Osgood-Schlatter's Syndrome
A real pain in the knee

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.