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.