Osgood Schlatter's Disease
Osgood Schlatter's disease is an osteochondritis or appophysitis injury at the tibial tubercle due to repetitive strain on the tibial tuberosity. The tibial tubercle is located on the anterior proximal tibia and is the attachment site of the patella tendon.
During adolescence children go through a growth spurt. The bones and cartilage grow faster than the muscles and tendons. With the tendons being shorter compared to the bones there is increased strains placed on the patella tendon and its attachment site, the tibial tuberosity. Increased strain from a strong quadricep contraction, in sports specifically, activates in deep knee bends causes increase strain. Micro tibial tuberosity avulsion may occur. As the bone or cartilage is pulled away, the bone continues to grow and the tibial tuberosity becomes enlarged. With increased tension/strain on patella tendon, combined with micro avulsions, pain becomes persistent.
Pain that worsens with activity and pain with palpation of the patella tendon and tibial tuberosity are the hallmark signs of Osgood Schlatter's disease. Pain may also increase with squatting, stairs, jumping, and/or kneeling. Radiographs may be used to rule out tumors, fractures, ruptures, or infection. Resisted extension at 90 degrees typically reproduces pain, but resisted SLR is painless. Ely's test for quadricep tightness is positive in almost all cases.
Physical therapy's goal is to increase muscle length, joint mobility, motor function, and strength over a 2-4 month period. Limitation of provocative activities along with ice are necessary when pain is unable to be modulated. Taping techniques such as the McConnel method have been attributed to decreasing knee pain. Low intensity quad stretching and strengthening should be performed.
Prognosis is generally good with most symptoms resolving in 2 years time for the majority of the cases.