Osgood-Schlatter disease

What it is

How reviews and guidelines describe it

A Cochrane review names the condition traction apophysitis of the tibial tubercle¹. An apophysis is a bony bump where a muscle attaches that grows from its own growth plate, and apophysitis is soreness and irritation there. Osgood-Schlatter’s disease is the condition’s eponym, a name taken from a person¹. It was first described in 1903, separately by Osgood in the United States and Schlatter in Switzerland⁴.

A 2021 systematic review, a study that searches for all the research on a question, calls it a knee condition linked to sport and growth⁷. It places painful changes around the apophysis of the tibial tuberosity, and says up to 10% of adolescents are affected⁷. A 2022 systematic review also links it with growth and sport⁴.

A 2022 Dutch general-practice study cites its 2016 guideline on knee complaints that did not follow an injury⁸. Under it, the condition is identified from the history and a physical examination⁸. It is managed conservatively, without surgery, according to how severe the symptoms are⁸.

Where the pull falls

The tibial tuberosity (a bump on the front of the shinbone, just below the knee) is where the tendon from the kneecap attaches². The four quadriceps muscles share one tendon that inserts into the kneecap and carries on below it as the patellar ligament². Through the kneecap and this ligament, the quadriceps straighten the knee².

It is thought of as a traction apophysitis of the tibial tubercle⁶. It is put down to high forces from the patellar tendon pulling on its attachment while the growth plate is still open⁶. A growth plate is a layer of cartilage near the end of a growing bone. Traction growth plates like this one sit where major tendons attach, and they mainly take tension⁹.

The Cochrane review states that this apophysis is commonly present from 8 to 12 in girls and 12 to 15 in boys¹. It says rapid growth and weight change in these years are considered the main reason these injuries appear at these ages¹.

Who it affects

How often studies found it

Group studied	What was found
956 school students aged 12 to 15 in Natal, Brazil	9.8% met the study’s criteria, with boys at 11.0% and girls at 8.3%3
389 students answering a questionnaire in 1985	12.9% had had it: 21.2% of those active in sport at 13, against 4.5% of those who were not10
Dutch general-practice records covering over 200,000 patients, 2012 to 2017	3.8 new cases per 1,000 person-years at ages 8 to 18: 4.9 in boys and 2.7 in girls8
127 youth elite male football players at a pre-season health check	17% had it, and 80% of those had lost no time from training or matches11

Prevalence is the share of people in a group who have a condition at a given time. Incidence is how many new cases appear in a group over a set time. Person-years are a count of people multiplied by the years each was followed. The Cochrane review notes that general-population figures exist only for the knee and heel forms of apophyseal injury¹.

Boys, girls and sport

The 2022 review reports a male-to-female ratio of 3 to 1, and both knees affected in 20 to 30% of patients⁴. It lists soccer, gymnastics, basketball, football, volleyball and athletics as sports commonly linked with it⁴. In a series of 126 consecutive patients, 101 were boys, 64 played football and 18 basketball⁵.

Where studies disagree on risk

The 2022 review covered 16 studies and found the causes and risk factors controversial⁴. Its main studies looked at muscle factors, chiefly a tight rectus femoris, the quadriceps muscle that also bends the hip^4,12. They also looked at the patellar tendon, repeated loading and sport, and the shape of the shinbone⁴. Single studies point different ways^3,5,11:

• Muscle length: in the Brazilian study, regular sport and a shortened rectus femoris were the factors linked with it³. In a one-year study of 37 adolescent male football players, quadriceps tightness was among the risk factors¹³.
• Growth and build: in the 126-patient series, onset age, growth rate, body mass index (weight for height) and muscle imbalance did not reach significance⁵. In a case-control study of 30 youth elite male football players, growth speed, bone maturity, flexibility and strength were not linked with it¹¹. A case-control study compares people who have a condition with similar people who do not.
• Earlier heel pain: in those 30 players, earlier Sever’s disease was strongly linked with it¹¹. The odds ratio, how many times higher the odds are in one group, was 16.8, with a wide confidence interval (a range showing precision)¹¹.

What studies found

How it changes over time

A prospective study follows people forward in time, and a cohort is a group followed over time. Studies that followed patients for months or years report how many still had pain^5,6,14.

