Osteoid osteoma (OO) is a common benign tumor in children and adolescents, but intra-and juxta-articular OO is rare and difficult to diagnose. The purpose of this study is to investigate the distinctions between intra- and juxta-articular OO, trying to avoid delaying diagnosis and optimize treatment strategies. Thirty patients diagnosed with OO in the intra- and juxta joint at our institution who underwent surgical resection were included. Clinical and epidemiological factors, preoperative radiograph parameters, including computed tomography (CT), magnetic resonance imaging (MRI), and bone scan, were documented. The outcomes of the involved extremity were evaluated at the final follow-up. Mean age at diagnosis, interval time, and follow-up time was 8.37±3.79 years old, 4.67±5.88 months, 3.57±2.18 years, respectively. Factors identified to be significantly associated with intra- and juxta-articular OO including pain with activity (P=0.004) and abnormal range of motion (P=0.00). The factor of abnormal range of motion (P=0.03) also influenced the existence of complications. Six children had a secondary operation to cure the recurrence. It is essential for clinicians and radiologists to be aware of the atypical clinical and radiographic features of intra- and juxta-articular OO, as the delayed diagnosis can lead to unnecessary pain and further complications after surgeries. The pain with activity and abnormal range of motion is helpful to identify the location of OO. The persistently abnormal range of motion also significantly leads to complications. The open surgeries to resect the nidus in juxta-articular OO were effective.