Tibial Tuberosity Bumps: Osgood-Schlatter Disease Insights

Proximal tibial prominence below the knee?

Hello, doctor.
I started noticing a hard bump near the proximal left tibia, just below the knee, around the age of 13, specifically near the tibial tuberosity.
There is no swelling, and it does not hurt when pressed; I can run and jump normally.
The only discomfort occurs when I kneel or bump into it.
Since I am an active person and did a lot of running and jumping during puberty, after researching and looking through literature, I feel it might be Osgood-Schlatter Disease.
However, a few days ago (I am now 22 years old), I accidentally discovered another hard bump below the original one (further down from the knee, at the relative distal end of the original bump), about the size of a peanut.
There is still no swelling, and it does not hurt when pressed.
However, I have two questions I would like to ask the doctor:
1.
Osgood-Schlatter Disease seems to commonly be associated with pain during the acute phase, but I did not experience any discomfort during either instance (at 13 years old and now at 22); I only noticed them by chance.
Is this a normal situation?
2.
I have been exercising very little this past year due to a busy schedule, and I have also been several years past puberty.
With less exercise and being beyond puberty, it seems less typical for a patient with Osgood-Schlatter Disease.
Is there still a high possibility that this new bump is related to Osgood-Schlatter Disease, or could it be indicative of another condition? I was quite anxious when I first noticed the bump as a child, and now, many years later, I have discovered another one...
I am a bit worried.
Thank you very much for your explanation and advice!

Yang, 20~29 year old female. Ask Date: 2020/09/14

Dr. Chen Bochen reply Orthopedics

1.
Your medical history and symptoms are consistent with Osgood-Schlatter Disease, but a diagnosis should be confirmed with X-rays.
However, Osgood-Schlatter Disease does not always cause pain.
2.
It typically does not occur after puberty, and there could be various reasons for this, such as osteochondroma (commonly known as a bone spur).
3.
I recommend that you visit a medical center's orthopedic oncology department for an X-ray examination.

Reply Date: 2020/09/14

More Info

Osgood-Schlatter disease (OSD) is a common condition that affects adolescents, particularly those who are active in sports that involve running, jumping, and kneeling. It is characterized by pain and swelling at the tibial tuberosity, which is the bony prominence just below the knee where the patellar tendon attaches to the tibia. The condition is caused by repetitive stress on the knee, leading to inflammation of the growth plate (apophysis) at the tibial tuberosity.

In your case, it seems you have developed a hard bump at the tibial tuberosity, which is consistent with Osgood-Schlatter disease. However, you mentioned that you do not experience pain during activities, and the bump only causes discomfort when kneeling or if it is bumped. This is not uncommon; some individuals with OSD may have minimal or no pain, especially if they are not currently active in sports or if the condition has stabilized.
To address your specific questions:
1. Lack of Pain in Osgood-Schlatter Disease: It is indeed possible for individuals with OSD to have minimal or no pain, particularly if the condition has become chronic or if the individual has adapted their activities to avoid aggravating the area. The acute phase of OSD typically involves significant pain and swelling, but as the condition progresses and the growth plate matures, symptoms may diminish. Your experience of discovering the bumps without associated pain is not unusual, especially if you have not been engaging in high-impact activities recently.

2. Age and Activity Level Considerations: Osgood-Schlatter disease is most common during periods of rapid growth, typically between the ages of 10 and 15 in girls and 12 to 16 in boys. Since you are now 22 years old and have reduced your physical activity, it is less likely that you are experiencing a new case of OSD. However, the presence of a new hard bump below the original site could indicate other conditions. For instance, it might be a benign bone growth or a residual effect of previous OSD. Other possibilities include conditions such as patellar tendinopathy or even a condition known as Sinding-Larsen-Johansson syndrome, which affects the inferior pole of the patella.

Given that you have a new hard bump and no associated pain, it would be prudent to consult with a healthcare professional, preferably an orthopedic specialist. They may recommend imaging studies, such as X-rays or an MRI, to assess the nature of the new bump and rule out any other underlying conditions.
In summary, while your symptoms align with Osgood-Schlatter disease, the new hard bump warrants further investigation to ensure that it is not indicative of another issue. It is always best to err on the side of caution and seek professional advice, especially when changes in your body occur. Regular follow-ups and monitoring can help manage any concerns you may have regarding your knee health.

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