Patients followed	What was found
126 patients in a prospective series, 105 followed a median of 3.6 years	78.8% still had pain on kneeling or pressing the bump, which did not hold them back5
51 adolescents aged 10 to 14 in a prospective cohort, all after a 12-week programme	37% of the 46 followed up still had knee pain from it at 24 months14
43 responders from one orthopaedic department, a median of 3.75 years later	26 (60.5%) reported knee pain from it, and 42.9% of those had pain daily6
400 of 1,281 Danish adults seen in hospital for it as teenagers, who answered a survey	85% reported a bony bump at the tubercle, and 73% ongoing pain or problems there15

In the series of 126, half were free of symptoms in or after sport by 16 months, and three-quarters by 25 months⁵. Its authors concluded that the condition settles by itself without specific measures⁵. The authors of the 43-responder study concluded it may not always be self-limiting⁶. The Cochrane review notes increasing evidence that traction apophysitis of the tibial tubercle can bring chronic pain and limits on activity into adulthood¹.

The Cochrane review notes increasing evidence that traction apophysitis of the tibial tubercle can bring chronic pain and limits on activity into adulthood.

In the series of 126, 28.3% had switched sport because of the condition⁵. In the cohort of 51, more than 1 in 5 had stopped sport because of knee pain at 24 months¹⁴. The Danish adults scored below healthy population estimates on all knee-health scales¹⁵.

In the cohort of 51, ultrasound (a scan made with sound waves) at 24 months showed mainly tendon changes, such as thickening¹⁴. An ununited ossicle, a small separate bone, showed in 32% of those scanned¹⁴.

What the Cochrane review compared

The review searched up to January 2025 and found 10 randomised controlled trials on apophyseal injuries, in 654 children¹. Such trials assign people to groups by chance. Three were on this condition¹. Certainty of evidence is how sure reviewers are that a finding is right.

Comparison	Evidence	What the review judged
Dexamethasone (a drug) against placebo (a dummy version), in children	One study of 23 participants, very low certainty	Very uncertain whether it changes short-term pain, physical function or sport participation1
Dexamethasone against usual care, in children	One study, very low certainty	Very uncertain for the same outcomes1
12.5% dextrose (a simple sugar) with lidocaine (a local anaesthetic), injected, against usual care	43 participants medium term, 35 long term, very low certainty	Very uncertain whether pain during activity changes1
Adverse events, dexamethasone or dextrose against placebo	Two studies of 74 participants, very low certainty	Very uncertain; withdrawals because of adverse events were not measured1

The review concludes that trials give too little evidence to support most approaches commonly used for this condition or the heel form¹. In many outcomes, the comparison groups got better too¹. It states that no trial of any design has rigorously tested ice, anti-inflammatory drugs, painkillers or stretching¹.

A randomised trial at Hvidovre University Hospital, called SOGOOD, compared a new approach with usual care in 130 adolescents aged 10 to 16¹⁶. Its ClinicalTrials.gov record lists it as completed in March 2024, with no results posted¹⁶. The Cochrane review’s declarations say physiotherapy associations and six charitable foundations funded it¹. Two of the review’s authors are named investigators in it¹.

Other reviews and studies

A 2025 meta-analysis, which pools the results of several earlier studies, looked at dextrose injections¹⁷. It included four studies of 166 patients, 162 of them male: three randomised trials and one case series¹⁷. At three months, it found no significant difference in patient-reported improvement between dextrose and placebo injections¹⁷. Pooling two trials, it found greater improvement at one year with dextrose (standardised mean difference, a gap on a common scale: 1.09)¹⁷. In two trials of athletic young patients, pain-free return to sport at three months was about twice as likely after dextrose (risk ratio 2.11)¹⁷.

The authors say dextrose may help, and that more high-quality trials are needed¹⁷. One trial enrolled adult military personnel and the others young athletes¹⁷. The authors judged every trial to have some concerns about risk of bias, mainly because the protocols were not registered¹⁷. The same meta-analysis was supported by a Korea University grant, and its authors declared no conflicts of interest¹⁷.

A 2021 systematic review of non-surgical options included 13 studies, only two of them randomised trials, of poor to moderate quality⁷. It found no randomised trial comparing specific exercises with sham or usual care⁷. A 2026 review followed PRISMA, a reporting standard for reviews, but calls itself a scoping review¹⁸. Such a review maps what research exists on a topic¹⁸. It included 15 studies of 712 patients, most of them retrospective, which look back at past records¹⁸.

