Osgood-Schlatter disease causes a painful bony lump below the knee, usually in sporty children and adolescents. Pain and swelling generally settle after puberty. But some 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?
In sporty adolescents, repeated stress on the small growth plate where the kneecap tendon attaches to the shin causes pain and swelling — traction apophysitis (the same mechanism as hip apophysitis). Pain is worse with sport and better with rest, and a lump may form on the tip of the shin just below the kneecap.
What happens to Osgood-Schlatter in adults?
Most cases improve after puberty, once the growth plates close. But in a small number, bony ossicles form in the tendon. These can move and inflame the surrounding tendon, causing pain, and a fall or twist can dislodge an ossicle, increasing the movement and the pain.
How do we diagnose Osgood-Schlatter in adults?
There’s usually a history of Osgood-Schlatter in teenagers, though not always. Adults typically report pain, swelling, and tenderness at the tibial tuberosity — where the kneecap tendon meets the shin — with a painful lump below the knee that is worse with sport and better with rest.
We examine the knee to confirm a painful bony lump and a prominent bone below the kneecap, with pain on squatting, lunging, or jumping. Imaging then confirms the ossicles and excludes other causes: an X-ray usually shows small bony ossicles near the shin, while ultrasound or MRI confirms any surrounding patellar tendonitis.
Osgood-Schlatter disease causes a painful bony lump below the knee, usually in sporty children and adolescents. Pain and swelling generally settle after puberty. But some 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?
In sporty adolescents, repeated stress on the small growth plate where the kneecap tendon attaches to the shin causes pain and swelling — traction apophysitis (the same mechanism as hip apophysitis). Pain is worse with sport and better with rest, and a lump may form on the tip of the shin just below the kneecap.
What happens to Osgood-Schlatter in adults?
Most cases improve after puberty, once the growth plates close. But in a small number, bony ossicles form in the tendon. These can move and inflame the surrounding tendon, causing pain, and a fall or twist can dislodge an ossicle, increasing the movement and the pain.
How do we diagnose Osgood-Schlatter in adults?
There’s usually a history of Osgood-Schlatter in teenagers, though not always. Adults typically report pain, swelling, and tenderness at the tibial tuberosity — where the kneecap tendon meets the shin — with a painful lump below the knee that is worse with sport and better with rest.
We examine the knee to confirm a painful bony lump and a prominent bone below the kneecap, with pain on squatting, lunging, or jumping. Imaging then confirms the ossicles and excludes other causes: an X-ray usually shows small bony ossicles near the shin, while ultrasound or MRI confirms any surrounding patellar tendonitis.
How do we treat Osgood-Schlatter in adults?
We treat it much like adult patellar tendonitis.
First, simple measures: reducing running and sports, ice, and ibuprofen gel or tablets. Then exercise therapy — the same quad-strengthening approach as the patellar tendonitis rehab programme.
We often add GTN patches, placed over the pain at the tibial tuberosity. Recent evidence shows that GTN patches reduce pain in acute tendinitis when used for 1–2 months.
Injections for Osgood-Schlatter in adults
When simple treatments fail, we consider injections.
We used to use cortisone, but we now know cortisone is ineffective for patellar tendonitis, and near the thin skin of the shin, it risks skin depigmentation and fat atrophy. So we don’t recommend cortisone for Osgood-Schlatter in adults.
Doctors have had more success with sclerosants such as dextrose or polidocanol. These are injected near areas of abnormal blood flow (neovascularisation) in the tendon, which correspond to the pain. The abnormal vessels carry abnormal nerves that transmit pain, and the injection targets both. Whatever the substance, injections should be done under ultrasound guidance for accuracy.
Surgery for Osgood-Schlatter in adults
Surgery is reserved for cases that fail simple treatment and one or two injections. The surgeon removes the bony ossicles through a small incision — evidence suggests ossicle removal improves pain in over 90% of cases. Recovery is at least two months, longer if removing the ossicle disturbs the patellar tendon.
Frequently asked questions about Osgood-Schlatter in adults
I have a painless bony bump below my knee from childhood — do I need to do anything?
Usually not. A painless Osgood-Schlatter bump is a harmless remnant of the adolescent condition and needs no treatment. See a doctor only if it becomes painful, swollen, or starts to affect your quality of life.
My old Osgood-Schlatter bump suddenly became painful — why?
A bony ossicle in the tendon can flare, often after a fall, twist, or knock that dislodges it, or after a sudden increase in activity. If the pain doesn’t settle with rest and simple measures, see a doctor for an ultrasound or MRI.
Can adults still get Osgood-Schlatter, or only worsen an old one?
True Osgood-Schlatter is a growth-plate condition of adolescence. In adults, the problem is usually a persistent bony ossicle from the original condition rather than a new case. A new painful lump in an adult with no childhood history needs assessment, as other causes of a knee lump exist.
Does cortisone help Osgood-Schlatter in adults?
