In Osgood-Schlatter disease, what assessment finding is typical?

• A. The pain is always bilateral.
• B. Pain worsens with quadriceps contraction.
• C. There will be an avulsion of the quadriceps tendon.
• D. Assessments vary. An X-ray can be used for diagnosis.

Answer: (B)

Osgood-Schlatter disease is a traction injury of the tibial tubercle caused by repetitive pulling of the patellar tendon through the growing knee in adolescents. The hallmark assessment finding is pain and tenderness at the tibial tubercle that gets worse with activities that contract the quadriceps, because bending the knee and forcing the quadriceps to contract increases tension on the patellar tendon and strains the developing tibial tubercle. This explains why resisted knee extension or activities like running and jumping provoke the pain.

It's common for the pain to be localized to the tibial tubercle and to fluctuate with activity, and it can be unilateral or, less frequently, bilateral. Imaging, such as an X-ray, can show fragmentation or irregularity of the tibial tubercle in some cases, but the diagnosis is largely clinical and based on the activity-related pain and tenderness. The idea that the problem always presents bilaterally, or that it involves an avulsion of the quadriceps tendon, doesn't fit the typical mechanism or presentation.