That Painful Bump Below the Knee: Osgood-Schlatter Is Not Growing Pains

Clinical Pearls

• OSD is a traction apophysitis of the tibial tubercle; location is the core of the differential diagnosis — the tubercle is OSD, the inferior pole of the patella is SLJ, and the mid-substance of the tendon is simple calcification.
• Diagnosis is clinical (tubercle tenderness + pain on resisted knee extension); X-rays are only used for unilateral/atypical presentations to rule out avulsion, tumors, or infection.
• “Self-limiting” needs a correction: soft tissue swelling and pain usually resolve in 12–24 months with growth plate closure, but once a loose ossicle forms, it mostly will not absorb and disappear. An adult cohort showed 73% still had residual discomfort (Krommes 2025).
• Conservative management success rate is >90%; steroid injection is not recommended (risk of subcutaneous atrophy and tendon rupture) — textbook phrasing is “not recommended,” not formally listed as a contraindication.
• Refractory ladder: dextrose prolotherapy (conflicting RCT evidence) → ESWT (weak evidence, traditionally a relative contraindication in children, use caution) → ossicle excision + tubercleplasty after skeletal maturity (good outcomes).

Abbreviations

Disease Background

Definition

• Traction apophysitis of the tibial tubercle secondary ossification center: an overuse injury caused by repetitive traction from the patellar tendon (Staheli Ch.9, Cuccurullo Ch.122).
• The lesion is at the distal insertion of the patellar tendon (tibial side), making it a symmetrical counterpart to SLJ at the proximal insertion (inferior pole of the patella) (McKinnis Ch.13).
• Symptomatic presentation persisting into adulthood is termed unresolved OSD (also known as a Mital lesion) (Mital 1980).

Epidemiology

• Predominantly occurs during the pubertal growth spurt: boys aged 12–15, girls aged 8–13 (girls present 2 years earlier) (Miranda-Comas Ch.16, Staheli Ch.9).
  • No new onset after growth plate closure; only appears before closure.
• Prevalence in athletic populations is 10–21%, significantly higher than in non-athletes (DeLee Ch.137, Miranda-Comas Ch.16).
• Bilateral in 20–50% of cases (mostly unilateral, though Cuccurullo reports up to 50% bilateral) (Cuccurullo Ch.122).
• Highest risk in sports involving running, jumping, kneeling, and kicking.

Pathophysiology

• Discrepant growth rates between bone and soft tissues: during the growth spurt, the rectus femoris relatively shortens, increasing tension in the extensor mechanism (DeLee Ch.137, Herring Tachdjians Ch.40).
• Repetitive concentric/eccentric quadriceps contraction → multiple submaximal micro-tears / micro-avulsion fractures of the secondary ossification center cartilage → inflammation, ossification, and tubercle enlargement (Frontera Ch.31, Cuccurullo Ch.122).
• Rectus femoris tightness is a known risk factor and the theoretical basis for stretching therapies (Herring Tachdjians Ch.40).
• The association with patella alta is controversial: Staheli/Herring consider it related, but studies cited by DeLee found no link between patella alta, OSD, and tubercle avulsion (Staheli Ch.9 vs DeLee Ch.137).

Natural History Model

• Flowers & Bhadreshwar model: normal apophysis development subjected to excessive traction → inflammation → majority heal; a minority continue with inflammation and persistent loose ossicles (Staheli Ch.9).

Complications List

• Rare, including (Sarwark Ch.33, Staheli Ch.9):
  • Tibial tubercle avulsion fracture: chronic OSD weakens the apophysis; forceful quadriceps contraction can cause acute avulsion.
  • Genu recurvatum: premature closure of the anterior proximal tibial epiphysis → anterior tibial bowing, knee hyperextension (severe but rare).
  • Patellar tendon rupture (extremely rare).
  • Persistent symptomatic ossicle (the most common long-term sequela).

