Osgood-Schlatter disease

Knee pain in children is often caused by issues with the biomechanics of the leg itself. For example, the way a child runs, hops, walks and stands, all tell us something about the ability of the lower limb to cope with changes in load. Statistically children with other mechanical imbalances such as knocked knees or flat feet are more likely to develop muscular pain.

Patellofemoral joint pain (pain at the front of the knee) is the most common cause of knee pain in children. With periods of growth, direct trauma or repetitive micro trauma all being causes of pain at the front of the knee. Osgood-Schlatter disease is an apophysitis of the patellar tendon. This is where you get a breakdown of the bone where tendons attach, which in this case is at the tibial tuberosity of the shin bone. Osgood Slatter Disease is chronic inflammation of the patellar tendon with associated micro avulsion of the patellar tendon off the tibia. We commonly see this condition in boys and girls (though more commonly boys) aged 8-15 years of age. More often than not it occurs due to repetitive stress being placed through the patellar tendon that you see with lots time spent playing sport.

Signs and Symptoms

• sometimes cause a painful limp

• pain is worse during or after the activity

• cause a painful lump at the front of the knee

• swelling at the patellar tendon attachment

This condition is what we define as self-limiting, in that it will resolve if you avoid the things that aggravate it. Having said that, as we see this presentation in the more intensely active children who engage in sports that require running and jumping, this is a hard pill to swallow. What I find works best is a compromise when it comes to managing load, if the child can reduce their sporting commitments, alongside physiotherapy management which includes things like taping, manual therapy, a home regime of stretches and strength work, often outcomes are quite good without having to resort to completely giving up all the things they love doing.

This condition can get worse it it isn’t managed well, with repetitive overloading a lump of bone or calcium can develop below the knee. In some cases this can be painful and may not resolve even after the child has finished growing. Surgery is a possibility if the pain doesn't resolve.

Common but not untreatable, Osgood-Slatter Disease will resolve once growth has ceased and the child may have a bump on the knee as a result.

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Sam and Andy