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The natural history of untreated Osgood-Schlatter disease is presented in the retrospective study of 69 knees in 50 patients. Seventy-six percent of the patients believed they had no limitation of activity, although 60% still could not kneel without discomfort. Two groups of patients were identified: those who presented with radiologic fragmentation and had either separated ossicles or an abnormally ossified tuberosity at review, and those who presented with soft tissue swelling without radiologic fragmentation and were asymptomatic at review. There was a low incidence of patellar instability or anterior knee pain, and no case of premature proximal tibial epiphyseal arrest.