Long-term Prognosis

• Soft tissue swelling and pain usually resolve over 12–24 months around growth plate closure (Staheli Ch.9, Sarwark Ch.33, Herring Tachdjians Ch.40).
• Residual tubercle prominence is common: most adults can still palpate the bump, usually asymptomatic.
• Not completely benign: Danish national cohort (adults with a history of adolescent OSD) (Krommes 2025):
  • 85% still had tubercle prominence; 73% still experienced pain or trouble from that site.
  • All six KOOS subscales were lower than normative estimates for healthy populations, with sports and quality of life showing the largest gaps (Cohen’s d > 0.8).
  • Risk of jumper’s knee in adulthood OR 70.4 (95% CI 32.9–155.0) — OSD is highly associated with subsequent patellar tendinopathy.
  • The longer the symptoms lasted and the stronger the pain, the worse the adult knee health (dose-response).
  • Contrasted against classic textbook claims that “>90% resolve with maturity” — the discrepancy stems from sampling (Krommes used a secondary care referral cohort, skewing severe); but clinically, patients should be honestly informed that symptoms can persist.
• Poor prognostic factors: imaging evidence of tubercle fragmentation is correlated with residual prominence and long-term symptoms (Herring Tachdjians Ch.40).

Clinical Assessment

Diagnostic Criteria

• Clinical diagnosis: localized tibial tubercle swelling + tenderness + pain provoked by resisted knee extension, without joint effusion (Staheli Ch.9, Frontera Ch.31).
• Meeting the clinical picture + soft tissue swelling is sufficient for diagnosis; routine imaging is not needed. X-rays are only ordered for unilateral, atypical cases, or when needing to rule out other lesions (Staheli Ch.9).

History Taking

• Progressive tibial tubercle pain, exacerbated by activity (running, jumping, kneeling, stairs) and relieved by rest.
• Parents often notice an antalgic gait (DeLee Ch.137).
• Recent history of a growth spurt.

Physical Examination

• Tibial tubercle tenderness + swelling + prominence; bony irregularities can be palpated in chronic cases (DeLee Ch.137).
• Tenderness possible over the distal 1/2 of the patellar tendon.
• Pain on resisted knee extension; quadriceps and hamstring tightness are common.
• No joint effusion (effusion should raise suspicion for other intra-articular pathologies).

X-ray Interpretation

• Lateral views are the most useful (Cuccurullo Ch.122, Braddom 7e Ch.37):
  • Acute phase: anterior soft tissue swelling over the tibial tubercle, blurring of the infrapatellar fat pad (Hoffa) borders.
  • After 3–4 weeks: tibial tubercle fragmentation / loose ossicles, sclerosis, tubercle enlargement.
  • Soft tissue swelling >4 mm (compared to contralateral side) supports the diagnosis (Frontera Ch.31).
• Pitfall: Simple apophyseal fragmentation can be a normal variant. It must correlate clinically; diagnosis should not be made solely on X-rays (Herring Tachdjians Ch.40).

How to differentiate bone fragmentation seen within the patellar tendon?

The keys are location + continuity + age + point of maximal tenderness (McKinnis Ch.13, see previous image for location reference):

• OSD: fragment/ossicle at the tibial tubercle (distal patellar tendon insertion), often accompanied by tubercle enlargement and deformity; tenderness is at the tubercle.
• SLJ: fragment/calcification at the inferior pole of the patella (proximal patellar tendon insertion), tenderness at the lower patellar border; shares the same mechanism as OSD as a symmetrical counterpart.
• Simple patellar tendon calcification (dystrophic / post-chronic tendinopathy): calcific deposits are in the mid-substance of the tendon, unconnected to bone, usually seen in older patients with chronic overuse.
• Will it disappear? Soft tissue swelling and symptoms will ease with maturity, but once an independently ossified ossicle / intra-tendinous calcification forms, it mostly “will not” auto-absorb. It will remain in the patellar tendon; patients with persistent symptoms have unresolved OSD and may require surgical excision (Krommes 2025, Mital 1980).

Ultrasound

• Useful for early detection and follow-up (Cuccurullo Ch.122, ElMiedany Ch.5):
  • Swelling of soft tissues and unossified cartilage, thickened distal patellar tendon with increased echogenicity.
  • Ossification center fragmentation/irregularity, decreased internal echogenicity.
  • Deep infrapatellar bursitis.
  • Doppler: hypervascularity at the affected patellar tendon insertion.
• ElMiedany classifies OSD ultrasound findings into 3 types, with Type I being igloo-like deformity of the tibial tubercle ossification + deep infrapatellar bursitis + patellar tendon changes (ElMiedany Ch.5).

MRI

• The most sensitive and specific modality (Cuccurullo Ch.122, Martinoli Ch.19):
  • Tibial tubercle bone marrow edema, distal patellar tendon thickening, preinsertional tendinosis.
  • Avulsion / bony fragmentation of the ossification center.
  • Blurring of the inferior margin of the infrapatellar fat pad, distended deep infrapatellar bursa (common).

