Knee_Problems_Children_Young_Adults_Flashcards
What is chondromalacia patellae?
Softening of the cartilage of the patella. Common in teenage girls. Characteristically causes anterior knee pain on walking up and down stairs and rising from prolonged sitting. Usually responds to physiotherapy.
What are the key features of Osgood-Schlatter disease (tibial apophysitis)?
Seen in sporty teenagers. Pain, tenderness, and swelling over the tibial tubercle.
What are the key features of osteochondritis dissecans?
Pain after exercise, intermittent swelling, and locking.
What are the key features of patellar subluxation?
Medial knee pain due to lateral subluxation of the patella. Knee may give way.
What are the key features of patellar tendonitis?
More common in athletic teenage boys. Chronic anterior knee pain that worsens after running. Tender below the patella on examination.
What are some causes of referred pain to the knee?
Referred pain may come from hip problems such as slipped upper femoral epiphysis.
summarise
A 16-year-old female presents with chronic left knee pain. The pain is typically felt after jogging. There is also intermittent swelling and locking of the same joint. What is the most likely diagnosis?
Chondromalacia patellae
Osteosarcoma
Juvenile idiopathic arthritis
Osteochondritis dissecans
Osgood-Schlatter disease
Osteochondritis dissecans
The correct answer is Osteochondritis dissecans. This condition is characterised by a fragment of bone in the knee joint that becomes detached due to a lack of blood supply. The fragment and its overlying cartilage can then move around inside the joint, causing symptoms such as pain, swelling, and locking - all symptoms described by this patient. It’s most common in adolescents and young adults, particularly those who are active or participate in sports.
Chondromalacia patellae is an incorrect option. While it does present with knee pain that worsens with activity, it typically involves a grinding sensation or clicking sound within the knee joint and is often associated with quadriceps muscle weakness. Additionally, chondromalacia patellae doesn’t usually cause intermittent swelling or locking of the joint.
Osteosarcoma, while it can occur in adolescents, generally presents more acutely with severe pain that often wakes the patient at night. There may be a palpable mass and systemic symptoms like fever or weight loss. Chronic exercise-induced pain followed by swelling and locking is not typical for osteosarcoma.
Juvenile idiopathic arthritis could potentially cause chronic knee pain in a 16-year-old female. However, this condition usually affects multiple joints rather than just one (polyarticular), comes along with morning stiffness which improves during the day (unlike our case where pain occurs post-exercise) and other systemic features might be present too such as fever or rash.
Finally, Osgood-Schlatter disease is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). It’s most common in teenagers who participate in sports involving running or jumping but typically presents with localised tenderness over tibial tuberosity and visible enlargement of it rather than joint swelling or locking. Also, Osgood-Schlatter disease causes discomfort on activity but rarely causes pain at rest unlike osteochondritis dissecans.
