Osgood-Schlatter disease causes a painful bony lump below the knee. Usually, it occurs in children and adolescents who are sporty. Generally, pain and swelling settle after puberty. However, a small percentage of adults develop bony ossicles in the tendon that can become loose and painful. So what is Osgood-Schlatter in adults, and how do we treat it?
What is Osgood-Schlatter disease?
Generally, in sporty young adolescents, repeated stress on the small growth plate near the attachment of the kneecap tendon to the shin causes pain and swelling. In medical terms, we call this traction apophysitis. Usually, pain and swelling are worse with sport and better with rest. Also, a lump may form on the tip of the shin just under the kneecap.
What happens to Osgood-Schlatter in adults?
Most cases of Osgood-Schlatter get better after puberty and the closure of growth plates. However, in a small number of cases, bony ossicles can form in the tendon. These ossicles can move and cause swelling of the surrounding tendon leading to pain.
An injury such as a fall or a twist can sometimes dislodge the ossicles, leading to increased ossicle movement.
Diagnosis of Osgood-Schlatter in adults
Generally, there is a history of Osgood-Schlatter as a teenager, but not always. Usually, people report pain, swelling, and tenderness at the tibial tuberosity, the kneecap attachment to the shin bone. In addition, there is a painful lump below the knee. Often, symptoms are worse with sport and better with rest.
Your doctor will examine your knee to confirm a painful bony lump below the kneecap. Often, there is a prominent bone sticking out below the kneecap. Also, pain may occur with squatting, lunging, or jumping.
Usually, imaging is needed to confirm bony ossicles and rule out other causes. Often, an X-ray will show small bony ossicles near the shin both. Ultrasound or MRI will confirm surrounding patellar tendonitis.
Treatment of Osgood-Schlatter in adults
Generally, we treat this condition similar to patellar tendonitis in adults. First, we try simple treatments, such as reducing running and sports activity, ice, ibuprofen gel, and tablets. Also, exercise therapy similar to what is used for patellar tendonitis is tried. Finally, we focus on developing strength in your quad muscle, similar to the rehab program for patellar tendonitis.
Often, we combine these simple treatments with GTN patches. We suggest placing these patches on pain at the tibial tuberosity. Recent evidence indicates that GTN patches reduce pain in acute tendonitis. Usually, people use these patches for 1-2 months.
Injections for Osgood-Schlatter in adults
Often, in cases that fail simple treatments, we try injections.
Traditionally, we used to use cortisone injections to settle Osgood-Schlatter in adults. However, we now know that cortisone injection for patellar tendonitis is ineffective. Also, cortisone injections near the skin and soft tissue of the shin can cause other problems such as skin depigmentation and fat atrophy. So, overall, we don’t think cortisone injections are suitable for Osgood-Schlatter in adults.
Recently, doctors have had more success with sclerosants such as dextrose or polidocanol. These substances are injected close to areas of abnormal blood flow in the tendon, called neovascularisation. These tendon changes correspond to pain at the tibial tuberosity. We know that these abnormal blood vessels are accompanied by abnormal nerves that can transmit pain. Injecting these substances destroy both these nerves.
Overall, injections should be done under ultrasound guidance to improve accuracy irrespective of the substance used.
Surgery for Osgood-Schlatter in adults
Generally, we reserve surgery for cases that fail simple treatments and one or two injections. Usually, the surgeon removes the bony ossicles using a small cut in the skin. Evidence suggests that ossicle removal improves pain in over 90% of cases.
Final word from Sportdoctorlondon for Osgood-Schlatter in adults
While most cases of Osgood-Schlatter resolve in adults, a small percentage will develop problems with bony ossicles in the patellar tendon. We suggest a trial of simple treatments first before considering more invasive surgery. Nonetheless, surgery is effective in over 90% of cases.
I have osgood schlatter +10 months, I had already take orthopaedicians advice last 8 months but no improvement in my injuries. Please help me. I am totally depressed for it. I want to fix it as soon as possible and return to my game.
Hi I presume you’ve stopped growing. If so, please read my blog again about surgical treatment options.
