What is the most likely cause of knee pain in a 13-year-old boy with tenderness over the left tibial tubercle, exacerbated by knee extension against resistance and squatting, in the absence of systemic symptoms such as fever, weight loss, or night sweats?

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Differential Diagnosis for Knee Pain in a 13-year-old Boy

  • Single most likely diagnosis
    • A. Osgood-Schlatter disease: This condition is characterized by pain and swelling over the tibial tubercle, which is the site of attachment for the patellar tendon. The patient's symptoms, including tenderness over the left tibial tubercle, pain with knee extension against resistance, and squatting, are consistent with Osgood-Schlatter disease. The disease is common in adolescents, especially those involved in sports that involve running, jumping, and quick changes of direction.
  • Other Likely diagnoses
    • B. Patellar tendinitis: This condition, also known as jumper's knee, is characterized by pain and inflammation of the patellar tendon. The patient's symptoms, including pain with knee extension against resistance and squatting, could be consistent with patellar tendinitis. However, the tenderness is more localized to the tibial tubercle, making Osgood-Schlatter disease more likely.
    • C. Patellofemoral pain: This condition is characterized by pain in the front of the knee, usually around or behind the patella. While the patient's symptoms could be consistent with patellofemoral pain, the localized tenderness over the tibial tubercle and the specific activities that reproduce the pain make Osgood-Schlatter disease more likely.
  • Do Not Miss diagnoses
    • E. Tibial osteomyelitis: This is a bone infection that can cause pain, swelling, and redness over the affected area. Although the patient's symptoms do not suggest an infectious process (no fever, weight loss, or night sweats), osteomyelitis can be a subtle diagnosis, and it is essential to consider it to avoid missing a potentially serious condition.
  • Rare diagnoses
    • D. Prepatellar bursitis: This condition is characterized by inflammation of the prepatellar bursa, which can cause swelling and pain in the front of the knee. However, the patient's symptoms do not suggest prepatellar bursitis, as there is no palpable effusion or swelling over the prepatellar area.
    • Other rare diagnoses, such as tumors or rheumatologic conditions, are not suggested by the patient's symptoms and are unlikely in this case.

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