Osgood-Schlatter and Sinding-Larsen Johansson disease

Introduction

Osgood-Schlatter disease is the most common cause of knee pain in the active adolescent patient. 

Characterised by pain at the tibial tubercle, Osgood-Schlatter disease occurs when the patella tendon pulls on the tibial tubercle leading to inflammation of the growth plate with the tibial tubercle often becoming quite prominent. Symptoms should resolve once the adolescent reaches skeletal maturity however the tibial tubercle will remain prominent. The condition will usually only affect one knee however can occur bilaterally.

Symptoms include pain and inflammation at the tibial tubercle with tenderness noted if pressure is applied to the tibial tubercle. Jumping, kicking, running may aggravate knee pain. 

In Sinding-Larsen-Johansson disease the pain is on the inferior pole of the patella and is also due to repeated micro-trauma from overuse. The management of Sinding-Larsen-Johansson disease is the same as that for Osgood-Schlatter disease.

Pre-referral investigations

• Physical examination observing for a tender prominent tibial tubercle.
• X-ray to rule out neoplasm, infection and acute injury if uncertain of diagnosis.

Pre-referral management

• Provide reassurance that this is a self-limiting condition with full resolution expected.
• Advise the family that the adolescent will need to modify activities to manage pain. Jumping, running and kicking activities will need to be limited until the adolescent can manage these activities without pain. In some cases this rest from activity may last several months. Knee immobilisation is not recommended.
• Simple measures such as applying ice, non-steroidal anti-inflammatory medications and simple quadriceps stretches may be useful in reducing inflammation and pain. 

When to refer

Refer to orthopaedics if:

• Significant impairment continues despite conservative management.
• Symptoms persist over 18 months – please note the prominence of the tibial tubercle will persist however pain and inflammation should resolve.
• Note referral for orthopaedic review is rarely required.

How to refer

• Routine non-urgent referrals from a GP or a Consultant are made via the Central Referral Service
• Routine non-urgent referrals from private hospitals are made via the PCH Referral Office.

Essential information to include in your referral

• Details of physical examination including presence and duration of limp, sites of tenderness, presence of prominent tibial tubercle.
• Medical and surgical history
• Details of current physical activity
• Conservative treatments already trialled
• History of any previous trauma or infection of lower limbs.

References

1. Lipman R, John R. A review of knee pain in adolescent females. Nurse Practitioner. 2015;40(7):28.
2. Ng JWG, Price K, Deepak S. Knee pain in children. Paediatrics and child health. 2019;29(12):521-7.
3. The Royal Children's Hospital Melbourne. Osgood-Schlatter Disease Melbourne: The Royal Children's Hospital Melbourne,;  [cited 2021 May]. Available from: https://www.rch.org.au/ortho/for_health_professionals/Osgood-Schlatter_disease/.

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