Good luck. I’ve had it for 20 years now. Make sure you try everything you can first before surgery. I had the surgery on one knee and it’s still painful. Sclerosant treatment this article mentioned is one I haven’t tried yet (I don’t think it was available until recently). In addition to R.I.C.E. the best thing you can do to get some relief is stretch all your leg muscles multiple times per day to take some of the tension off.
Hello, Im 28 years old male, actively weight lifting, for almost one year ive had OSD on my left knee, and my orthopaedicians asked me to get PRP or Platelet RIch Plasma injected to my OSD, does this treatment really can heal the OSD in adult case? Im looking forward for your answer, thanks
Hi, I don’t use PRP for OSD in adults. I’m not convinced a PRP will help. LM
I have had a big bump below my knee since i was about 13 and now im 20 and its still there. Never had any pain until recently. I feel like the only way to get rid of the bump would be surgery at this point.
Please refer to my blog for options other than surgery. Surgery doesn’t work for everyone.
LM
I’m currently going through the process of seeing GP again first time was over 10 years ago when it first appeared now I’m 23 and it’s become so bad I’m considering a career change I am struggling to work on my feet all day. Both times I’ve been sent to physio which didn’t touch it, so far on waiting list for physio again (2 months waiting so far) but I’m not expecting more than the single session I got last time
Im 63 years old, Ive had OSD since I was a teen. Its never gone away. I have a very large knot right below my kneecap.
It bothers me everyday, sometimes the pain is so intense I cant do anything. Its always hurting.
Somedays its difficult to walk. I cant run, I cant squat, kneel, or get on my knee at all.
Its difficult to drive, sleep etc…
What can be done?
Please help
Hi Frank, Please read through my blog discussing options – rehab, GTN patches, injections, and surgery. I’d try the simple treatments and then move to injections and surgery based on your response. LM
I have a bony bump below my knee. It’s been there since I was a kid; I’m mid 40s now. It hurts to sit on my knees etc. I want them removed.
I’ve been suffering from 2011; now I’m 24 years old but there are still pain & symptoms but manageable. I can play Cricket, Badminton etc with low to moderate intensity. I’m planning for joining gym to do resistance training & weight training for my overall wellbeing. Will it be harmful for my right knee?
Heavy slow resistance at gym should not be harmful to Osgood sclatter’s disease is adults.
Middle aged male here. I’ve had a mild form for some years and fortunately can still be reasonably active but I miss going for multi-day long hikes. Celebrex works well but would like to avoid taking it daily. Is GTN ointment a reasonable alternative to GTN patches?
Thank you
We don’t have any studies on ointment – just patches.
When I was a kid I had 3 weeks off school with severe knee pain, which was diagnosed as ‘growing pains’.
I’m 55 now and have had no real problems since, until recently, when the area below my knee swelled up and was sore after a run. If I don’t run it’s okay, just some mild pain around the ‘bump’ if I press on it. But if I run it swells up and hurts for a day or two. I’ve rested it for 3 months and it’s just the same.
Basically, I can live with it, it’s not so bad, but I want to get back running for the sake of my cardiac health. If I strap it and take it easy and I likely to cause any damage if I run?
Thanks for your article.
Hi Andrew,
As I explained in the article, we treat this condition similarly to tendonitis – so yes, you can still run with pain as long as the pain remains stable. see my blog on the management of tendonitis – which explains these principles a little more:
https://sportdoctorlondon.com/tendonitis-specialist/
Hi, I found all of these comments very helpful as I’m 45 and had my left leg in plaster for a month when I was 13. I have lumps under both knees but the left is considerably bigger. I returned to exercise nearly 3 years ago and have aggravated the knee simply by kneeling and have been suffering for about 11 months now. I’m looking to knee supports that will support me when kneeling during exercise/stretching as the pain is too great. Can you recommend the best type of knee support please?
Hi Kevin, Patellar tendon supports (you can google) might work better than a general knee support. Place the support just above the Osgood bump.
