In this photo, the tibial tubercle (the knot below the knee) seems swollen; however, some people have more prominent knot than others anyway.

by James Hubbard, MD, MPH

Children can get most of the same knee injuries as adults. They can sprain, tear, or break something at any age. But some knee injuries are more common in kids. In fact, one always begins in the growing years.

Osgood-Schlatter is technically a disease, but I think of it as an injury—kind of the tennis elbow of children’s knees. In fact, Osgood-Schlatter treatment and tennis elbow treatment are about the same.

Knee Anatomy: Can You Find Your Tibial Tubercle?

There’s a little knot called the tibial tubercle just below your knee. It’s where the kneecap tendon (actually a ligament) attaches to your lower leg bone. At the top of your kneecap, another tendon connects the kneecap to the big quadriceps muscle in your thigh. Together, the tendons and muscle straighten out your knee.

In children, the tibial tubercle has not fully fused with the lower leg bone. Part of it remains cartilage until adulthood. Therefore, the tubercle tends to move ever so slightly when the knee straightens. Over time this can cause inflammation and resultant pain and sometimes swelling (of the tubercle, not the knee joint).

The tibial tubercle is at the bottom of the knee. This is a child because the tubercle is still partially attached by cartilage instead of all bone. (Cartilage doesn’t show up on X-rays.)

This condition is called Osgood-Schlatter disease. And, no, there’s no one specific injury that causes it. It happens over time.

The Trauma-Free Injury: When to Suspect Osgood-Schlatter Disease

Any knee swelling needs to be seen by a doctor—usually X-rayed to make sure nothing is broken. The same goes for any knee pain that keeps a kid from his/her normal activities.

But if you can’t get to a doctor right away, suspect Osgood-Schlatter when a child has all of these signs or symptoms:

  1. There’s been no trauma—no specific fall or hit that caused the pain.
  2. The child is between 10 and 18 years old.
  3. The tibial tubercle, and only the tibial tubercle, is tender.
  4. The knee joint is not swollen.
  5. It doesn’t hurt nearly as badly just to stand still.
  6. Running or jumping makes it worse.
  7. The pain is intense when the child sits with his/her knee bent and tries to straighten it while you hold the ankle (to put up a little resistance).
How Common is Osgood-Schlatter?

About 20 percent of kids who participate in sports will get some degree of pain. About 5 percent of nonsporting kids will. Boys get Osgood-Schlatter more than girls, but girls are gaining ground as their sports participation increases.

There are theories about why some kids get it and some don’t, but we don’t know for sure.

Remember, all of these signs and symptoms should be present. And don’t try 5, 6, or 7 if anywhere but the tibial tubercle is swollen, there are external signs of an injury, or the leg looks distorted.

See my post on how to know if a knee injury is bad for some idea of what else it could be.


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Osgood-Schlatter Treatment: How to Give Your Tubercle a Break

Osgood-Schlatter treatment is the same as the treatment for many joint and muscle injuries: RICE. Your child may not like it. Then again, the first few days are prime time for videogames!

Rest. This is essential. There’s no way around this. The child has to stop activities for a few days. After that, he/she’s still going to have to slow down (no running or jumping) since this pain can last for several weeks to months.

Ice. Frequent, intermittent icepacks for 10 minutes at a time for the first few days may help. (Put a cloth between the ice pack and skin.)

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Compression. An elastic bandage or a strap across the area of pain may help. It should be wrapped firmly but not tightly enough to cut off circulation.

Elevation. Elevation of the knee to heart level or above for a few days may help.

Naproxen (Aleve) or ibuprofen (Advil) can ease the pain.

When the pain goes away, the child can gradually regain full activities.

The good news is the child almost always gets better and usually has no problems as an adult.

What about you and your family? Has anyone had this? How long did it last? Has anyone had continued problems as an adult?

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Photos by sportEX journals.