Orthopaedic Consultation Summary for GP

Dear Dr Miller,

Thank you for referring Leo Vance, a 13-year-old boy, regarding his left knee pain.

Diagnosis

Left tibial tubercle apophysitis (Osgood-Schlatter disease).

Management

• Activity modification with relative rest from high-impact jumping and sprinting for 4 to 6 weeks.
• Referral to physiotherapy for eccentric quadriceps strengthening and hamstring stretching, alongside a patellar tendon strap for sporting activities.
• Simple analgesia with ibuprofen 200 mg PO TID PRN and local ice application post-activity.

History of Presenting Complaint

Leo presents with a 4-month history of insidious-onset anterior left knee pain, coinciding with a recent growth spurt. He rates the pain as 6/10 in severity at its worst. The pain is aggravated by running, jumping, kneeling, and ascending stairs, and is relieved by rest. He reports mild localised swelling over the proximal tibia and mild stiffness following activity, but denies mechanical locking, catching, or instability. There is no history of acute trauma or prior knee injuries. Previous treatment has been limited to ad hoc rest, which provided temporary relief. Current medications include paracetamol (Panadol®) 500 mg PO QID PRN, which provides minimal benefit; he takes no regular supplements.

Social History

Leo is a Year 8 student who plays competitive club basketball three times a week and participates in school athletics, specifically high jump and hurdles.

Examination

On inspection, Leo walks with a normal gait, though he exhibits a mild antalgic component when asked to perform a single-leg squat on the left. There is prominence and mild soft tissue swelling over the left tibial tuberosity, with no joint effusion or erythema. Palpation reveals focal tenderness directly over the left tibial tubercle, while the patellar tendon body and joint lines are non-tender. Active and passive knee range of movement is full (0 to 135 degrees), though terminal flexion reproduces pain at the tibial tuberosity. Quadriceps and hamstring strength is 5/5 bilaterally, with pain elicited on resisted left knee extension; significant bilateral hamstring tightness is noted (popliteal angle 40 degrees). Ligamentous stability testing (Lachman, anterior/posterior drawer, and varus/valgus stress) is intact and symmetric.

Imaging

Plain radiographs of the left knee (AP and lateral views) dated 10/05/2026 demonstrate mild fragmentation of the tibial tubercle apophysis with overlying soft tissue swelling, consistent with Osgood-Schlatter disease. The tibiofemoral and patellofemoral joint spaces are preserved with no acute fracture or osteochondral defect identified.

Discussion

Leo and his mother were educated on the benign, self-limiting nature of traction apophysitis and its correlation with rapid skeletal growth. Non-operative management was emphasised as the standard of care, focusing on load management and physiotherapy, while noting that surgical intervention (such as ossicle excision) is rarely indicated and only considered after skeletal maturity if a painful ununited ossicle persists. Potential complications, including persistent bony prominence and prolonged symptom duration if overload continues, were also outlined.

Leo and his mother expressed concern regarding whether continuing to play basketball would cause permanent joint damage; they were reassured that while activity may provoke pain, it does not cause long-term structural joint damage, and he may continue modified training within his pain tolerance.

Yours sincerely,

Dr Sarah Jenkins Paediatrician