GPAtlas🧭 When to suspect
Suspect Osgood-Schlatter disease (OSD) – a traction apophysitis of the tibial tuberosity – in an active adolescent presenting with activity-related anterior knee pain localised to the tibial tuberosity. The pain arises where the patellar tendon inserts onto the still-ossifying apophysis: during the growth spurt the pull of a strong quadriceps mechanism repeatedly stresses this immature insertion, producing pain, swelling and a tender bony prominence.
The presentation is characteristic. Pain is worse with running, jumping, squatting, stair-climbing and kneeling, eased by rest, and the onset is insidious and atraumatic rather than a single injury. It typically affects boys aged 12–15 and girls aged 8–12 (girls earlier, reflecting earlier skeletal maturation), is commoner in jumping and pivoting sports, and is bilateral in up to 30%.
The two key primary-care skills are simple: diagnose OSD clinically in a typical presentation, and do not anchor on it – an adolescent with knee pain still needs the sinister mimics excluded, above all a slipped upper femoral epiphysis and a bone tumour around the knee.
Source: Association of Paediatric Chartered Physiotherapists (APCP)
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