Sports injury prevention and overuse injuries — formative SAQs

SAQ 1 (10 marks) — The thirteen-year-old with knee pain

Stem: A thirteen-year-old boy who plays basketball for his school, a club team and a representative squad presents with six weeks of gradually worsening pain over the front of his right knee that comes on with jumping and eases with rest. He trains about twenty hours a week. On examination there is no effusion and no limp, the pain is reproduced by pressing over the bony bump below the kneecap, and resisted knee extension reproduces the discomfort. Outline the diagnosis, the injury mechanism, your assessment of the risk factors, and your management. ^{[2] [7]}

Model answer

Diagnosis and mechanism (3 marks). This is Osgood-Schlatter disease, a traction apophysitis at the tibial tubercle where the patellar tendon inserts. The mechanism is repetitive submaximal load applied faster than the growing apophysis can remodel, producing cumulative microdamage at the cartilaginous apophysis that fails before the adult tendon or bone would. It is an overuse, or microtrauma, injury rather than an acute macrotrauma, and the gradual onset, the activity-related pain relieved by rest, the focal tenderness over the tubercle, and the absence of an effusion or a limp all fit. ^{[7] [2]}

Assessment of risk factors (3 marks). I screen the validated injury-risk triad of sport specialization, high training volume and inadequate recovery. He specialises in one sport across three teams, trains around twenty hours a week (more than his age, a recognised volume threshold), and the organised hours exceed twice his free-play hours, so the triad is strongly positive. I take a training history for rest days, a recent load spike and a growth spurt, and I screen for the red flags that would move him off the simple-apophysitis pathway: night pain, a limp, focal bony tenderness elsewhere, weight loss, and any sign of relative energy deficiency in sport. This boy has none of these. ^{[1] [2]}

Management (4 marks). The principle is relative rest, meaning modification of the aggravating activities to a pain-tolerable level while keeping the limb active, not immobilisation or cessation of all sport. I apply ice after activity, teach a quadriceps and hamstring stretching and strengthening programme, and advise a graded return to play that progresses as his pain allows. I address the cause by reviewing his training hours and his three-team schedule with him, his family and his coaches, and I counsel against early sport specialisation and for at least one to two rest days each week and two to three months away from the specialised sport each year. I give a clear safety-net to return if night pain, a limp, or focal bony tenderness emerge, and I explain that the condition resolves as the apophysis fuses at skeletal maturity. ^{[7] [1]}