Osgood-Schlatter's Syndrome
A real pain in the knee
Brian
FitzGerald, BSN, LATC
Knee pain is common in adolescents who experience a rapid growth
spurt, but in physically active teens, such pain is just as likely
to indicate an acute or overuse injury. In the case of Osgood-Schlatter's
syndrome (OS), both growth and injury can play a role, and activity
restrictions provide the best route to an excellent prognosis.
OS is a traction apophysitis of the tibial tuberosity, or inflammation
created where a tight patella tendon creates tension, pulling
away from bone attachment below the knee. The problem is associated
with growth spurts, since rapidly lengthening bones cause the
quadriceps, hamstring, gastrocnemius muscles and their tendons
to become tight and inflexible, creating tension and tenderness
at the insertion of these muscle tendons to the bone. A bony prominence
can often develop over the traction site, causing discomfort with
kneeling and contact. This condition becomes exacerbated by sports
requiring repetitive quadriceps contractions.
Although it is generally a benign condition, OS is one of the
most common causes of knee pain in adolescent athletes. More serious
consequences, including formation of a free ossicle at the site
of traction that may require surgical excision, can be avoided
with early diagnosis and treatment.
Generally, OS can be treated symptomatically in the primary care
setting. However, if pain persists (especially during inactivity),
the patient should be referred to an experienced specialist to
rule out the possibility of free ossicle, avulsion fracture, infection
or tumor.
Treatment generally includes rest and ice until symptoms subside,
followed by stretching and strengthening exercises of the quadriceps.
If on examination the tendon is "hot" to the touch, the patient
should be advised to stop any activities that aggravate the condition,
treat with NSAIDS and ice. Once the knee is no longer tender,
a patient who is compliant with stretching exercises may return
to activity, but should use an infrapatella strap or patella tracking
brace.
