Paediatric and Adolescent Knee Problems Flashcards
What are two of the main reasons knee extensor mechanism pain is fairly common in adolescence?
- Body weight increases
- Sporting activities increase
What is apophysitis?
Inflammation of a growing tubercle where a tendon attaches
What is the name of the condition which involves apophysitisof the tibial tubercle?
Osgood-Schlatter’s disease
What is the name given to the condition which involves inflammation of the inferior pole of the patella?
Sinding-Larsen-Johanssen disease
Which is more common, Sinding-Larsen-Johanssen disease or Osgood-Schlatter’s disease?
Osgood-Schlatter’s disease
What is the treatment for both Sinding-Larsen-Johanssen disease and Osgood-Schlatter’s disease?
They are self limiting conditions
Rest and potentially physio
(patients may be left with a bony prominence - this does not require surgery)
Anterior knee pain is more common in which sex?
Females
What may some risk factors for developing patellofemoral dysfunction?
- Female gender
- Muscle imbalance
- Ligamentous laxity
- Subtle skeletal predisposition e.g. genu valgum, wide hips, femoral neck anteversion
What are the treatment options for patello-femoral dysfunction in adolescents?
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
Dislocation and subluxation of the patella is most common in which age group?
Adolescents
What may predispose to patellar instability?
- Trauma
- Ligamentous laxity
- Shallow femoral trochlea
- Genu valgum
- Hip anteversion
What can dislocation of the patella cause?
Osteochondral fracture
A fracture of hyaline cartilage with or without subchondral bone may break off
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
a) Fixed with pins
b) Removed via arthroscopic surgery
What are the treatment options for patellar instability?
- Physiotherapy
- Surgery to correct bony predispositions
- Surgery to reconstruct the medial patellofemoral ligament
What is osteochondritis dissecans?
An osteochondritis involving a fragment of hyaline cartilage with varying amount of bone that breaks off from the surface of the joint
What is the most common joint affected by osteochondritis dissecans?
Knee
(medial femoral condyle is most common site)
In what age range does osteochondritis dissecans occur?
Adolescence
How do patients present with osteochondritis dissecans?
- Poorly localised pain
- Effusion
- Occasionally locking
How are defects imaged in patients with osteochondritis dissecans?
- X-ray - special views often required as it is difficult to see
- MRI
Which other condition may osteochondritis dissecans predispose to and why?
OA
The area where bone broke off on the bone surface acts like a pot-hole on a road
What are the treatment options for osteochondritis dissecans?
- Lesions at risk of breaking off (as seen on MRI) can be fixed
- Loose fragments can be removed
When meniscal tears occur in children, there is a higher risk of which type of tears?
Peripheral or bucket handle
Which meniscus can be abnormally shaped in some children and what shape does it present as?
Lateral meniscus presents as a circle (rather than C-shaped)
In children, a C-shaped meniscus can be a source of pain and popping sensation, what is the treatment?
Arthroscopic partial menisectomy