No. Cortisone is ineffective for patellar tendonitis, and near the shin’s thin skin,n it risks depigmentation and fat atrophy. We prefer sclerosant injections (dextrose or polidocanol) under ultrasound guidance when needed.
Can I keep running or training with adult Osgood-Schlatter?
Often, yes. Like tendonitis, you can usually train through stable pain — heavy, slow resistance work isn’t harmful. If the pain escalates or the knee swells, scale back and get it assessed.
Is surgery worth it for the bump?
For painful ossicles that fail rehab and injections, surgery removes the ossicle and improves pain in over 90% of cases. For a painless bump, surgery isn’t needed. Recovery is at least two months.
Final word from Sport Doctor London about Osgood-Schlatter in adults
Most Osgood-Schlatter settles by adulthood, but a small number develop troublesome bony ossicles in the patellar tendon. Try simple treatments first — rest, rehab, GTN patches — then sclerosant injections, with surgery a last resort that works well (over 90%) for the right patient.
If you have a painful Osgood-Schlatter bump, Dr Masci can assess it in London. Contact the team here or call +44 (0) 203 488 0350.
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……. I am 60 yrs old..and have had an asgood knot since my teen age yrs.. a pretty good size below my rt knee.. and the other day I used my rt leg to lower the foot lift on my chair…. and now I cant squat with my rt leg… and I’ve noticed the knot was getting larger … and now can’t squat… or some days walking my knee swelling …
it might be a flare of a bony ossicle from Osgood Sclatter’s disease – you should see your doctor if your pain doesn’t settle.
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
Very kindly I say this to you: I am a female- NOW-75 yrs old. Back when I was age 13,(1962) I was diagnosed by a German Dr who took one look (when 3 other dr’s had no clue) and said: Because you are 5’10-you’ve grown more quickly as only younger men have this disease. REMEMBER, I was a young woman–NOT A MAN– I played field hockey, basketball- racquetball, and his simple advice was- Perhaps if you refrain from such high activity, that you will somehow relieve the pain. BUT, in your case, because the lower BONES on both knees, you may have really continuing issues in your later life. I tried to refrain- did a lot of swimming in Ft.Laud, but at AGE 35- all of a sudden, no longer could I kneel or even get up off the floor without pain, I had to raise myself on my SIDE and Arms. No problem, I continued on in life- swimming, snorkeling, BUT NEVER COULD I JOG OR RUN at all. Sometimes doing even STEPS upstairs–I found that I had to use the elevator..I had to work and couldn’t afford to just run up stairs 2 at a time. Over time- the pain wasn’t there, BUT the disability of this caused me to THINK TWICE before JUMPING UP or DOWN in any situation–ANY AT ALL– So,now, I am feeling BOTH of those protruding bones beneath my kneecaps-I can touch them and they don’t hurt– BUT, finally, at age 75, NOW- I have had to make decisions-moreso–I live in a groundfloor condominum, no steps except 1- I can walk 1-2mi w/ ease- but if I overdue-I will pay the price of not being able to do the next day..When I go to outside fairs, concerts, constantly, I have a walker in my car, just in case..and it has happened..I finally got a Disability Parking Pass, but RARELY do I use it- ONLY will I take that chance. I’ve learned in my entire life–this is something that isn’t going away-or ever. I’ve had Xrays of 2 yrs ago- they all say–we see it, we know of it, YOU are doing quite well–but I NEVER take any medication..only an ALEVE for a day-in order to get some relief. This hasn’t been a very pleasant journey for me..but, being in the medical field.. I can ONLY FEEL SO BLESSED that I’ve known this disease and have to accept it- and actually feel I am a lot better off than most people. Amen. Godspeed.
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 alump belowe the knee that has suddenly started getting biggel and it become painful and inflamed. If I need surgery how long does it take to heal?
Thanks Thomas. Assuming the lump is a bony ossicle from Old Osgood-Sclatter’s disease, you’ll need at least 2 month recovery before you can return to sport. It depends on the extent of the patellar tendon debridement. Sometimes, removing the bony ossicle upsets the patellar tendon, which means a longer recovery. I’d try other treatments first (as outlines in the blog).
Also, the lump at the front of the knee may be due to other causes:
https://sportdoctorlondon.com/lump-on-the-side-of-knee/
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
Hello 😊 I have had OSD since I was about 7 years old. I was never a sporty kid until my teens. I am now 33 and its still here and painful as ever. I have tried all the non evasive solutions but nothing has worked. Should I start to consider surgery?
Hi Dannii, if you’re tried conservative measures and you have bony ossicles at the attachment of the tendon to the bone, I think surgery is an option for you.
Lorenzo
Hi I’m 51yr old female and the pointy boney lump under my right knee is slowly growing. I only noticed it a few months ago, so iv not had it since childhood. It’s damn annoying and now iv noticed it in my left leg as well. At times both knees swell up tight as and go a dark shiny red and extremely hot.
Hi Sam,
I suggest you see your doctor to find out what caused your lump. There are many causes of lumps in the knee: https://sportdoctorlondon.com/lump-on-the-side-of-knee/
Lorenzo