Summary Osgood-Schlatter disease is osteochondrosis or traction apophysitis of the tibial tubercle, commonly presenting as anterior knee pain in the pediatric population. Diagnosis is made clinically with an enlarged tibial tubercle and supplemented with radiographs of the knee that reveal irregularity and fragmentation of the tibial tubercle. Treatment is nonoperative with NSAIDs, activity modification with quadriceps stretching and typically resolves with physeal closure. Epidemiology Demographics male:female ratio more common in boys age bracket boys 12-15y girls 8-12y Anatomic location bilateral in 20-30% Risk factors jumpers (basketball, volleyball) or sprinters Etiology Pathophysiology stress from extensor mechanism Anatomy Tibial tubercle is a secondary ossification center age <11y, tubercle is cartilaginous age 11-14y, apophysis forms age 14-18y, apophysis fuses with tibial epiphysis age >18y, epiphysis (and apophysis) is fused to rest of tibia Presentation Symptoms pain on anterior aspect of knee exacerbated by kneeling Physical exam inspection enlarged tibial tubercle tenderness over tibial tubercle provocative test pain on resisted knee extension Imaging Radiographs recommended views lateral radiograph of the knee findings irregularity and fragmentation of the tibial tubercle MRI indications not essential for diagnosis diagnosis can be made based on history, presence of tender swelling and radiographs alone findings soft tissue swelling thickening and edema of inferior patellar tendon fragmentation and irregularity of ossification center Differential Sinding-Larsen-Johansson syndrome chronic apophysitis or minor avulsion injury of inferior patella pole occurs in 10-14yr old children, especially children with cerebral palsy Osteochondroma of the proximal tibia Tibial tubercle fracture Jumpers knee Treatment Nonoperative NSAIDS, rest, ice, activity modification, strapping/sleeves to decrease tension on the apophysitis and quadriceps stretching indications first line of treatment outcomes 90% of patients have complete resolution cast immobilization x 6 weeks indications severe symptoms not responding to simple conservative management above Operative ossicle excision indications refractory cases (10% of patients) in skeletally mature patients with persistent symptoms Complications Complications of cast immobilization quadriceps wasting Prognosis Self-limiting but does not resolve until growth has halted