Paediatric & Adolescent Knee Problems

Question 1

what is patellar tendonitis

Answer 1

jumpers knee - inflammation of patellar tendon

Question 2

what is treatment of patellar tendonitis

Answer 2

self limiting requires rest and possibly physiotherapy

Question 3

what is apophysitis

Answer 3

inflammation of a growing tubercle where a tendon attaches which can occur at either end of patellar tendon due to repetitive strain

Question 4

what are the two different kinds of apophysitis

Answer 4

osgood-schlatter disease = inflammation of tibial tubercle apophysis, most common sinding-larsen-johanssen = inflammation of inferior pole of patella

Question 5

what is treatment of apophysitis

Answer 5

self limiting requires rest +/- physiotherapy

Question 6

what may patient be left with after apophysitis

Answer 6

bony prominence which does not require surgery

Question 7

what is patellofemoral dysfunction

Answer 7

just adolescent knee pain which is common in adolescence, especially girls

Question 8

what is cause of patellofemoral dysfunction

Answer 8

unclear may be due to muscle imbalance, ligamentous laxity and subtle skeletal predisposition there may be softening of hyaline cartilage of patella (chondromalacia patellae)

Question 9

how is patellofemoral dysfunction treated

Answer 9

self limiting physio to rebalance muscles most patients outgrow condition very rarely resistant cases may require surgery to shift the forces on patella (tibial tubercle transfer) but results unpredictable

Question 10

what is patellar instability

Answer 10

dislocation and subluxation of patella, common

Question 11

what may cause patellar instability

Answer 11

trauma = tear in medial patellofemoral ligament ligamentous laxity and variations in body anatomy (shallow femoral trochlea, valgus, hip anteversion)

Question 12

what may the dislocations in patellar instability cause

Answer 12

osteochondral fracture with a fragment of hyaline cartilage with or without subchondral bone breaking off

Question 13

what % of first time dislocations go on to have second episode

Answer 13

20% have second episode 10% have multiple dislocations

Question 14

what is treatment of patellar instability

Answer 14

many stabilise as grow older and physio may help recurrent dislocation may require surgery to correct any bony predisposition or to reconstruct the medial patellofemoral ligament

Question 15

what is osteochondritis dissecans (OCD)

Answer 15

osteochondritis where a fragment of hyaline with variable amounts of bone fragments breaks off the surface of the joint

Question 16

does OCD only occur in adolescent

Answer 16

no, also adulthood

Question 17

how can OCD predispose to osteoarthritis

Answer 17

can result in loose bodies within knee joint and a pothole on surface and this predisposes to osteoarthritis

Question 18

what is symptoms of OCD

Answer 18

poorly localised pain effusion occasionally locking

Question 19

how is OCD diagnosed

Answer 19

defect can be difficult to see on standard xrays and my require special views or MRI to diagnose

Question 20

how is OCD treated

Answer 20

lesions at risk of breaking off (with fluid signal behind them on MRI) may be fixed and loose fragments may require removal