercle.

This traction can lead to partial avulsion through the ossification center and heterotopic bone formation.

This puts strain on areas of tendon attachment. Osgood Schlatter Disease is associated with physical activity that involves running and jumping.

7 Interesting Facts of Osgood Schlatter Disease

  • Osgood-Schlatter disease is painful swelling of anterior proximal tibia, usually found in adolescents, due to traction apophysitis of tibial tubercle
    • Patients are typically athletic adolescents at the beginning of a rapid phase of growth
  • Patients usually present with gradually increasing pain, swelling, and tenderness over tibial tuberosity
  • Diagnosis can be made on clinical findings, but plain radiography is often useful, especially in unilateral, acute, or persistent cases
  • Mainstay of treatment is conservative approach: activity modification, ice, antiinflammatory agents, rehabilitation, and time
  • Overall prognosis is good; long-term sequelae and surgical treatment are uncommon
    • Usually a self-limiting disorder; most patients outgrow the condition after skeletal maturity

What are the causes?

Osgood Schlatter Disease is caused by a strain on areas of tendon attachment during activity.

It occurs when the muscles and tendons that attach muscle to the tibial tubercle are becoming longer.

Who are at risk?

You may be at increased risk for Osgood Schlatter disease if:

  • You are physically active and participate in sports or activities that involve running and jumping.
  • You are experiencing puberty and growth spurts, especially between the ages of 8 and 15 years.

What are the symptoms?

The most common symptom is pain that occurs during activity. Other symptoms include:

  • A lump or swelling below one or both of your kneecaps.
  • Tenderness or tightness of the muscles above one or both of your knees.

How is this diagnosed?

Osgood Schlatter Disease may be diagnosed by:

  • Symptoms and medical history.
  • Physical exam.
  • X-ray.

Although the diagnosis may be made clinically, radiographs may aid in the exclusion of other etiologies of knee pain.

Lateral radiographs may reveal irregular ossification of the proximal tibial tubercle, calcification and thickening of the patellar tendon, and soft tissue swelling.

How is this treated?

Osgood Schlatter disease can improve in time with simple treatment and less physical activity. Surgery is rarely needed. Treatment may include:

  • Medicines, such as NSAIDs.
  • Resting the affected knee or knees.
  • Physical therapy and stretching exercises.
  • Wearing a knee strap (patellar tendon strap). The strap may help to lessen the strain on the tendon.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured knee or knees:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.


  • Rest as instructed by your health care provider.
  • Limit your physical activities until the pain goes away. Choose activities that do not cause pain or discomfort.
  • Do stretching exercises for your legs as directed, especially for the large muscles in the front and back of your thighs.
  • Wear the knee strap as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

  • Increasing pain or swelling in the knee area.
  • Trouble walking or difficulty with normal activity.
  • A fever.
  • New or worsening symptoms.


  • Osgood Schlatter disease is an inflammation of the tibial tubercle, which is an area below your kneecap (patella).
  • The inflammation causes pain and tenderness in the area below your kneecap. It is most often seen in children and adolescents during the time of growth spurts.
  • The most common symptom is pain that occurs during activity.
  • This condition is treated with rest, pain medicine, and physical therapy. Wearing a knee strap may help.
  • Follow your health care provider’s instructions about what activities to avoid, how to apply ice, and when to contact your health care provider.

Osgood Schlatter Disease Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Quadriceps, prone

  1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
  2. Bend your __________ knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
  3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your __________ thigh and knee.
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Standing lunge (hip flexors)

  1. Stand with the foot of your injured leg 2–3 ft (0.6–1 m) in front of your other foot.
  2. Keeping good posture with your head over your shoulders, tuck your tailbone underneath you. Slowly shift your weight toward your front leg until you feel a stretch in the front of your back hip and thigh. It is okay if your back heel comes off the floor.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise C: Hamstring, doorway

  1. Lie on your back in front of a doorway with your __________ leg resting on the wall and your other leg flat on the floor in the doorway. There should be a slight bend in your __________ knee.
  2. Straighten your __________ knee. You should feel a stretch behind your __________ knee or thigh. If you do not feel that stretch, scoot your bottom closer to the door.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Straight leg raises (hip flexors and quadriceps)

