A 14-year-old male reports anterior knee pain that worsens with kneeling. What diagnosis is most likely?

The most likely diagnosis for a 14-year-old male experiencing anterior knee pain that worsens with kneeling is Osgood-Schlatter Disease. This condition is common in adolescent athletes and is associated with growth spurts. Osgood-Schlatter Disease occurs due to irritation and inflammation of the patellar tendon where it attaches to the tibial tuberosity.

The characteristic symptoms include localized pain and tenderness below the kneecap, particularly exacerbated by activities such as running, kneeling, or jumping. The age and activity level of the patient fit the typical demographic for this condition, which is common in active adolescents.

Other diagnoses may present with knee pain but differ in their typical presentations, age group, or causative factors. For example, overdeveloped quadriceps can cause pain, but this is less likely to localize specifically to the tibial tuberosity as seen in Osgood-Schlatter Disease. Osteosarcoma of the tibia is rare in this age group and usually would present with more severe symptoms and possibly systemic signs. Patellar fasciitis could cause anterior knee discomfort, but pain during kneeling is more characteristic of lower attachment issues like those seen in Osgood-Schlatter Disease.