An adolescent male presents with unilateral knee pain and swelling (Figure 90-1). His pain is worse after athletic participation and with kneeling. On examination, he has point tenderness and edema of the tibial tubercle. He is diagnosed with Osgood-Schlatter disease and treated with rest, ice, and non-steroidal anti-inflammatory medication. His symptoms improve but he continues to have mild flares of pain when he is more active.

Osgood Schlatter disease was described in 1903 by Dr. Osgood and Dr. Schlatter as pain and edema of the anterior tibial tubercle.^1,2 These clinical findings result from traction apophysitis at the patellar tendon insertion site on the proximal tibial tubercle.

Osteochondritis of tibial tubercle; tibial tuberosity avulsion.

• Occurs in adolescents after a rapid growth spurt.

• More common in males than females (Figure 90-2).³

• More common in athletes (21.2%) than nonathletes (4.5%).⁴

• Overuse injury.

• Repetitive strain leads to chronic avulsion of tibial tubercle apophysis.

• Chronic avulsion results in separation and elevation of the patellar tendon insertion at the tibial tubercle.

• Callous formation during the healing process leads to a pronounced tibial tubercle.

• Participation in athletic activities that involve repetitive running and jumping.

• Pubertal growth spurt.

• More proximal attachment of the patellar tendon.⁵

• Broad patellar tendon attachment at the tibia.⁵

• High riding patella.⁶

Clinical Features

• Tenderness and prominence of the tibial tubercle.

Distribution

• Typically unilateral but can have bilateral involvement.⁴