Does an adult with a history of Osgood-Schlatter disease as a child need an X-ray for new knee pain?

X-Ray Recommendation for Adult with Prior Osgood-Schlatter Disease and New Knee Pain

Yes, obtain knee radiographs (AP, lateral, and tunnel views) as the initial imaging study for any adult presenting with new knee pain, regardless of childhood Osgood-Schlatter history. 1

Clinical Reasoning

The history of Osgood-Schlatter disease does not change the standard diagnostic approach to new adult knee pain. Here's why radiographs are indicated:

Standard Initial Imaging for Knee Pain

• Radiographs are the recommended first-line imaging for adults with knee symptoms including pain, swelling, tenderness, or loss of motion, according to the American Academy of Orthopaedic Surgeons. 1

• The American College of Radiology explicitly states that approximately 20% of patients inappropriately receive MRI without recent radiographs (within the past year), which represents substandard care. 2, 3

• Initial radiographs should include anteroposterior, lateral, and tangential patellar views to adequately evaluate the knee joint. 3

Why Osgood-Schlatter History Doesn't Exempt You

• Osgood-Schlatter disease typically resolves with growth plate closure, but residual ossicles or fragmentation at the tibial tuberosity can persist into adulthood and cause symptoms. 4, 5

• New adult knee pain in someone with prior Osgood-Schlatter could represent:

  • A symptomatic unresolved ossicle requiring surgical excision 5
  • Unrelated new pathology (meniscal tear, osteoarthritis, fracture) 1, 3
  • Loose bodies or osteochondritis dissecans 1
  • Referred pain from hip or spine 3

• Radiographs will identify residual Osgood-Schlatter changes (tibial tuberosity irregularity, ossicles) AND rule out other acute or chronic pathology. 4, 6

When to Proceed Beyond Radiographs

• If radiographs are normal or show only effusion and pain persists despite conservative treatment, then MRI without contrast is the next appropriate step. 2, 3

• MRI without contrast effectively evaluates bone marrow lesions, meniscal tears, cartilage damage, and can identify symptomatic ossicles from prior Osgood-Schlatter disease. 2, 7

• CT without contrast is an alternative if MRI is contraindicated, particularly for evaluating osseous fragments with 86-100% sensitivity. 7

Common Pitfalls to Avoid

• Do not skip radiographs and proceed directly to MRI based on the Osgood-Schlatter history—this violates standard imaging guidelines and may miss important radiographic findings. 2, 3

• Do not assume new pain is simply residual Osgood-Schlatter symptoms without imaging confirmation, as adults can develop unrelated knee pathology. 3, 4

• Do not order contrast-enhanced MRI initially—reserve this for specific inflammatory conditions like synovitis, Hoffa's disease, or pigmented villonodular synovitis if non-contrast imaging is inconclusive. 2, 3