Staging and Classification

• Clinically, descriptive imaging staging is used more often than formal grading; see above for ElMiedany’s 3 ultrasound types.
• The key is distinguishing between active (immature, healable) vs. unresolved (persistent symptomatic ossicle post-maturity); the latter dictates surgical intervention (Mital 1980).

Differential Diagnosis Table

Red Flags and Referral Timing

• Suspected avulsion fracture: inability to perform a straight-leg raise (SLR), visible widening/displacement of the tubercle → refer to pediatric orthopedics (urgent) (Sarwark Ch.33).
• Atypical / unilateral / night pain / systemic symptoms → image to rule out tumors or infection.
• No improvement after weeks to months of conservative management → refer to pediatric sports medicine / orthopedics (Sarwark Ch.33).

Clinical Management

Management Decision-Making

OSD Management Algorithm (Axes: Skeletal Maturity × Symptom Severity/Recalcitrance)

There are no formal society CPGs for OSD; the grades below are literature evidence levels, not society SoRs.

• Skeletally immature + typical presentation (vast majority) → patient education + relative rest + stretching, maintaining activity within tolerable limits → >90% success (Herring Tachdjians Ch.40).
  • Add infrapatellar strap, ice, and knee pads for symptom control.
• Recalcitrant to ≥3 months of conservative care with high athletic demands → consider dextrose prolotherapy (conflicting RCT evidence); or ESWT (weak evidence, traditionally a relative contraindication in children, use caution).
• Skeletally mature + symptomatic ossicle (unresolved OSD), failing 6–12 months of conservative care → ossicle excision + tubercleplasty (good outcomes).
• Suspicion of avulsion at any time (SLR lag vs. contralateral / tubercle displacement) → refer to orthopedics.
• Not recommended: steroid injection into the tibial tubercle or patellar tendon (risk of subcutaneous atrophy and tendon rupture) (Staheli Ch.9, Herring Tachdjians Ch.40).
  • Original texts use “not recommended / no longer recommended”; the literature does not formally list it as a contraindication. Opposition stems from clinical consensus + theoretical risk + lack of efficacy evidence; steroid injections fell into the “disagree” category in the Lyng 2020 survey (Lyng 2020).
  • Clinical decision remains the same (do not inject), but in education and documentation, it shouldn’t be framed as an “absolute contraindication”.

Treatment Goals

• Control pain, maintain tolerable sports participation, protect the apophysis from avulsion, and await natural maturation.

Prevention and Training Volume Control

• No OSD-specific prevention guidelines exist; the following is society consensus for adolescent overuse injuries, which encompasses OSD (AOSSM 2016).
• Early sport specialization is defined by three conditions being met simultaneously (AOSSM 2016):
  • Intensive training or competition for more than 8 months a year (almost year-round).
  • Focusing on a single sport to the exclusion of other sports and free play.
  • Occurring before puberty (around seventh grade / age 12).
• Two quantitative thresholds requiring close monitoring for overuse injury, burnout, and overtraining (AOSSM 2016):
  • Weekly training hours exceeding the child’s age (e.g., >13 hours/week for a 13-year-old).
  • Intensive training exceeding 16 hours per week.
• All adolescents (including non-athletes) can benefit from periodized integrative neuromuscular training (INT); specialized athletes especially need a dedicated INT phase (AOSSM 2016).
• Each sport has its own loading profile and corresponding overuse injuries — OSD correlates with running, jumping, kicking, and kneeling (AOSSM 2016, DeLee Ch.137).
• Concrete training volume example (safe training recommendations for tennis players aged 12 and older) (AOSSM 2016):
  • Organized training under 12 hours per week, competition under 12 events per year.
  • Injury prevention training at least 2 hours per week.
  • Incorporate a second sport that has an off-season.
• ⚠️ The above are consensus statements (expert opinion level), not RCT-based evidence; and they are not validated against OSD endpoints specifically.

Conservative Treatment

Activity Modification / Relative Rest

• Relative rest (activity within tolerable discomfort), not strict bed rest — 78.9% of physicians disagree with complete rest.
  • Evidence: Moderate — single-arm trial of education + activity modification + progressive strengthening improved self-reported outcomes (Hansen 2023, Lyng 2020).
• Avoid deep knee flexion movements like squats, kneeling, or cycling with low seat height; for severe cases, restrict intense sports short-term (4–8 weeks) (Cuccurullo Ch.122).

