Patellofemoral Pain Syndrome and Osgood-Schlatter Disease Are Distinct Conditions
Patellofemoral pain syndrome (PFPS) and Osgood-Schlatter disease are separate clinical entities that should be differentiated, though both can cause anterior knee pain in adolescents. 1
Key Distinctions
Osgood-Schlatter Disease
- Osgood-Schlatter is a traction apophysitis of the tibial tubercle caused by repetitive strain on the secondary ossification center of the tibial tuberosity, occurring in growing children (boys 12-15 years, girls 8-12 years) 2
- Presents with localized pain, swelling, and tenderness specifically over the tibial tuberosity with a characteristic bony prominence 3
- Pain is exacerbated by jumping activities (basketball, volleyball) and direct contact like kneeling 2
- Radiographs show irregularity and fragmentation of the tibial tuberosity apophysis, which is diagnostic 3
- This is a self-limiting condition that resolves with closure of the tibial growth plate 2, 4
Patellofemoral Pain Syndrome
- PFPS presents with diffuse retropatellar and/or peripatellar pain rather than focal tibial tuberosity pain 5
- Pain occurs during squatting, stair ambulation, running, and prolonged sitting with knees flexed 5
- No specific bony prominence or apophyseal changes are present 1
- PFPS has a poor prognosis with over 50% reporting persistent pain beyond 5 years, unlike the self-limiting nature of Osgood-Schlatter 5
Clinical Approach to Differentiation
When evaluating anterior knee pain, Osgood-Schlatter should be excluded before diagnosing PFPS 1. The distinction is straightforward:
- Palpate the tibial tuberosity: Focal tenderness and prominence indicate Osgood-Schlatter 2, 3
- Assess pain location: Retropatellar/peripatellar pain suggests PFPS; tibial tuberosity pain indicates Osgood-Schlatter 5, 1
- MRI can evaluate Osgood-Schlatter or Sinding-Larsen-Johansson syndrome when diagnosis is uncertain 5
Management Differs Significantly
For Osgood-Schlatter
- 90% respond to rest, icing, activity modification, and rehabilitation exercises 2
- Limit physical activities for 12-24 months until symptoms resolve 6
- Surgical excision of ossicles is reserved for skeletally mature patients with persistent symptoms despite conservative treatment 2, 4
For PFPS
- Knee-targeted exercise therapy underpinned by education is the primary intervention 5
- Hip-and-knee targeted strengthening should be prescribed based on tolerance to loaded knee flexion 5
- Prefabricated foot orthoses, taping, and movement retraining are supporting interventions tailored to individual presentation 5
The critical pitfall is misdiagnosing one condition as the other, which leads to inappropriate treatment expectations—Osgood-Schlatter will resolve with skeletal maturity while PFPS often persists and requires ongoing exercise-based management 5, 2.