LM
Hi Lorenzo,
I am now 23 and have had this pain, in the place where my Patella Tendon attaches to the top of my Tibia bone, for around 3 years now. Before this, I was playing football around 4-5 times a week with no problems and COVID 19 hit and I didn’t play for 4-5 months. The first time I tried to come back and play I got this pain and it hasn’t gone away since.
I have tried Physio, which hasn’t worked, and have had multiple scans and X-Rays and nothing was found. I have tried multiple different methods and none seemed to be working. I contacted a specialist and have now had an operation. I am 4 months after my operation and have started building my leg up in a slow process but the pain is still as prominent as before.
I have done further research and found a few websites with statements suggesting it could be abnormal blood vessels accompanied by abnormal nerves that can transmit pain. This seemed like something that could be possible as when I rub my knee, effectively getting the blood flowing round it, and then go to use it as I would normally the pain is still there but is lessened.
I was hoping this would be an area you might be able to advise on?
Thanks
Mason
Hi Mason, You may have distal patellar tendonitis. Sometimes MRI scans can miss the pathology. I’d suggest an ultrasound to visualise the tendon. Tratment options are GTN patches or injections such as sclerosants to target abnormal blood vessels and nerves in the tendon (if ultrasound shows abnormal changes).
LM
I’m a 57yo male. I’ve had a very prominent bony bump below each of my knees for as long as I can remember. Imagine having a superball under the skin. That’s how big mine are. Strangely, the only time they hurt is if I try to crawl on my hands and knees or kneel down. I was only recently diagnosed. They are so symmetrical that I didn’t think it was a deformity until I noticed nobody else had them. If there is no pain, should I simply live with it?
Hi David, Yes I wouldn’t do anything about it unless it affects your quality of life or you experience pain.
LM
I am 67 and my experience has been identical to yours. Bumps under knees from at least age 12. Never had a problem with them at all. No pain under any circumstances. But now, by age 67, one of them is so big that I cannot kneel on that knee unless I am wearing knee pads. The bump is the first thing to have contact with the ground so all of my weight it on it. I am about to see an ortho about having it removed.
I have prominent bony bumps below both my knees, its not painful, i just am very conscious about it and dont wear anything above the knee. I’ve had it since i can remember, im 57 years old now
These lumps are almost certainly remnants of Osgood scletter’s disease. You don’t need to do anything if your knees aren’t painful.
LM
OMG, I can’t imagine having to try and hide the bumps. I have always thought they were kind of cool. There were never any problem until now. As I said in an earlier reply, I am now 67 and one of them has grown to the point that it contacts the ground before any other part of my knee. It feels like I am kneeling on a marble, which is painful. It has got to go!
I have a pronounced lump below my right knee that has recently become incredibly painful if I kneel on it. The pain is sharp and quite severe lasting for about twenty seconds after I take the weight off it. Otherwise it’s not painful.
I often have to get down and kneel at work, so it’s a touch inconvenient, but then I’m nearly 60. Should I just defer kneeling ?
Hi Jon, that’s one option – or using a cushion under your knee if you have to kneel. I’d suggest seeing your doctor to get a correct diagnosis.
LM
I lived with my two bumps for 66 years before the one on the right became a problem when kneeling. I have grown over the 5 or 6 decades I’ve had it and now I am 67 and it has got to go. I don’t have to kneel for work, but I love to garden and do other work that requires kneeling and putting on knee pads to clean the house is a bit much, lol. Good luck with your problem!
Hello I have had this under my left knee since I was a teenager. Was really sore back then but hasn’t had any issues with it for 20 years. Im 33 now. I train and run and play tennis every day with no issues. I recent jarred my knee playing tennis and the bumb has been killing me the last 2 weeks. Do you think I will have the sore effects of this going forward now ?
Hard to tell at this early stage – I’d suggest anti-inflammatory treatments (NSAIDs, ice etc). You should see your doctor if your knee pain fails to settle. LM
Hi I’m a 52-year-old male that has had Osgood since he was a teenager I have it in both knees I have large bone fragments protruding below both my kneecaps unfortunately I’ve never had great healthcare so I have been living with extreme pain for 40 years