Knee Pain

Question 1

What are some DDx of knee pain in children/adolescents, that worsens with exercise?

Answer 1

1. Chondromalacia patellae
2. Osgood-Schlatter disease(tibial apophysitis)
3. Osteochondritis dissecans
4. Patellar subluxation
5. Patellar tendonitis

Question 2

Chondromalacia patellae:

• what is it?
• typical population?
• classic presentation?
• Mx?

Answer 2

• Softening of the cartilage of the patella
• Common in teenage girls
• Anterior knee pain with stairs and rising from prolonged sitting, lots of sports
• Physio

Question 3

Osgood-Schlatter:

• what is it?
• typical population?
• classic presentation?
• Mx?

Answer 3

• Inflam at tibial tuberosity
• Sporty boys
• Mx - stretches (calf and thigh stretch), taping, ice packs, and stop causative activities

Typically, pain is:
• Unilateral
• Localised to tibial tuberosity
• Initially gradual/mild/intermittent -> severe/cont
• Relieved by rest and made worse by kneeling and activity, such as running or jumping

Question 4

Osteochondritis dissecans:

• what is it?
• typical population?
• classic presentation?
• Mx?

Answer 4

• Pathophys: bone starts to separate due to lack of blood supply, and cartilage above cracks
• Children and adolescents
• Pain after exercise, intermittent swelling and locking

• Mx: rest and avoiding high stress sports, may require surgery if much older

Question 5

Patellar subluxation:

• classic presentation
• Mx

Answer 5

• Medial knee pain due to lateral subluxation of the patella, knee ‘gives way’
• Mx - strengthen VMO

Question 6

Patellar tendonitis:

• typical population?
• classic presentation?

Answer 6

• Athletic teenage boys
• Chronic anterior knee pain that worsens after running+ jumping
• Tender below the patella on examination