Osgood-Schlatter disease (OSD) is a common traction apophysitis of the tibial tuberosity in adolescents, typically associated with sports participation and repetitive strain of the patellar tendon. Despite its frequency, current management is largely empirical, relying on expert consensus rather than high-level evidence. Since 2018, several studies have explored new conservative and minimally invasive treatments, yet their methodological quality and clinical relevance remain uncertain.To update and synthesize current evidence on the effectiveness of non-surgical treatments for Osgood-Schlatter disease, to assess methodological quality using validated Cochrane tools, and to determine whether recent studies provide stronger evidence supporting a specific therapeutic strategy.A systematic literature review was conducted following the PRISMA guidelines and registered in PROSPERO (CRD420251028687). All studies evaluating non-surgical interventions for OSD were included without language restriction, provided they reported at least one relevant clinical outcome (pain, symptom duration, return to sport, functional recovery, or quality of life). The databases searched included PubMed, Embase, CENTRAL, and Medline, complemented by grey literature. The risk of bias was assessed using the Cochrane tools ROB 2 (for randomized trials) and ROBINS-I (for non-randomized studies).Among 3,491 records identified, 16 original studies published between 1948 and 2022 met the inclusion criteria, involving 1,162 patients. Four double-blind randomized controlled trials assessed subpatellar injections of dextrose plus lidocaine versus lidocaine alone, with conflicting results. Twelve non-randomized studies investigated various conservative treatments—rest, stretching, physiotherapy, taping, nonsteroidal anti-inflammatory drugs, shockwave therapy, platelet-rich plasma, and immobilization—showing heterogeneous designs and high risk of bias.Overall, the methodological quality of available studies remains low. Only injective approaches have been evaluated through randomized trials, but none compared invasive versus conservative modalities. Evidence supporting traditional conservative management remains indirect but consistent with expert recommendations. The heterogeneity of study populations and outcome measures limits comparability and meta-analytic synthesis.Current evidence on non-surgical management of Osgood-Schlatter disease remains weak. Classical conservative measures—activity modification, stretching, muscle strengthening, and taping—should remain first-line approaches (recommendation grade C). Future high-quality comparative trials are needed to assess the true effectiveness of these non-invasive therapies and guide standardized treatment protocols.