Abstract
Both acute and chronic knee injuries are common in the pediatric population. Although children and youth share many of the same musculoskeletal diagnoses as adults, there are many diagnoses that are specific to the athlete whose musculoskeletal system is still developing. It is essential to have a thorough understanding of both mature and developing knee anatomy in order to accurately diagnose and manage these injuries. Much of the clinical assessment is specific to anatomy, and an accurate diagnosis can often be made clinically at the bedside. Diagnosis can often be confirmed with plain imaging, CT scan, or MRI, depending on the specific injury considered. Once diagnosis has been confirmed, a collaborative approach to management is essential. The team may include physiotherapists, athletic therapists, and/or orthopedic surgeons in addition to the patient’s primary care physician. Together with an athlete’s coach, it is not only possible, but almost always desirable, to have the young athlete continue to participate in their sport with a tailored training schedule while they are rehabilitating their injury.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Public Health Agency of Canada Injury Surveillance Online, Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). Distribution of all body parts touched by the injury. http://dsol-smed.phac-aspc.gc.ca/dsol-smed/issb/chirpp/Final%20BdyPrt.xls. Accessed 22 Dec 2006.
Bernhardt DT. Knee and leg injuries. In: Birrer RB, Griesemer BA, Cataletto MB, editors. Pediatric sports medicine for primary care. Philadelphia: Lippincott, Williams & Wilkins; 2002.
Davids JR. Common orthopedic problems II. Pediatr Clin N Am. 1996;43(5):1067–90.
Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg. 2004;17(1):47–56.
Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S59–67.
Stanitski CL. Patellar instability in the school age athlete. In: Dilworth Cannon W, editor. AAOS instructional course lectures, vol. 47. Rosemont: American Academy of Orthepedic Surgeons; 1998.
Virolainen H, Visure T, Kuseela T. Acute dislocations of the patella: MR findings. Radiology. 1993;189(1):243–6.
Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am. 2003;34(3):385–96.
Maenpaa H, Lehto MU. Patellar dislocation. The long term results of nonoperated managements in 100 patients. Am J Sports Med. 1997;25(2):213–7.
Longo UG, Ciuffreda M, Locher J, Berton A, Salvatore G, Denaro V. Treatment of primary acute patellar dislocation: systematic review and quantitative synthesis of the literature. Clin J Sport Med. 2017;27(6):511–23.
Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am. 2008;90(3):463–70.
Nikku R, Nietoscaara Y, Kallio PE, Aalto K, Michelsson JE. Operative versus closed treatment of primary dislocation of the patella: similar 2-year results in 125 randomized patients. Acta Orthop Scand. 1997;68(5):419–23.
Andrade A, Thomas N. Randomized comparison of operative vs. non operative treatment following first time patellar dislocation. Presented at: The European Society of Sports Traumatology, Knee Surgery and Arthroscopy; April 2002; Rome, Italy.
Bales CP, Joseph HG, Moorman CT. Anterior cruciate ligament injuries in children with open physes. Am J Sport Med. 2004;32(8):1978–85.
DeLee JC. Ligamentous injury of the knee. In: Stanitski CL, DeLee JC, Drez D, editors. Pediatric and adolescent sports medicine, vol. 3. Philadelphia: WB Saunders; 1994. p. 406–32.
Prince JS, Laor T, Bean JA. MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. AJR Am J Roentgenol. 2005;185(3):756–62.
Stracciolini A, Casciano R, Levey Friedman H, Stein CJ, Meehan WP 3rd, Micheli LJ. Pediatric sports injuries: a comparison of males vs females. Am J Sports Med. 2014;42(4):965–72.
Huston LJ, Greenfield ML, Wojtys EM. Anterior cruciate ligament injuries in the female athlete: potential risk factors. Clin Orthop Rei Res. 2000;(372):50–63.
Sugimoto D, Myer GD, Micheli LJ, Hewett TE. ABC’s of evidence-based anterior cruciate ligament injury prevention strategies in female athletes. Curr Phys Med Rehabil Rep. 2015;3(1):43–9.
Dekker TJ, Rush JK, Schmitz MR. What’s new in pediatric and adolescent anterior cruciate ligament injuries? J Pediatr Orthop. 2018;38(3):185–92.
Kocher MS, Garg S, Micheli LJ. Physeal sparing reconstruction of the anterior cruciate ligament in skeletally immature prepubescent children and adolescents. J Bone Joint Surg. 2005;87A(11):2371–9.
