Paediatric and Adolescent Knee Problems

Question 1

What are two of the main reasons knee extensor mechanism pain is fairly common in adolescence?

Answer 1

1. Body weight increases
2. Sporting activities increase

Question 2

What is apophysitis?

Answer 2

Inflammation of a growing tubercle where a tendon attaches

Question 3

What is the name of the condition which involves apophysitisof the tibial tubercle?

Answer 3

Osgood-Schlatter’s disease

Question 4

What is the name given to the condition which involves inflammation of the inferior pole of the patella?

Answer 4

Sinding-Larsen-Johanssen disease

Question 5

Which is more common, Sinding-Larsen-Johanssen disease or Osgood-Schlatter’s disease?

Answer 5

Osgood-Schlatter’s disease

Question 6

What is the treatment for both Sinding-Larsen-Johanssen disease and Osgood-Schlatter’s disease?

Answer 6

They are self limiting conditions

Rest and potentially physio

(patients may be left with a bony prominence - this does not require surgery)

Question 7

Anterior knee pain is more common in which sex?

Answer 7

Females

Question 8

What may some risk factors for developing patellofemoral dysfunction?

Answer 8

1. Female gender
2. Muscle imbalance
3. Ligamentous laxity
4. Subtle skeletal predisposition e.g. genu valgum, wide hips, femoral neck anteversion

Question 9

What are the treatment options for patello-femoral dysfunction in adolescents?

Answer 9

Most cases are self limiting and adolescents grow out of them

Physio can help

Surgery may be required in resistant cases to shift the forces on the patella - a tibial tubercle transfer

Question 10

Dislocation and subluxation of the patella is most common in which age group?

Answer 10

Adolescents

Question 11

What may predispose to patellar instability?

Answer 11

1. Trauma
2. Ligamentous laxity
3. Shallow femoral trochlea
4. Genu valgum
5. Hip anteversion

Question 12

What can dislocation of the patella cause?

Answer 12

Osteochondral fracture

A fracture of hyaline cartilage with or without subchondral bone may break off

Question 13

During patellar dislocation, osteochondral fracture may occur and this may involve both small and large bone segments of bone breaking off. What is done for:

a) Large useful segments
b) Small segments

Answer 13

a) Fixed with pins
b) Removed via arthroscopic surgery

Question 14

What are the treatment options for patellar instability?

Answer 14

1. Physiotherapy
2. Surgery to correct bony predispositions
3. Surgery to reconstruct the medial patellofemoral ligament

Question 15

What is osteochondritis dissecans?

Answer 15

An osteochondritis involving a fragment of hyaline cartilage with varying amount of bone that breaks off from the surface of the joint

Question 16

What is the most common joint affected by osteochondritis dissecans?

Answer 16

Knee

(medial femoral condyle is most common site)

Question 17

In what age range does osteochondritis dissecans occur?

Answer 17

Adolescence

Question 18

How do patients present with osteochondritis dissecans?

Answer 18

1. Poorly localised pain
2. Effusion
3. Occasionally locking

Question 19

How are defects imaged in patients with osteochondritis dissecans?

Answer 19

1. X-ray - special views often required as it is difficult to see
2. MRI

Question 20

Which other condition may osteochondritis dissecans predispose to and why?

Answer 20

OA

The area where bone broke off on the bone surface acts like a pot-hole on a road

Question 21

What are the treatment options for osteochondritis dissecans?

Answer 21

1. Lesions at risk of breaking off (as seen on MRI) can be fixed
2. Loose fragments can be removed

Question 22

When meniscal tears occur in children, there is a higher risk of which type of tears?

Answer 22

Peripheral or bucket handle

Question 23

Which meniscus can be abnormally shaped in some children and what shape does it present as?

Answer 23

Lateral meniscus presents as a circle (rather than C-shaped)

Question 24

In children, a C-shaped meniscus can be a source of pain and popping sensation, what is the treatment?

Answer 24

Arthroscopic partial menisectomy