Question
A 12 year old boy who plays football has a painful lump below his kneecap.
- Describe the radiograph and the pathology.
- What is the differential diagnosis?
- Outline management and prognosis.
Answer
Radiograph and pathology
- Fragmentation of the tibial tubercle apophysis with soft tissue swelling
- Osgood-Schlatter disease, a traction apophysitis
- Repetitive quadriceps pull at the patellar tendon insertion
- Boys 12 to 15, girls 8 to 12
- Bilateral in about a quarter
Differential diagnosis
- Sinding-Larsen-Johansson syndrome at the inferior pole of the patella
- Tibial tubercle avulsion fracture
- Patellar tendinopathy
- Infection or tumour if pain is constant or at night
Management
- Self limiting, settles with physeal closure
- Activity change and ice
- Quadriceps and hamstring stretching
- Knee pad for kneeling
- Avoid steroid injection
- Excision of a persistent painful ossicle after skeletal maturity
- Rarely leads to genu recurvatum from anterior tibial physeal arrest
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.