Skip to Main Content


Condition/Disorder Synonym


  • Apophysitis of the tibia tubercle

  • Lannelongue disease

  • Osgood-Schlatter syndrome (OSS)

  • Osteochondritis of the tibia tubercle

  • Juvenile osteochondrosis of the tibia tubercle


ICD-9-CM Code


  • 732.4 Juvenile osteochondrosis of the lower extremity, excluding the foot


ICD-10-CM Codes


  • M92.4 Juvenile osteochondritis of the patella

  • M92.5 Juvenile osteochondrosis of the tibia and fibula


Preferred Practice Pattern


  • 4E: Impaired joint mobility, motor function, muscle performance, and range of motion (ROM) associated with localized inflammation1


Key Features




  • Disease described by Robert Bayley Osgood and Carl Schlatter in 1903.

  • Repetitive traction at the growth plate at the quadriceps insertion can cause inflammation and microfracturing.

  • Short-term disorder associated with overuse and growth spurt with increased femur length and inability of quadriceps to lengthen as fast2


Essentials of Diagnosis


  • Insidious gradual onset aggravated by quadriceps tightness and tibial tuberosity immaturity3,4

  • Intermittent pain and swelling increased with activity or compression on the tibial tuberosity (kneeling)

  • Osteochondrosis of the proximal tibia, the diagnosis is Blount disease.

  • Possibility of migration of the ossicle and fragmentation5


General Considerations


  • Three types of tibial tuberosity avulsion fractures

    • - Type 1: Small fragment displaced proximally, no surgery required

    • - Type 11: Articular surface remains intact, fracture at the secondary center of ossification and proximal tibia epiphysis

    • - Type III: Total break through articular surface

  • Bilateral symptoms in 20% to 30%6

  • Quadriceps tightness increases along with a decrease in hamstring tightness




  • Adolescent

  • More common in boys than girls7

  • Symptoms usually disappear when the adolescent growth spurt completes, usually around ages 9 to 16, about 14 in girls and 16 in boys8


Clinical Findings


Signs and Symptoms


  • Pain increasing with severity

  • Swelling at the tibia tubercle

  • Enlargement of the tibia tubercle

  • Anterior knee pain

  • Tenderness at the tibia tubercle

  • Tight quadriceps muscles

  • Anterior knee pain with deep squatting, descending stairs, prolonged sitting9


Functional Implications


  • Decreased sitting tolerance

  • Difficulty descending stairs

  • Decreased ability to squat

  • Decreased participation in running or jumping


Possible Contributing Causes


  • Intrinsic risk factors are maturity of the tibial tuberosity, rapid growth of the femur, quadriceps flexibility.

  • Complaints of anterior knee pain following sports involve jumping and running (ie, football, soccer, basketball, running) and kneeling.


Differential Diagnosis


  • Sinding-Larsen-Johansson syndrome (traction pull on the distal patella)10

  • Patella tendonitis

  • Meniscal injury

  • Patellofemoral syndrome, arthritis, subluxation, or instability11

  • Plica syndrome11

  • Anterior knee pain11

    • - Patellar subluxation or dislocation

    • - Jumper knee (patellar tendonitis)

    • - Posterior cruciate ligament (PCL) injury


Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.