A child who plays soccer reports knee pain and swelling with focal tenderness at the tibial tuberosities. What is the treatment?

A child who plays soccer reports knee pain and swelling with focal tenderness at the tibial tuberosities. What is the treatment?

• A. Apply ice packs to both knees and avoid activities that cause pain
• B. Begin quadriceps-stretching exercises now to prevent further injury
• C. Obtain radiographic studies to rule out fractures or ligament tears
• D. Refer to a pediatric orthopedic specialist to evaluate the need for surgery

Answer: (A)

This presentation is typical for Osgood-Schlatter disease, a traction-type injury of the tibial tubercle seen in active adolescents. The best initial treatment is conservative: reduce pain and traction forces by resting from painful activities and using cold therapy after activity to decrease swelling. Applying ice packs to the knee after activity helps control pain and swelling, and avoiding activities that provoke pain lets the tibial tubercle heal. Analgesia with NSAIDs can be used as needed. As symptoms improve, a gradual return to activity with gentle quadriceps and hamstring stretching and strengthening can be started. Imaging isn’t routinely required in clear, straightforward cases, and surgical referral isn’t needed unless symptoms persist despite conservative management or if there are red flags suggesting another problem.

This presentation is typical for Osgood-Schlatter disease, a traction-type injury of the tibial tubercle seen in active adolescents. The best initial treatment is conservative: reduce pain and traction forces by resting from painful activities and using cold therapy after activity to decrease swelling.

Applying ice packs to the knee after activity helps control pain and swelling, and avoiding activities that provoke pain lets the tibial tubercle heal. Analgesia with NSAIDs can be used as needed. As symptoms improve, a gradual return to activity with gentle quadriceps and hamstring stretching and strengthening can be started. Imaging isn’t routinely required in clear, straightforward cases, and surgical referral isn’t needed unless symptoms persist despite conservative management or if there are red flags suggesting another problem.