Osgood-Schlatter Lesion

What is it?

Osgood-Schlatter lesion (sometimes also called Osgood-Schlatter disease, osteochondritis dissecans or tibial apophysitis) occurs in children and adolescents when small bits of growing bone and cartilage become separated from the lower leg bone (tibia) just below the knee. This condition is not truly a fracture or a broken bone, nor is it a sprain or strain. It happens because the large tendon from the upper thigh muscles and kneecap pulls very hard on the lower part of the knee during running and especially jumping. This is why Osgood-Schlatter Lesion is common in young basketball players and dancers. Children and teens with Osgood-Schlatter Lesion complain of pain at the knee or just below it. Often there is pain and swelling on both legs just below the knee joint, and the area may be tender if pressed. Usually it doesn’t hurt much just to move the knee without standing on it. Older teens and adults rarely develop this condition because most of the cartilage turns to solid bone and is less fragile.

Pain and reduced ability to walk, run, or play sports are the biggest concerns. Of course, your doctor will also have considered the possibility that other more serious conditions are present, such as fractures, arthritis, or infection. If necessary your doctor will have done an X-ray to rule out these other conditions. In most cases surgery is not needed unless other treatments fail.

In the vast majority of children and teens, Osgood-Schlatter can be treated with just resting the legs and use of ibuprofen (Advil® or Motrin®), which reduces both pain and inflammation. Resting the legs means restricting one’s movements to normal walking only – no running, jumping, climbing, or other strenuous use of the knees. Occasionally crutches are helpful, particularly when some walking is unavoidable. In very rare cases when other treatment fails, surgery may be needed to re-attach the bone to the knee.

The pain in Osgood-Schlatter Lesion usually starts to go away as soon as the child or teen begins proper rest and takes some pain medication. With proper rest the pain should nearly disappear entirely within a week. If it does not, or if the pain gets worse, first check with your child or teen to be sure that they are really resting as instructed. If s/he is, then check back with your doctor to be sure something else is not going on, such as a fracture or an infection.

It is often very hard to convince an athletic and competitive teen to stop playing in sports or other activities for long enough to heal the condition. Most team players will understand the idea that for them to give the team their best effort, they have to recover completely first. Professional athletes know that it is better to take a few days or a week off and then come back to the team at a hundred percent. They don’t to try to be a hero and then lose the game because of poor performance related to an injury.

Knee pain in an active child or teen can have many causes. Injury is among the most common, and of course a broken bone is always a concern. Broken bones are usually much more painful than Osgood-Schlatter. Boys are more likely to have Osgood-Schlatter than girls. Boys are also more likely to have tendonitis (swelling and pain) of the tendon over the kneecap. Boys (and some girls), especially if they are overweight or obese, can have a hip injury called SCFE that may cause knee pain as well. Girls with knee pain may have "patellofemoral pain syndrome," (PFPS) caused by the kneecap hitting against the end of the upper leg bone. It is important to distinguish between Osgood-Schlatter and PFPS because the treatments are quite different.

Children and teens of either sex may have an infection of the bones or joint at the knee. These infections cause severe pain, redness, and swelling of the knee only on one side, and often produce fever and general illness as well. Finally, in children with knee pain on both sides that does not go away with rest and pain medication, there is the rare possibility of one of the childhood forms of arthritis. Your doctor may check for these conditions if the knee pain does not go away with routine rest and care.