Acute Symptom Control

• Ice (15–20 mins, 2–3 times daily, especially post-exercise), short-term NSAIDs for pain relief (Sarwark Ch.33, Herring Tachdjians Ch.40).
  • Evidence: Low — provides analgesia but does not accelerate healing or alter the disease course (Miranda-Comas Ch.21).
• Knee pads to protect the tubercle in impact-prone sports (e.g., volleyball, soccer).

Physical Therapy

• Quadriceps and hamstring stretching (targeting rectus femoris tightness) is the most useful treatment (Staheli Ch.9, Herring Tachdjians Ch.40).
  • Evidence: Low to Moderate — largely based on narrative reviews and biomechanical rationale; case report showed return to competition after 2 months of kinesiotherapy + static stretching (Gaweł 2021).
• Addition of progressive quadriceps/gluteal strengthening, correcting landing mechanics, and addressing biomechanical factors like lumbo-pelvic control and subtalar pronation (Miranda-Comas Ch.21).

Bracing

• Infrapatellar strap (placed over the patellar tendon between the patella and the tubercle) for offloading and analgesia (Sarwark Ch.33, Herring Tachdjians Ch.40).
  • Evidence: Low — 2024 biomechanics study showed significant reductions in peak and cumulative quadriceps force during running (p < 0.001), primarily decreasing vastus forces; limited impact on rectus femoris forces, so patients with rectus tightness may benefit less (Zhang 2024).
• Knee immobilizer occasionally used for 7–10 days in severe pain to reduce inflammation, removed daily for ROM exercises (Staheli Ch.9, Abdelgawad Ch.8).

Emerging Therapies

Dextrose Prolotherapy

• 12.5–20% hyperosmolar dextrose injected into the tubercle / patellar tendon insertion, used for recalcitrant OSD.
• Conflicting RCT evidence, though all three trials reported good safety profiles without adverse events:
  • Evidence: Conflicting — Topol 2011 (n=54) found dextrose superior to lidocaine and usual care, with a higher proportion of asymptomatic sports participation at 1 year (Topol 2011); Wu 2022 (n=70, ultrasound-guided 12.5%) showed better VISA-P scores at 3, 6, and 12 months versus saline (Wu 2022).
  • Evidence: Negative — Nakase 2020 (43 knees, 20% dextrose) found no significant difference compared to saline; both groups improved over time (Nakase 2020).
• Discrepancies may stem from concentration differences (12.5% vs. 20%), use of ultrasound guidance, or sampling variations; not yet sufficient to become standard of care.

Extracorporeal Shockwave Therapy (ESWT)

• Mechanisms: disintegration of calcifications, hyperstimulation analgesia, neovascularization, alteration of cell permeability (Bellew Ch.16).
• Evidence: OSD-specific evidence is limited to case series; no RCTs or systematic reviews exist.
  • Evidence: Very Low — multimodal analgesic adjunct in OSD (Schmitz 2015, Lyng 2020).
    • Early high-energy focused ESWT was traditionally considered a relative contraindication in children due to concerns over growth plate damage in animal studies.
    • Recent animal and case data suggest radial ESWT (rESWT) is relatively safe in immature bone.
  • Evidence: Very Low — case series of 15 OSD patients receiving focused, low-energy ESWT reported no adverse events (Shafshak 2023).
• Suggested protocol parameters (no OSD-specific consensus; adopting general soft-tissue tendinopathy guidelines) (Braddom 7e Ch.18):
  • 2000–3000 shocks per session, 3 consecutive sessions, once a week.
  • EFD set at the upper limit of moderate intensity tolerated by the patient (low <0.12, high >0.12 mJ/mm² are common cutoffs; alternative definitions use low 0.08–0.28, medium 0.28–0.60, high >0.60 mJ/mm²).
  • Ultrasound localization of lesion depth as the target.
  • Contraindications: bleeding disorders, pacemakers, anticoagulation, pregnancy, acute injuries — along with “children” as a traditional relative contraindication. Therefore, its use in OSD should be restricted to recalcitrant cases or those nearing skeletal maturity, with fully informed consent (Bellew Ch.16).
• Out-of-pocket reference (Taiwan): Not covered by National Health Insurance.
  • Nationally announced range is approximately NT$1000–2000 per session.

