Bilateral Knee Osgood Schlatter's Disease

Jimmy (not his real name) is a 15 yrs old hockey junior state player who has been suffering from pain in both knees since 3 years ago. He also noticed that his tibial tuberosity was more prominent than other players. The pain would worsen with intensive weight training and running on hard turf surface. His dad was planning to give him some additional quadriceps strengthening exercises for his 'thin' legs but decided to ask for my opinion.

I examined his knees and found that he indeed has a protruding tibial tuberosity on both knees. It was painful for him to attempt to bend his knees fully but he was able to do so with my assistance (passive movement). He had pain squatting beyond 120 degrees.

In most cases, Osgood-Schlatter disease is caused by microtrauma in the deep fibers of the patellar tendon at its insertion on the tibial tuberosity and which may be associated with avulsion. The condition is usually self-limiting and symptoms resolve with skeletal maturity in over 90% of cases, when the tibial tubercle fuses to the remainder of the tibia.

He would require a plain X-ray to demonstrate any bone ossicles or avulsion and an ultrasound scan by an experienced sonographer may confirm the diagnoses.

I advised him to lay off running on the turf and focus on light skill workout. He was also encouraged to do some aqua-jogging for fitness. His pain would usually take 2-4 weeks to subside. He was also prescribed NSAIDS to relieve his pain and a patella band to unload the stress from the tibial tuberosity. Surgery is very rarely indicated.

Links of Interest:
Osgood Shlatter's Disease
Tibial tubercle avulsion