  1. Lie on your back with your __________ leg extended and your other knee bent.
  2. Tense the muscles in the front of your __________ thigh. You should see your kneecap slide up or see your muscle bulge just above the knee, or both.
  3. Keeping these muscles tight, raise your __________ leg to the height of your __________ knee. Do not let your moving leg bend.
  4. Hold this position for __________ seconds.
  5. Keep the muscles tense as you lower your leg.
  6. Relax your muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Straight leg raises (hip abductors)

  1. Lie on your side with your __________ leg in the top position. Lie so your head, shoulder, knee, and hip line up. You may bend your bottom knee to help you keep your balance.
  2. Roll your hips slightly forward so your hips are stacked directly over each other and your __________ knee is facing forward.
  3. Leading with your heel, lift your top leg 4–6 inches (10–15 cm). You should feel the muscles in your outer hip lifting.
    1. Do not let your foot drift forward.
    1. Do not let your knee roll toward the ceiling.
  4. Hold this position for __________ seconds.
  5. Slowly return to the starting position.
  6. Let your muscles relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Additional Info on Osgood Schlatter disease


  • Persistent bone pain in adolescents may rarely represent primary or metastatic tumor; investigate further and refer to orthopedist

Osgood-Schlatter disease is painful swelling of anterior proximal tibia, usually found in adolescents, due to traction apophysitis of tibial tubercle

Most cases are overuse injuries due to microtrauma from repetitive quadriceps contraction

It is a common cause of anterior knee pain in skeletally immature adolescents, but it can affect all ages

Clinical Presentation


  • Patients are typically athletic adolescents at the beginning of a rapid growth phase
    • May be bilateral in up to 30% of patients, with one knee typically more severe 
  • Often associated with recent increase in physical training load or with a growth spurt
  • Early presentation is characterized by focal pain and possibly mild swelling over tibial tubercle
    • Onset of pain is typically gradual
    • Pain may be intermittent and exacerbated by running, jumping, or kneeling
    • May report vague, achy anterior knee pain, worsened with squatting or stairs
  • As disease progresses, pain becomes more constant and severe
  • Not typically associated with mechanical symptoms such as catching, locking, or instability
  • Symptoms may be recurrent and not resolve until after adolescent growth spurt

Physical examination

  • Tenderness is usually focal and localized to tibial tuberosity and patellar tendon
    • Tibial tuberosity is often enlarged at distal patellar tendon insertion
  • Pain can be reproduced with extension of knee against resistance
  • Tightness in quadriceps and hamstring muscles may be noted
  • Knee effusion is typically not present
  • Examine the hips, because hip pain can be referred to knees
  • With unilateral knee pain, examine the unaffected knee, as the condition is often bilateral


  • Thought to be caused by overuse at knee joint resulting in repetitive traction from quadriceps muscle at patellar tendon on tibial tubercle ossification center
  • Less frequently, may also be caused by kneeling or other direct knee contact

Risk factors and/or associations

  • Most common in growing children and adolescents
    • Boys aged 12 to 15 years (mean age of about 13)
    • Girls aged 8 to 12 years (mean age of about 11)
  • Sometimes described as more prevalent in boys, but other literature has reported similar frequency in both genders 
    • Difference may reflect increased participation in competitive sports by girls 
Other risk factors/associations
  • Participation in competitive sports, especially those involving jumping and running (eg, soccer, gymnastics, basketball, volleyball)
    • More than 20% of 13-year-old adolescents active in sports have signs and symptoms of Osgood-Schlatter disease

How is Osgood Schlatter disease diagnosed?

  • History and physical examination may be all that is needed to make a clinical diagnosis 
  • Use of radiography on initial classic presentation is variable in the literature
    • Obtain radiographs if pain is acute or occult trauma is suspected, to help rule out avulsion fracture or displaced apophysis 
    • Obtain radiographs in cases of unilateral or persistent pain to rule out other causes (eg, infection, neoplasm, fractures) 
    • If radiographs are not obtained on initial presentation, careful follow-up is warranted 


  • Plain radiography
    • Recommended to investigate unilateral cases, to rule out other conditions (eg, acute tibial apophyseal fracture, infection, or tumor), and to confirm diagnosis 
    • Common radiographic findings:
      • Soft tissue swelling anterior to tibial tuberosity is the most important radiologic finding 
      • In early disease, irregularity of apophysis with separation from tibial tuberosity may be seen 
      • In late disease, fragmentation of apophysis may be seen 
    • Comparison views of unaffected contralateral knee are often helpful 
  • Advanced imaging: CT, MRI, and bone scans
    • Rarely indicated unless other diagnoses are being considered (eg, fractures) 
    • MRI may assist in diagnosis of atypical presentation 
      • Role of MRI in diagnosis, management, and prognosis is currently limited
  • Ultrasonography 
    • May be used as adjunct devoid of radiation to assist in diagnosis or to follow the progress of the disorder 
    • 4 pathologic findings have been noted in the literature:
      • Pretibial swelling
      • Fragmentation of ossification center
      • Insertional thickening of patellar tendon
      • Excessive fluid collection in infrapatellar bursa

