Orthopaedic Assessment Letter for Referring GPs

Diagnosis

• Right Osgood-Schlatter disease.

Plan

• Activity modification and relative rest from high-impact jumping for 6 weeks.
• Referral to physiotherapy for quadriceps and hamstring stretching and eccentric strengthening.
• Simple analgesia with ibuprofen (Nurofen®) 200 mg PO TID PRN and ice application post-activity.

Thank you for referring Liam O'Connor, whom I saw today. Liam is a 13-year-old school student male presenting with atraumatic right anterior knee pain.

He reports an insidious onset of dull aching pain over the proximal tibia over the past 4 months, which he rates at 6/10 in severity during flare-ups. The pain is exacerbated by running, jumping, kneeling, and ascending stairs, and is relieved by rest. There is no associated joint locking, giving way, or systemic symptoms, though the pain currently limits his ability to complete full basketball games. He denies any acute trauma or prior knee injuries. He has trialled intermittent paracetamol (Panadol®) 500 mg PO QID PRN with minimal relief and explicitly denied having tried any formal physiotherapy or bracing prior to today.

Liam is a year 8 student who lives at home with his parents and plays competitive club basketball three times a week, alongside recreational cycling. His past medical history is significant only for mild exercise-induced asthma, with no prior surgical history, and his only regular medication is salbutamol (Ventolin®) 100 mcg INH PRN, with no known drug allergies.

On examination, he walked with a normal gait, though inspection revealed a prominent, localised swelling over the right tibial tuberosity without joint effusion or erythema. There was marked focal tenderness on palpation of the right tibial tuberosity, full active and passive range of motion from 0 to 135 degrees, normal 5/5 quadriceps strength despite pain on resisted knee extension, and stable cruciate and collateral ligaments with tight bilateral hamstrings. Plain X-rays of the right knee performed in 04/2026 at i-Med demonstrated anterior soft tissue swelling and minor fragmentation of the tibial tuberosity apophysis, with normal joint spaces and no acute fracture.

We discussed the benign, self-limiting nature of traction apophysitis and reassured Liam and his mother that symptoms typically resolve completely upon physeal closure. We reviewed non-operative management strategies, emphasising that surgical intervention is not indicated and that continuing sport is safe if pain remains tolerable and subsides within 24 hours. I provided an educational handout on load management and addressed his mother's concerns regarding long-term joint damage, confirming that persistent bony prominence is a common cosmetic sequela but does not impair future adult knee function.

Thank you for your continued care of Liam. Please contact me if you have questions or need further information about the management plan.

Yours sincerely,