paeds- knee problems Flashcards
Extensor mechanism problems
Knee extensor mechanism pain is a fairly common occurrence during adolescence as body weight increases and sporting activities increase.
Patellar tendonitis (jumper’s knee) can occur which is self‐limiting and requires rest and possibly physiotherapy.
Adolescent knee pain
Anterior knee pain (patellofemoral dysfunction) is common in adolescence, especially in girls.
The aetiology is unclear and may be due to muscle imbalance, ligamentous laxity and subtle skeletal predisposition (genu valgum, wide hips, femoral neck anteversion).
There may be softening of the hyaline cartilage of the patella (chondromalacia patellae).
Adolescent knee pain treatment
majority of cases are self‐limiting and the mainstay of treatment is physiotherapy to rebalance the muscles.
Most patients “grow out” of the condition.
Occasionally resistant cases may require surgery to shift the forces on the patella (known as a tibial tubercle transfer) however the results can be unpredictable.
Patellar instability
Dislocation and subluxation of the patella is most common in adolescence and may be related to trauma with a tear in the medial patellofemoral ligament and may be predisposed to by ligamentous laxity and varitions in bony anatomy (shallow femoral trochlea, valgus, hip anteversion).
Dislocations may cause osteochondral fracture with a fragment of hyaline cartilage with or without subchondral bone breaking off.
Small fragments may need retrieved by arthroscopic surgery whilst larger fargments may be fixed.
20% of first time dislocations go on to have a second episode of dislocation and 10% have multiple dislocations.
Many patients “stabilize” as they grow older and physiotherapy may help.
Recurrent dislocation may require surgery to correct any bony predisposition or to reconstruct the medial patellofemoral ligament.
Osteochondritis dissecans (OCD)
OCD as previously discussed is an osteochondritis where a fragment of hyaline cartilage with variable amount of bone fragments and breaks off the surface of the joint.
knee is the most common joint affected with the medial femoral condyle the most common site.
The condition usually occurs in adolescence but can occur later in adulthood.
OCD Symptoms & investigations
Patients present with poorly localized pain, effusion and occasionally locking.
Defects can be difficult to see on standard xrays and may require special views or MRI to diagnose.
A quarter of cases are bilateral.
OCD diagnosis & treatment
OCD can result in loose bodies within the knee joint and a “pothole” on the surface which predisposes to osteoarthritis.
Lesions which are at risk of breaking off (with fluid signal behind them on MRI) may be fixed and loose fragments may require removal.
Meniscal problems
Meniscal tears can occur in children and adolescents with a higher proportion of peripheral or bucket handle meniscal tears which may benefit from meniscal repair.
Moreover young patients have a higher chance of healing with a meniscal repair.
Meniscal problems symptoms & treatment
Some children have an abnormally shaped discoid meniscus (usually the lateral meniscus) which is circular rather than C‐shaped and can be a source of pain and a “popping” sensation.
Arthroscopic partial menisectomy may help.