The 2026 review concluded that non-surgical approaches are effective¹⁸. In the non-surgical studies it included, full recovery of daily activities ranged from 14.3% to 100%¹⁸. That conclusion differs from the Cochrane review’s, which found too little trial evidence for most common approaches¹.

One study followed 51 adolescents aged 10 to 14 through 12 weeks of activity changes and knee strengthening, with no comparison group¹⁹. A successful outcome was reported by 80% at 12 weeks and 90% at 12 months¹⁹. These are not two separate groups: the 24-month cohort above followed the same 51 adolescents after this programme¹⁴.

Surgery

The 2026 review concluded that surgery is rare and seems reserved for people with closed growth plates and lasting symptoms¹⁸. It describes removing or smoothing the raised tubercle, removing the bursa (a small fluid-filled sac) and nearby irritated tissue, or removing loose ossicles¹⁸. Its three ossicle-removal studies were retrospective: one cohort study of 11 knees and two case series of 18 and 23 knees¹⁸. A case series reports on a group of patients with no comparison group.

Across six surgical studies, 79% to 100% of patients returned to daily activities¹⁸. Five of the six reported complications, at rates from 0% to 75.8%, including infections, thickened scars and leftover pain¹⁸.

Among Finnish military recruits over 13 years, surgery for unresolved Osgood-Schlatter disease occurred at 42 per 100,000 recruits²⁰. Of 107 of these men followed a median of ten years, 87% reported no limits in everyday life or work²⁰. Of them, 38% reported no pain at all when kneeling²⁰. Six had minor complications and two had a further operation²⁰.

Connections

The condition sits where the patellar ligament attaches to the tibia, at the tibial tuberosity².

Sever’s disease is the heel form, and the Cochrane review counts the two as the most common lower-limb apophyseal injuries¹. The quadriceps include the rectus femoris, the only one of the four that crosses two joints¹².

Traction growth plates of cartilage shape a bone but do not add to its length, unlike the growth plates that lengthen it⁹. Overuse conditions of them, including this one and Sever’s disease, are common in young athletes⁹.

Sources

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7. Neuhaus C, Appenzeller-Herzog C, Faude O (2021). A systematic review on conservative treatment options for OSGOOD-Schlatter disease.. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine. doi:10.1016/j.ptsp.2021.03.002 PMID 33744766
8. van Leeuwen GJ, de Schepper EI, Rathleff MS, Bindels PJ, Bierma-Zeinstra SM, van Middelkoop M (2022). Incidence and management of Osgood-Schlatter disease in general practice: retrospective cohort study.. The British journal of general practice : the journal of the Royal College of General Practitioners. doi:10.3399/BJGP.2021.0386 PMID 34990396
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11. Schultz M, Tol JL, Veltman L, Kaaden van der L, Reurink G (2022). Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors.. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine. doi:10.1016/j.ptsp.2022.02.024 PMID 35305497
12. Begum FA, Kayani B, Chang JS, Tansey RJ, Haddad FS (2020). The management of proximal rectus femoris avulsion injuries.. EFORT Open Reviews. doi:10.1302/2058-5241.5.200055 PMID 33312709
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15. Krommes K, Bjerre A, Thorborg K, Nielsen MF, Hölmich P (2025). Long-Term Knee Health in Adults with a History of Adolescent Osgood-Schlatter: A National Cohort Study of Patients in Secondary Care in Denmark 1977-2020.. Sports medicine (Auckland, N.Z.). doi:10.1007/s40279-025-02214-5 PMID 40439870
16. Krommes K (principal investigator); Hvidovre University Hospital (sponsor) (2021). A Comparison of Two Different Treatment Approaches for Adolescents With Osgood Schlatter (ClinicalTrials.gov NCT05174182). ClinicalTrials.gov. Link
17. Rhim HC, Bjork LB, Shin J, Park J, DeLuca SE, McCarron KC, Jang KM, Ha C (2025). Efficacy of Hyperosmolar Dextrose Injection for Osgood-Schlatter Disease: A Systematic Review with Meta-Analysis.. Diagnostics (Basel, Switzerland). doi:10.3390/diagnostics15101282 PMID 40428275
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20. Pihlajamäki HK, Mattila VM, Parviainen M, Kiuru MJ, Visuri TI (2009). Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men.. The Journal of bone and joint surgery. American volume. doi:10.2106/JBJS.H.01796 PMID 19797569

Every source the library cites

Changes

• October 15, 2026 First published.