Inflammation of the front of the tibial bone at the anterior tibial tubercle below the epiphysis.

Osgood-Schlatter disease occurs most prevalently during the years of rapid adolescent growth, though it can occur later in life. Microtrauma with stress occurring within the cartilaginous substance of the anterior tibial tubercle can cause this condition. It is primarily caused from repetitive overuse of the knee with repeated pulling of the kneecap tendon, such as with excessive activity in sports. Usually only one knee is affected, though both may be involved. The disease causes degenerative changes in the bones and can progress to avascular and aseptic necrosis.

Symptoms may include swelling, warmth, and tenderness below the kneecap. Pain may occur with palpation, and when kneeling, jumping, climbing stairs, running, squatting, lifting weights, or with activities requiring bending and full extension of the leg. Range of motion (ROM) may be decreased. Symptoms worsen with activity and are relieved with rest.

Physical examination and bone x-rays are performed. Usually x-ray evaluation is normal except for soft tissue swelling anterior to the tibial tubercle. Fragmentation of the ossification center of the tibial tubercle is not diagnostic and may be seen in normal knees.

Activity may be limited with substitution of nonoffensive activities until pain subsides. Ice applied after activity and use of a protective device for the knee may decrease pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for pain and swelling. Once pain subsides, activity may be slowly resumed in conjunction with the implementation of strengthening and stretching exercises. Cast immobilization has not substantially influenced the duration of treatment and is seldom used at this time.

Activity may be limited for 6 to 18 months. When treated improperly, recurrence later in life is possible. There may be slow healing and repair when the disease advances to avascular and aseptic necrosis. The need for surgery is rare. Chronic pain is the most common residual.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)). Federal Register that updated the musculoskeletal schedule per 85 FR 76453.

• Shin splints can be evaluated based on impairment of the tibia and fibula including nonunion, malunioin, or medical tibial stress syndrome (MTSS) or based on pain associated with shin splints.

• For evaluating impairment of the tibia and fibula including nonunion, malunion (evaluated under the corresponding knee or ankle codes based on associated impairment), or MTSS. Evaluations based on MTSS are based on conservative treatment, i.e., rest, ice, elevation, medication, compression socks, and/or massage.

• MTSS, or shin splints, is a type of joint or periarticular pathology which is a requirement for application of 38 CFR 4.59, for assignment of the minimum compensable evaluation under 38 CFR 4.71a, DC 5262 when painful motion is shown and shin splints are otherwise noncompensable.

• The minimum compensable evaluation is warranted when painful motion due to shin splints occurs in nearby affected joints such as the ankle or knee or when shin pain or other similar pain occurs with motion.  However, when a separate knee or ankle disability exists and has been compensably evaluated, do not assign a compensable evaluation under 38 CFR 4.59 for shin splints causing painful motion in an already-compensable SC knee or ankle joint.

• Shin splints without pain that is not associated with motion, such as pain on palpation, are noncompensable under 38 CFR 4.59.

• Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation.