Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

early stage

1st line – modification of activities and nonpharmacologic measures

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ACUTE
|
early stage
1st line – 

modification of activities and nonpharmacologic measures

During the early stage of the disease there is usually excellent response to simple activity modification: for example, abstaining from sports, and application of cold pack or compress to the anterior knee.

OSD typically has a self-limiting course, and therefore amelioration of pain and avoidance of pain-provoking activities is usually all that is necessary for most patients with this condition.

Activities that involve forceful knee extension and provoke pain should be avoided.

Those patients who have mild pain and no weakness should be allowed to continue sports.

Those who do exhibit weakness of quadriceps and/or hamstrings or have moderate to severe pain should abstain from sports until symptoms abate.

A cold pack or a bag with ice may be applied directly to the anterior aspect of the knee as needed.

A compressive bandage (such as an ace wrap) may be applied to the affected knee for symptomatic relief, especially if swelling is present.

Plus – nonsteroidal anti-inflammatory drugs (NSAIDs)

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ACUTE
|
early stage
Plus – 

nonsteroidal anti-inflammatory drugs (NSAIDs)

Treatment recommended for ALL patients in selected patient group

During the early stage of the disease there is usually excellent response to NSAIDs.

OSD typically has a self-limiting course and therefore amelioration of pain and avoidance of pain-provoking activities is usually all that is necessary for most patients with this condition.

A variety of NSAIDs may be used to relieve symptoms.

Primary options

ibuprofen: children: 5-10 mg/kg orally every 6-8 hours when required; maximum 40 mg/kg/day; adults: 400-800 mg orally every 6-8 hours when required, maximum 3200 mg/day

OR

naproxen: children >2 years of age: 5 mg/kg orally every 12 hours when required; adults: 500 mg orally twice daily when required, maximum 1250 mg/day

Plus – physical therapy

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ACUTE
|
early stage
Plus – 

physical therapy

Treatment recommended for ALL patients in selected patient group

During the early stage of the disease there is usually excellent response to physical therapy.

OSD typically has a self-limiting course and therefore amelioration of pain and avoidance of pain-provoking activities is usually all that is necessary for most patients with this condition.

Physical therapy should be started after acute symptoms abate.

Goal of therapy is strengthening of the quadriceps and hamstrings, as well as improving flexibility about the knee.

Exercises that cause high shear forces on the tibial tubercle should be avoided.

Plus – bracing and immobilization

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ACUTE
|
early stage
|
severe or prolonged pain
Plus – 

bracing and immobilization

Treatment recommended for ALL patients in selected patient group

For patients with prolonged or severe pain, knee immobilization and bracing may be necessary. Evidence from randomized controlled trials is lacking.[17]​ Some patients with severe or prolonged pain from OSD may benefit from a brief period (several days to 1 week) of knee immobilization in a knee immobilizer brace.

Full weight-bearing should be allowed and encouraged while in a brace.

Prolonged immobilization (for example, with a cylinder cast) is no longer recommended because it leads to quadriceps atrophy.[1]

Knee padding or protective bracing with devices such as an infrapatellar strap may help relieve symptoms in patients who desire or need to continue participating in athletic activities despite their condition.[26]

ONGOING

progressive or late stage

1st line – surgery

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ONGOING
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progressive or late stage
1st line – 

surgery

Review of literature indicates that up to 10% to 12% of patients with OSD may have prolonged symptoms despite conservative management and some may go on to require surgical treatment. Surgery should not be performed until after the patient reaches skeletal maturity.[1]

Equal first-line surgical options include drilling of the tibial tubercle, partial resection of the tibial tubercle, excision of the separated ossicle, and combination of these procedures. A vast majority of patients who undergo surgical treatment for persistent symptoms of OSD report excellent pain relief and are able to return to full activities, including athletic participation.[19][20][21][22][23][24][25]

persistence of pain into late adolescence or adulthood

1st line – surgery

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ONGOING
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persistence of pain into late adolescence or adulthood
1st line – 

surgery

Bony overgrowth of the tibial tubercle or persistence of a bony ossicle into adulthood may be a purely cosmetic problem or may cause pain and functional limitations. The bony prominence at the tibial tubercle results from the small ossicle that forms from the fragmentation of the apophysis. This ossicle may impinge on the patellar tendon, causing pain and limiting activity.[4] This can be addressed surgically with excision of the ossicle and/or osteoplasty of the tibial tubercle, with excellent long-term outcomes.[25]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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