Surgical Interventions

Ossicle Excision + Tubercleplasty

• Indications: skeletally mature + symptomatic ossicle (unresolved OSD), failing 6–12 months of conservative care, with persistent kneeling pain / activity limitations (Sarwark Ch.33, Mital 1980).
• Procedure: excision of loose ossicles and bursal tissue, often combined with distal patellar tendon debridement and tubercleplasty; can be performed open, arthroscopically, bursoscopically, or ultrasound-guided.
  • Evidence: Moderate (consistently good in case series) — arthroscopic ossicle excision + tubercleplasty improved Kujala scores from 69.9 to 98.5, Lysholm from 76.3 to 99.5, with 100% returning to pre-injury sports (Dimnjaković 2026); bursoscopic excision in military personnel improved Lysholm from 71 to 99, VAS from 6.5 to 0.9, with 17/18 satisfied (Eun 2015).
  • Evidence: Moderate — long-term follow-up of military personnel post-surgery showed 87% without daily limitations and 75% returning to pre-surgical activity levels (Pihlajamaki via DeLee Ch.137).
  • ⚠️ Case series have small sample sizes (the former n=12, mean age 21.7 years, preoperative symptoms lasting an average of 77 months) and lack randomized controls.
• Surgical complications cannot be ignored: out of 6 surgical studies reviewed, 5 reported complications ranging from 0–75.8%, including infection, hypertrophic scarring, and residual pain (Ndjonko 2026).
  • Compared to 0–66.7% in non-surgical groups (mostly quadriceps atrophy and skin irritation) — the advantage of surgery lies in efficacy, not safety.
• A literature review (15 studies / 712 patients) covered non-surgical, injection, and surgical categories, with surgery reserved for recalcitrant mature cases (Ndjonko 2026).
  • ⚠️ The article title claims to be a systematic review, but the authors self-described the design as a scoping review, Level of evidence 4; it should not be cited as high-level evidence.

Post-operative Rehabilitation

• Progressive quadriceps/hamstring strengthening and stretching, ROM restoration; return to play dictated by symptoms and muscle strength. Principles echo conservative rehabilitation, avoiding premature high-load traction on the tubercle.

Evidence Summary Table

Production Workflow for These Notes

Materials used

• Pediatric orthopedics and sports medicine textbooks: Tachdjian’s 6e, Staheli 4e, Sarwark, DeLee 5e, Braddom 7e, Cuccurullo 4e, Miranda-Comas, Frontera, Abdelgawad; imaging and ultrasound from McKinnis 5e, Martinoli, and ElMiedany
• Consensus statement: the AOSSM 2016 early sport specialization consensus (the source for the prevention and training-volume section)
• Primary literature: the Danish national cohort study on residual symptoms in adulthood (Krommes 2025), three dextrose prolotherapy RCTs (Topol 2011 / Nakase 2020 / Wu 2022), the surgical series (Eun 2015, Dimnjaković 2026, Mital 1980), and reviews of ESWT efficacy and safety
• Evidence on patient education design: Hansen 2023 on developing a leaflet for children, and Lyng 2020 on current clinical practice

Tools used

• audit_note.py — my own note-format audit script
• PubMed MCP — filling in volume/issue/page and PMIDs for the three 2025–2026 papers, and checking each paper’s stated study design and level of evidence
• textbook_search — semantic search over a local markdown index of my textbooks
• OpenEvidence — an independent search to sanity-check the treatment-recommendation wording
• Custom Python/PIL plotting scripts — the anterior knee pain location figure and the cover image, one of each per language (scripts/figures/)
• Hugo’s bilingual pipeline i18n_sync.py — the English version is machine-translated first, then medical terminology is proofread by hand

This workflow itself became textbook-to-note. If you have a Claude or Codex subscription, this kind of mechanical verification and organizing work can be handed off, leaving the judgment to you. Getting started and talking to agents are good entry points.

About this version

The pro version is taken straight from my own clinical notes, unedited for the blog, keeping my original citation style (book + chapter, or author + year; full bibliography below). Copyrighted images from textbooks and journals aren’t included here — every figure is one I redrew myself.

If I’ve gotten something wrong, corrections are welcome.

