Synopsis
Diagnose tibial-tubercle traction apophysitis clinically, distinguish it from acute avulsion and sinister bone pain and guide load modification that preserves adolescent activity and strength.
- Osgood-Schlatter disease is traction apophysitis at the tibial tubercle in a growing adolescent, commonly during running and jumping sports.
- Key findings are activity-related focal tubercle pain, tenderness and prominence, worsened by jumping, sprinting, squatting, stairs and kneeling.
- The knee joint itself should have no large effusion, instability or loss of passive range; these findings suggest another diagnosis.
Key red flags
An acute explosive event with loss of straight-leg raise is a tibial-tubercle avulsion until imaging proves otherwise.
Investigation priorities
Confirm characteristic load-related tubercle pain and exclude joint, extensor, hip and sinister pathology.
Management branches
Gradual activity-related tubercle pain occurs in a growing child without red flags or acute extensor failure.
- Localise tenderness, examine knee and hip fully and quantify recent sport and growth-related load.
- Explain the benign self-limiting biology and agree activity limits based on limp and next-day response.
Key medicines
Ibuprofen for a short painful flareSelect the appropriate oral milligram dose and formulation volume from current BNFC paediatric tables, prescribe only for the brief painful flare, and state the maximum daily frequency.
Paracetamol as an alternativePrescribe the current BNFC dose by age and weight, stating exact milligrams, liquid volume, dosing interval and 24-hour maximum.