Osgood–Schlatter Disease: Knee Pain in Growing Children

What is Osgood–Schlatter disease?

Despite the name, it is not a disease in the usual sense. The patellar tendon runs from the kneecap to a bony point at the top of the shin bone, called the tibial tubercle. In children, this point is still a soft growth area. Repeated running, jumping and kicking make the strong thigh muscles pull on it, and the area becomes inflamed, tender and sometimes enlarged.

It is one of the commonest causes of knee pain in active children and teenagers, and it can affect one or both knees.

Symptoms, as parents and children describe them

• "There's a hard bump below his kneecap and it hurts when I touch it"
• "My knee hurts after football training and the next morning"
• Pain with running, jumping, climbing stairs or kneeling
• Pain when kneeling on the bump, for example during prayer
• Tightness at the front of the thigh

The pain usually comes and goes with activity and eases with rest. The bump may remain even after the pain has gone.

Who gets it

Osgood–Schlatter disease typically appears during a growth spurt, commonly between around 10 and 15 years of age, usually a little earlier in girls than in boys. It is common in children who play football, basketball, volleyball, athletics, gymnastics and martial arts, particularly when training volume rises quickly, such as at the start of a new season or academy programme. Tight quadriceps and hamstring muscles during rapid growth add to the pull on the tendon.

Diagnosis

The diagnosis is usually clear from the child's age, the story and a tender bump at the top of the shin. An X-ray is sometimes taken, especially when only one knee is affected, the pain is severe, or there are unusual features, to exclude other problems such as a fracture or, rarely, a bone lesion. Ultrasound or MRI is seldom needed.

Treatment

Most children recover without any procedure. Treatment focuses on calming the area and managing load:

• Reducing the sports that hurt most, rather than stopping all activity
• Ice for 15 to 20 minutes after sport
• Stretching the front and back of the thigh, and strengthening the hips and core
• A soft knee pad for kneeling, and a strap below the kneecap for some children
• Simple pain relief for short periods if advised by your doctor

A physiotherapist can guide a graded programme so the child stays active. Surgery is rarely needed and is only considered in young adults whose growth has finished and who still have pain from a small loose bone fragment.

Recovery and outlook

Symptoms usually come and go over months, and sometimes one to two years, until the growth plate closes. Most children continue their sport throughout, adjusting the intensity when the knee flares. In Qatar's hot months, training indoors or at cooler times of day, with enough rest between sessions, helps young athletes manage both the heat and the load on their knees.

The bump below the kneecap may remain into adulthood but is usually painless.

When to see a knee specialist in Doha

• The pain is in one knee only and is severe or getting worse
• Your child limps, cannot bear weight, or the knee is swollen
• There is pain at night, at rest, or with fever
• The pain started suddenly with a jump or fall
• Symptoms continue despite several weeks of reduced activity

These features suggest something other than Osgood–Schlatter disease and need examination. Dr. Gelber assesses knee pain in children and teenagers at Aman Hospital in Doha.