Ramski DE, Kanj WW, Franklin CC, Baldwin KD, Ganley TJ. Anterior cruciate ligament tears in children and adolescents: a meta analysis of nonoperative versus operative treatment. Am J Sports Med. 2014;42(11):2769–76.
Kramer DE, Micheli LJ. Meniscal tears and discoid meniscus in children: diagnosis and treatment. J Am Acad Orthop Surg. 2009;17(11):698–707.
Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid and cysts. Orthop Clin N Am. 2003;34(3):329–40.
Kocher MS, Micheli LJ. The pediatric knee: evaluation and treatment. In: Insall JN, Scott WN, editors. Surgery of the knee. 3rd ed. New York: Churchill Livingstone; 2001. p. 1356–97.
Andrish JT. Meniscal injuries in children and adolescents. J Am Acad Orthop Surg. 1996;4(5):231–7.
Kocher MS, Di Canzio J, Zurakowski D, Micheli LJ. Diagnostic performance of clinical examination and selective magnetic resonance images in the evaluation of intra-articular knee disorders in children and adolescents. Am J Sports Med. 2001;29(3):292–6.
Mintzer CM, Richmond JC, Taylor J. Meniscal repair in the young athlete. Am J Sport Med. 1998;26(5):630–3.
Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscal tears that extend into the vascular zone in patients younger than twenty years of age. Am J Sports Med. 2002;30(4):589–600.
Rubman MH, Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscal tears that extend into the avascular zone: a review of 198 single and complex tears. Am J Sports Med. 1998;26(1):87–95.
Diduch D, Scuderi GR, Scot WN. Knee injuries. In: Scuderi GR, McCann PD, editors. Sports medicine: a comprehensive approach. 2nd ed. Philadelphia: Elsevier; 2005. p. 346–87.
Mosier SM, Stanitski CL. Acute tibial tubercle avulsion fractures. J Pediatr Orthop. 2004;24(2):181–4.
McKoy BE, Stanitski CL. Acute tibial tubercle avulsion fracture. Orthop Clin N Am. 2003;34(3):397–403.
Hand WL, Hand CR, Dunn AW. Avulsion fractures of the tibial tubercle. J Bone Joint Surg Am. 1971;53(8):1579–83.
Stanitski CL. Acute tibial tubercle avulsion fracture. In: Stanitski CL, DeLee JC, Drez D, editors. Pediatric and adolescent sports medicine, vol. 3. Philadelphia: WB Saunders; 1994. p. 329–34.
Watson-Jones R. Fractures and joint injuries. 5th ed. Baltimore: Williams and Wilkins; 1976.
Ogden JA, Tross RB, Murphy MJ. Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am. 1980;62(2):205–15.
Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012;32(8):749–59.
Little RM, Milewski MD. Physeal fractures about the knee. Curr Rev Musculoskelet Med. 2016;9(4):478–86.
Duri ZAA, Patel DV, Aichroth PM. The immature athlete. Clin Sports Med. 2002;21(3):461–82.
Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg. 1984;66B(5):685–93.
Crossley K, Bennell K, Green S, McConnell J. A systematic review of physical interventions for patellofemoral pain syndrome. Clin J Sport Med. 2001;11(2):103–10.
van der Heijden RA, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SMA, van Middelkoop M. Exercises for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;1:CD010387.
Koshino T, Sugimoto K. New measurement of patellar height in the knees of children using the epiphyseal line midpoint. J Pediatr Orthop. 1989;9(2):216–8.
Blackburn JS, Peel TYE. A new method of measuring patellar height. J Bone Joint Surg. 1977;59B(2):241–2.
Panni AS, Biedirt RN, Maffulli N, Tartarone M, Romanini E. Overuse injuries of the extensor mechanism in athletes. Clin Sports Med. 2002;21(3):483–98.
Safran MR, Fu FH. Uncommon causes of knee pain in the athlete. Orthop Clin N Am. 1995;26(3):547–59.
Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band friction syndrome. Clin J Sport Med. 2000;10(3):169–75.
Fyfe I, Stanish WD. The use of eccentric training and stretching in the treatment and prevention of tendon injuries. Clin Sports Med. 1992;11(3):601–24.
Medlar RD, Lyne ED. Sinding-Larsen-Johansson disease. J Bone Joint Surg. 1978;60A(8):1112–6.
