From growing pains to growing evidence: a 2025 update on novel insights in lower limb osteochondroses

Osteochondrosis encompasses a heterogenous group of pathologies affecting endochondral ossification in the growing child and adolescent. The cause of each disease is multifactorial, though many are often related to overuse injury, and may be epiphyseal, physeal, or apophyseal. Identification and treatment of this group of disorders is complex, thus this review aims to briefly describe common pathologies, their management, and highlight novel developments within the field.

Machine learning as well as advanced diagnostic tools for more precise evaluation and prognostication of osteochondroses have been studied including perfusion MRI in Legg-Calvé-Perthes disease. Novel treatments include leukocyte-rich platelet-rich plasma (LR-PRP), which offer promising improvements in pain and function in Osgood-Schlatter disease. Surgical technique studies have begun to examine optimal operative management of Freiberg's disease.

The osteochondroses are an often-self-limiting spectrum of pathologies affecting the physis in children and adolescents that may be managed with conservative treatment, though some require surgical intervention. Advances in imaging, prognostication tools, and treatment modalities support earlier and accurate diagnoses, as well as better informed treatment decisions.