Paediatric and Adolescent Knee Problems

Question 1

What are the two types of extensor mechanism pathologies that cause knee problems in paediatrics/adolescence?

Answer 1

Patellar tendonitis (aka “jumper’s knee”)

Apophysitis

Question 2

Apophysitis refers to inflammation of a growing tubercle where a tendon attaches. In the knee, what are the two areas that this can occur (and their corresponding names)?

Answer 2

Can occur at either end of the patellar tendon

If occuring at the inferior pole where it inserts into the tibial tubercle, this is Osgood-Schlatter’s disease, most common presentation

If occuring at the superior pole where the tendon inserts into the patella, this is known as Sinding-Larson-Johanssen disease

Question 3

What may adolescent knee pain be due to?

Answer 3

Aetiology unclear, but appears more commonly in girls

Muscle imbalance?

Ligamentous laxity?

Subtle skeletal predisposition?

Question 4

At what point in a person’s life is subluxation and dislocation of the patella most common?

What is the prognosis?

Answer 4

Most common in adolescence

20% of first time dislocations will go on to have another dislocation, and 10% have multiple subsequent dislocations

Question 5

What is osteochondritis dissecans?

Where does it most commonly occur?

Answer 5

Fragment of hyaline cartilage breaks off with a variable amount of bone and is free floating in the joint capsule

Most commonly breaks off from the medial epicondyle of the femur