Week 3 - F - Knee problems - Patellar tendonitis, apophysitis, patellofemoral pain, patellar instability, Osteochondritis, meniscus Flashcards
Remember to examine the hip when a paediatric comes in with a knee problem Knee extensor mechanism pain is a fairly common occurrence during adolescence as body weight increases and sporting activities increase What is a common knee extensor mechanism pain due to sport activity? (clue - jumper’s knee)
Patellar tendonitis aka jumper’s knee can occur during adolescence
What is the treatment of patellar tendonitis?
It ususally self limiting therefore rest and physiotherapy if needed
What is an apophysis? Where can apophysitis affected the knee?
An apophysis is the bony tubercle where a tendon attaches Apophysitis is the inflammation of this bony tubercle where the tendon attaches Apophysitiis can occur at either end of the patellar tendon due to repetitive strain
Inflammation of the tibial tubercle apophysis is more common than inflammation at the inferior pole of the patella What are both conditions known as?
nflammation of the tibial tubercle apophysis is more common and is known as Osgood‐Schlatter’s disease. Inflammation of the inferior pole of patella is known a Sinding‐Larsen‐Johanssen disease
How are both Osgood Schlatter’s disease and Sinding-Larsen-Johanssen treated?
Both are self limiting conditions requiring rest +/- physiotherapy NSAIDs may help with painful symptoms
What is patellofemoral pain syndrome and who does it typically affect?
Patellofemoral pain syndrome is a term that describes pain that occurs in front of your knee behind or around the patellar bone It typically occurs in young active females - especially runners
What is thought to be the aetiology of patellofemoral pain syndrome?
It is thought to be possibly associated with muscle imbalance, lower limb malalignment or maybe ligamentous laxity
There may be associated softening of the hyaline cartilage of the patella in conjunction with patellofemoral pain syndrome (aka patelofemoral dysfunction). What is this known as?
The softening of the hyaline articular cartilage of the patella is known as chondromalacia patellae
What is the treatment of patellofemoral dysfunction?
The majority of cases are self limiting and the mainstay of treatment is physiotherapy to rebalance the muscles - quadriceps strengthening exercises
What is patellar instability and when is it most common?
Patellar instability is dislocation and subluxation of the patella - it is most common in adolescents
What pathology may patellar instability be related to?
Patellar instability may be related to trauma with a tear in the medial patellofemoral ligament and may be predisposed to ligamentous laxity and variations in bony anatomy
What test is carried out on the knee examination to test for patellar instability?
Patellar apprehnsion test - exert a lateralising force on the patella with the knee extended and look for pain
What may dislocations occurring in patellar instability cause?
Dislocations may cause osteochondral fracture with a fragment of hyaline caritlage with or without subchondral bone breaking off - may be managed conservatively or need surgery to remove fragments
What is osteochondritis dissecans?
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.
What is the most common site affected by osteochondritis dissecans?
The knee is the most common joint affected with the lateral side of the medial femoral condyle being the most common site
What are the symptoms of osteochondritis dissecans?
Pain and effusions after exercise and locking may occur Defects can be difficult to see on standard x rays and MRI may be required MRI scan reveals articular surface defects / loose bodies
Meniscal tears can occur in children and adolescents with a higher proportion of peripheral or bucket handle meniscal tears which may benefit from physical repair What is a bucket handle meniscal tair? What is the presentation?
A bucket-handle tear gets its name because the torn segment of the meniscus pulls away forming a handle shaped segment of damaged meniscus tissue. Patient usually presents foloowing twisting on a flexed knee with the inability to fully extend the knee - knee locking
Some children have an abnormally shaped discoid meniscus What is a discoid meniscus? Which meniscus is more commonly affected?
A discoid meniscus is where the mensicus is circular rather than C-shaped The lateral meniscus is more commonly affected