Osgood RB. Lesions of the tibial tubercle occurring during adolescence. Boston Med Surg J. 1903;148:114–7.
Schlatter C. Verletzungen des schnabelforminogen fortsatzes der oberen tibiaepiphyse. Beitre Klin Chir Tubing. 1903;38:874–8.
Kujala UM, Kvist M, Heinonen O. Osgood Schlatter’s disease in adolescent athletes: retrospective study of incidence and duration. Am J Sports Med. 1985;13(4):236–41.
Krause BL, Williams JP, Catteral A. Natural history of Osgood Schlatter’s disease. J Pediatr Orthop. 1990;10(1):65–9.
Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh HW. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. Pediatrics. 2011;128(5):e1121.
Mital MA, Matza RA, Cohen J. The so–called unresolved Osgood Schlatter lesion. Clin Orthop. 1993;289:202–4.
Stanitski CL. Osteochondritis dissecans of the knee. In: Stanitski CL, DeLee JC, Drez D, editors. Pediatric and adolescent sports medicine, vol. 3. Philadelphia: W.B. Saunders; 1994. p. 387.
Wall E, Von Stein D. Juvenile osteochondritis dissecans. Orthop Clin N Am. 2003;34(3):341–53.
Linden B. The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand. 1976;47(6):664–7.
Hefti F, et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B. 1999;8(4):231–45.
Carroll NC, Mubarack SJ. Juvenile osteochondritis dissecans of the knee. J Bone Joint Surg. 1977;59B:506.
Litchman HM, McCullough RW, Gandsman EJ, et al. Computerized bloodflow analysis for decision making in the treatment of osteochondritis dissecans. J Pediatr Orthop. 1988;8(2):208–12.
Cain EL, Clancy WG. Treatment algorithm for osteochondral injuries of the knee. Clin Sport Med. 2001;20(2):321–42.
Milgram JW. Radiological and pathological manifestations of osteochondritis dissecans of the distal femur. Radiology. 1978;126(2):305–11.
Cahill BR, Berg BC. 99m-Technetium phosphate compound joint scintigraphy in the management of juvenile OCD of the femoral condyles. Am J Sports Med. 1983;11(5):329–35.
Cahill BR, Phillips MR, Navarro R. The results of conservative management of juvenile osteochondritis dissecans using joint scintigraphy. A prospective study. Am J Sports Med. 1989;17(5):601–5.
Hughes JA, Cook JV, Churchill MA, Warren ME. Juvenile osteochondritis dissecans: a 5-year review of the natural history using clinical and MRI evaluation. Pediatr Radiol. 2003;33(6):410–7.
O’Connor MA, Palaniappan M, Khan N, Bruce CE. Osteochondritis dissecans of the knee in children. J Bone Joint Surg. 2002;84B(2):259–62.
King JB, Cook JL, Khan KM, Maffulli N. Patellar tendinopathy. Sports Medicine Arthrosc Rev. 2000;8(1):86–95.
Testa V, Capasso G, Maffulli N, et al. Ultrasound guided percutaneous longitudinal tenotomy for the management of patellar tendinopathy. Med Sci Sports Excerc. 1999;31(11):1509–15.
Ferretti A, Ippolito E, Mariani PP, et al. Jumper’s knee. Am J Sports Med. 1983;11(2):58–62.
Stanitski CL. Plica. In: Stanitski CL, DeLee JC, Drez D, editors. Pediatric and adolescent sports medicine, vol. 3. Philadelphia: WB Saunders; 1994. p. 317–9.
Rovere GD, Adair D. Medial synovial shelf plica syndrome; treatment by intraplical steroid injection. Am J Sports Med. 1985;13(6):383–6.
Kelly BT, Green DW. Discoid lateral meniscus in children. Curr Opin Pediatr. 2002;14(1):54–61.
Bellier G, Dupont JY, Larrin M, et al. Lateral discoid menisci in children. Arthroscopy. 1989;5(1):52–6.
Watanabe M, Takada S, Ikeuchi H. Atlas of arthroscopy. Tokyo: Igaku-Shoin; 1969.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
McTimoney, M. (2018). Knee Injuries. In: Micheli, L., Purcell, L. (eds) The Adolescent Athlete. Contemporary Pediatric and Adolescent Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-56188-2_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-56188-2_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-56187-5
Online ISBN: 978-3-319-56188-2
eBook Packages: MedicineMedicine (R0)