Bilateral anteroposterior radiograph of a 12-year-old girl with a 3-week history of pain in her right anterior knee
Lateral radiograph of the patient
Merchant view radiograph of the patient
A 12-year-old girl presents with a 3-week history of pain in her right anterior knee. She recently started playing basketball, and the knee pain seems to increase with jumping and running. On examination, tenderness to palpation over the tibial tubercle is noted. The pain is made worse with passive hyperflexion and active extension against resistance. She has no pain over the patellofemoral joint with repetitive flexion, and there is no abnormal tracking of the patella. Bilateral anteroposterior, lateral, and Merchant view radiographs are taken.
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Osgood-Schlatter disease (OSD) or traction apophysitis is an inflammation of the growth plate at the tibial tubercle where the patella tendon attaches. OSD occurs in adolescents during peak growth age, which is when skeletal growth outpaces the stretch of surrounding tendons. In OSD, the tight patella tendon pulls on the tibial apophysis, causing inflammation and, in some cases, partial or complete avulsion of the tibial tubercle.
Partial avulsion will cause a noticeable bump on the anterior tibia and is a common finding in people with long-standing OSD. Pain, tenderness, and swelling will be present over the tibial tubercle during palpation, and pain is made worse with resisted active knee extension. Lateral radiograph of the knee is the most telling in patients with OSD, often showing irregularity and fragmentation of the tibial tubercle.1,2
Symptoms generally resolve with a period of rest, activity modification, ice, and nonsteroidal anti-inflammatory drug therapy. Physical therapy can help patients stretch the quadriceps muscle to relieve tension on the tibial apophysis. OSD may cause pain for several months and therefore a lengthy period of conservative treatment may be necessary. Athletes may play through mild pain if tolerable. An infrapatella strap may be used during sport participation to help with the pain. Severe pain may signal an impending avulsion fracture, and the athlete should rest accordingly. The pain generally subsides with rest or when skeletal growth is complete, which is generally around age 14 years for girls and age 16 years for boys. Patients should be advised, however, that a bump on the anterior tibia, if present, will persist through adulthood.1
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Pihlajamäki HK, Mattila VM, Parviainen M, Kiuru MJ, Visuri TI. Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men. J Bone Joint Surg. 2009;91:2350-2358.
- Woon C. Osgood Schlatter’s disease (tibial tubercle apophysitis). http://www.orthobullets.com/sports/3029/osgood-schlatters-disease-tibial-tubercle-apophysitis. 2017. Accessed March 27, 2017.