A 14-year-old boy presented to an outpatient clinic with intermittent bilateral anterior knee pain for the past year that was relieved by rest. He was actively involved in sports and frequently played football in between the pain episodes but had no history of trauma or falls. He described the pain as throbbing in nature, especially upon applying pressure (kneeling during prayer). The pain was aggravated by exercise, particularly playing football, and was temporarily relieved by taking paracetamol. He reported that the bone just below both anterior knees appeared to have become more prominent since 2 months ago. There was no knee joint swelling, and no systemic symptoms, such as fever, loss of appetite, weight changes or fatigue, were present. A physical examination revealed prominent swelling of the bilateral tibial tuberosity, with tenderness on pressure. However, there was no overlying erythema or limited range of motion with tenderness over the joint line of either knee and no knee joint effusion. Figures 1 and 2 show the findings of a left and right knee radiograph