Differential Diagnosis

Most common

The following conditions may coexist with Osgood-Schlatter disease (especially after traumatic event) or exist as separate disease process

Treatment Goals

  • Promote healing
  • Prevent further injury
  • Control pain

Recommendations for specialist referral

  • Refer to orthopedic surgeon for further evaluation and treatment in cases with:
    • Significantly displaced apophysis
    • Fracture
    • Unusually severe or prolonged symptoms

Treatment Options

Mainstay of treatment is conservative approach: activity modification, ice, antiinflammatory agents, rehabilitation, and time 

NSAIDs are the most commonly used antiinflammatory agents; corticosteroid injections are not indicated 

  • Counsel on using NSAIDs sparingly for pain not relieved by rest
  • Potential exists for masking of symptoms during sports or other activities, which may lead to further injury 

Though rarely necessary, surgical excision of ossicles and/or tubercleplasty can provide pain relief after patient is skeletally mature 

Nondrug and supportive care

  • Activity modification: cessation of, or decreased participation in, exacerbating activities 
    • Duration of initial rest is typically 2 to 3 weeks 
      • After patients are symptom free during activities of daily living, they can gradually return to sport
  • Cryotherapy 
    • Ice packs and cold therapy units are frequently recommended to reduce pain and inflammation
    • Ice pack may be applied for 20 minutes up to every hour as needed (keep towel or fabric between ice and skin) 
  • Physical therapy 
    • Recommended once acute symptoms have abated
    • Includes exercises for strengthening and improving flexibility of surrounding musculature (ie, hamstring, iliotibial band, quadriceps, gastrocnemius muscle)
      • Quadriceps strengthening exercises can increase stress across the tibial tuberosity, so it is important that the intensity is gradually and gently increased to avoid further trauma
  • Knee immobilization
    • Rarely necessary; in moderately severe or prolonged cases, bracing for 2 to 3 weeks may be considered 
  • Protective knee padding
    • May be helpful to protect area from blunt trauma, especially if activities require frequent kneeling
  • Infrapatellar strap
    • Limited studies have shown that use of an infrapatellar strap to decrease traction forces may improve symptoms during activity 

Special populations

  • Osgood-Schlatter disease in adults 
    • 10% of patients may continue to have symptoms into adulthood
      • Pain with kneeling is the most common symptom
    • Adults with anterior knee pain and tibial tuberosity ossicles on plain radiographs may need ultrasonography or MRI to search for active inflammation 
    • Surgical intervention can be considered after skeletal maturity if symptoms affect quality of life and are refractory to conservative measures


  • Persistent discomfort with kneeling
  • Painful ossicles in distal patellar tendon
  • Very rarely, complete tibial tubercle avulsion fracture


  • Overall prognosis is good; long-term sequelae and surgical treatment are uncommon
    • Full recovery is expected in about 90% of patients after complete closure of tibial tuberosity growth plate 
    • Residual discomfort in kneeling and need for activity restriction may exist in a few cases 
    • Prominence of tibial tuberosity may persist
    • Symptoms may wax and wane for 12 to 24 months before complete resolution 
  • Typically a self-limiting disorder, but it may cause disruption of training
    • A retrospective questionnaire study found that pain caused athletes to completely stop training for an average of 3.2 months and to limit training for an average of 7.3 months 


  • Conditioning and training programs (preseason and in-season) focus on neuromuscular control, balance, coordination, flexibility, and strengthening of lower extremities to reduce risk of overuse injuries
  • Limit the total amount of repetitive sport activity engaged in by pediatric athletes
    • 1 to 2 days off per week from competitive practices, competitions, and sport-specific training
  • Progression of training intensity, load, time, and distance (increase by no more than 10% per week)


Yen YM: Assessment and treatment of knee pain in the child and adolescent athlete. Pediatr Clin North Am. 61(6):1155-73, 2014 Reference


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