Reference

Books

• Staheli Ch.9 — Fundamentals of Pediatric Orthopedics, 4th ed, 2008
• Sarwark Ch.33 — Pediatric Orthopaedics and Sports Injuries: A Quick Reference Guide, 3rd ed, 2021
• Cuccurullo Ch.122 — Physical Medicine and Rehabilitation Board Review, 4th ed, 2020
• Herring Ch.40 — Tachdjian’s Pediatric Orthopaedics, 6th ed, 2022
• DeLee Ch.137 — DeLee & Drez’s Orthopaedic Sports Medicine, 5th ed, 2020
• Braddom Ch.18 / Ch.37 — Physical Medicine and Rehabilitation, 7th ed, 2021 (ESWT physical parameters, Lower Limb Pain)
• McKinnis Ch.13 — Fundamentals of Musculoskeletal Imaging, 5th ed, 2022 (OSD vs SLJ differential)
• Martinoli Ch.19 — Musculoskeletal Ultrasound, 1st ed, 2007
• Frontera Ch.31 — Clinical Sports Medicine, 1st ed, 2007
• Miranda-Comas Ch.16 / Ch.21 — Essential Sports Medicine, 2nd ed, 2021
• Bellew Ch.16 — Michlovitz’s Modalities for Therapeutic Intervention, 6th ed, 2016
• Abdelgawad Ch.8 — Pediatric Orthopedics and Sports Medicine, 2nd ed, 2020
• ElMiedany Ch.5 — Musculoskeletal Ultrasonography in Rheumatic Diseases, 2015

Papers

• LaPrade RF, Agel J, Baker J, et al. AOSSM Early Sport Specialization Consensus Statement. Orthop J Sports Med. 2016;4(4):2325967116644241. doi:10.1177/2325967116644241
• Krommes K, Bjerre A, Thorborg K, et al. Long-Term Knee Health in Adults with a History of Adolescent Osgood-Schlatter: A National Cohort Study of Patients in Secondary Care in Denmark 1977-2020. Sports Med. 2025;55(7):1769-1781. doi:10.1007/s40279-025-02214-5. PMID: 40439870
• Ndjonko LCM, Klein JH, Chakraborty Y, et al. Treatments for Osgood Schlatter Disease: A Systematic Review of the Literature. Orthop J Sports Med. 2026;14(3):23259671251387354. doi:10.1177/23259671251387354. PMID: 41788553
• Dimnjaković D, Plečko M, Đukić E, Bojanić I. Standard knee arthroscopy with free ossicle removal and tubercleplasty provides optimal results for unresolved Osgood-Schlatter disease. Knee. 2026;62:104498. doi:10.1016/j.knee.2026.104498. PMID: 42190337
• Topol GA, Podesta LA, Reeves KD, et al. Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease. Pediatrics. 2011;128(5):e1121-8. PMID: 21969284
• Nakase J, Oshima T, Takata Y, et al. No Superiority of Dextrose Injections Over Placebo Injections for Osgood-Schlatter Disease. Arch Orthop Trauma Surg. 2020;140(2). PMID: 31713082
• Wu Z, Tu X, Tu Z. Hyperosmolar Dextrose Injection for Osgood-Schlatter Disease: A Double-Blind, Randomized Controlled Trial. Arch Orthop Trauma Surg. 2022;142(9). PMID: 34673998
• Lyng KD, Rathleff MS, Dean BJF, et al. Current management strategies in Osgood Schlatter: A cross-sectional mixed-method study. Scand J Med Sci Sports. 2020;30(10):1985-1991. doi:10.1111/sms.13751. PMID: 32562293
• Hansen R, Rathleff MS, Lundgaard-Nielsen M, Holden S. Development of an informative leaflet for children with Osgood-Schlatter disease. Scand J Med Sci Sports. 2023;33(12). PMID: 37726948
• Gaweł E, Zwierzchowska A. Therapeutic Interventions in Osgood-Schlatter Disease: A Case Report. Medicine (Baltimore). 2021;100(50):e28257. PMID: 34918694
• Zhang X, Ren W, Wang X, et al. Quantitative Analysis of Quadriceps Forces in Adolescent Females During Running With Infrapatellar Straps. J Sports Sci Med. 2024;23(4):787. PMID: 39649570
• Shafshak TS, Amer MA. Extracorporeal shockwave therapy in Osgood-Schlatter disease (case series). J Orthop Surg Res. 2023. PMID: 37608382
• Schmitz C, Császár NB, Milz S, et al. Efficacy and Safety of Extracorporeal Shock Wave Therapy for Orthopedic Conditions. Br Med Bull. 2015;116(1):115-38. PMID: 26585999
• Eun SS, Lee SA, Kumar R, et al. Direct Bursoscopic Ossicle Resection in Young and Active Patients With Unresolved Osgood-Schlatter Disease. Arthroscopy. 2015;31(3). PMID: 25442658
• Mital MA, Matza RA, Cohen J. The So-Called Unresolved Osgood-Schlatter Lesion. J Bone Joint Surg Am. 1980;62(5). PMID: 7391096