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 and eased by rest
• Onset is insidious and atraumatic rather than a single injury
• Typically affects boys aged 12–15 and girls aged 8–12 (girls earlier, reflecting earlier skeletal maturation)
• Commoner in jumping and pivoting sports
• Bilateral in up to 30%
The two key primary-care skills are simple:
• Diagnose OSD clinically in a typical presentation
• 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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