Knee Pain that Schlatters
Author: BuMin Kong, MD; Susie Lee, BA
Peer-Reviewer: Mark Hopkins, MD
Final Editor: Alex Tomesch, MD, CAQ-SM
A 13 year old male presents with 2 months of right knee pain that is now worsening. The pain is dull, intermittent, and improves with ibuprofen and rest. Exam shows a fit male with mild swelling and tenderness over the anterior/inferior aspect of the right knee without obvious signs of trauma.
Image 1. Case courtesy of Dr Hani Makky Al Salam, Radiopaedia.org, rID: 1215
What is your diagnosis?
Osgood Schlatter disease, also known as tibial tubercle apophysitis. It is caused by repetitive traction of the patella tendon over the tibial tubercle [1]. Note the irregularity/fragmentation of the tibial tubercle in image 1.
-
Pearl: Osgood Schlatter disease is a clinical diagnosis but x-rays can be helpful if there is concern for fractures or masses. X-rays may be normal or show fragmentation or calcification of the apophysis (see image 2).
Image 2 showing apophysis fragmentation and calcification as well as soft tissue swelling anterior to the apophysis. Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 7511
What is the pathophysiology of this diagnosis?
The tibial tubercle is an apophysis, which is a cartilaginous structure that ossifies and fuses with the tibial epiphysis. This ossification/fusion process occurs at early adolescence and is prone to injury with repetitive traction. Therefore, Osgood Schlatter disease is often seen in adolescent athletes from 10 to 15 years of age [1].
-
Pearl: Patella tendon rupture and total avulsion of the tibial tubercle should be ruled out by physical exam (intact extensor mechanism), bedside sonography, and/or x-ray
Image 3. Comminuted avulsion fracture of the tibial tubercle.
Case courtesy of Dr Hani Makky Al Salam, Radiopaedia.org, rID: 12158
References
[1] Smith JM, Varacallo M. Osgood Schlatter Disease. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/
[2] Circi, E., Atalay, Y., & Beyzadeoglu, T. (2017). Treatment of osgood–schlatter disease: Review of the literature. MUSCULOSKELETAL SURGERY, 101(3), 195–200. https://doi.org/10.1007/
[3] Neuhaus, C., Appenzeller-Herzog, C., & Faude, O. (2020). A systematic review on conservative and non-operative treatment options for Osgood-Schlatter Disease. https://doi.org/10.31236/osf.
[4] Kushner RL, Massey P. Tibial Tubercle Avulsion. [Updated 2021 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/