knee pain in adolescents

Anterior Knee PaininAdolescent Athletes : 

Anterior Knee PaininAdolescent Athletes

Topics : 

The Adolescent Athlete Anterior Knee Pain Etiology in Adolescents Knee Anatomy Patellofemoral Stress Syndrome Osteochondroses Internal Derangement of the Knee Significance Topics

The Adolescent Athlete : 

Adolescent athlete’s risk of injury factors; Extrinsic factors Environment, Equipment, Training and Coaching Intrinsic factors Musculoskeletal strength, bulk, flexibility Disease states, Developmental Growth The Adolescent Athlete

The Adolescent Athlete : 

Maximum growth in stature peaks in girls at age 12 when the average growth is about 9 to 10 centimetres per year In boys it happens two years later at around age 14 and at a greater speed about 11 to 12 centimetres in a year The Adolescent Athlete

The Adolescent Athlete : 

Growth distinguishes the adolescent athlete Open growth plates Rapid growth of musculo-tendinous units Rapid growth of bones – The bones grow first Tightness of muscle and tendons predisposes adolescent to lots of overuse injuries Excessive pressure on anchoring of tendons into apophyseal growth plates creates apophysitis The Adolescent Athlete

Causes of Anterior Knee Pain in Adolescents : 

Causes of Anterior Knee Pain in Adolescents

Relevant Knee Anatomy : 

Relevant Knee Anatomy

Patellofemoral Stress Syndrome : 

PFS - umbrella term for all peri-patellar or retro-patellar pain in the absence of other noted pathologies Local contributing factors are patella position, soft tissue contributions and neuromuscular control of the vasti group of muscles Key Tests; Apprehension test Clark’s Test Q-Angle Patellofemoral Stress Syndrome

Patellofemoral Stress Syndrome : 

Short Term Management Plan Control of pain and inflammation REST, Icing, Stretching, Anti-inflammatory medication (NSAIDs) Mid Term Management Plan Restore strength and function so that the patient may return to their sports activity   Long Term We will evaluate the patient’s feet for orthotics, consider brace for kneecap, possible surgery/arthroscopy Patellofemoral Stress Syndrome

Osteochondroses : 

condition mainly affects children involve a defect in ossification at either the bone epiphysis, the joint surface itself, or at an apophysis (bony projection) When articular surfaces become ischaemic (lack of blood flow), osteochondritis develops - associated with avascular necrosis and sclerosis Osteochondroses

Osteochondroses – Osgood-Schlatter Disease : 

results from repetitive microtrauma to the skeletally immature tibial tubercle. most commonly found in boys and athletes participating in sports with kicking, jumping and squatting It is related to the start of the second growth spurt in adolescence and symptoms occur 4 -6 months after peak growth velocity Osteochondroses – Osgood-Schlatter Disease

Osteochondroses – Osgood-Schlatter Disease : 

Pain usually goes within a few months without any treatment If symptoms over 1 year then immobilization in a plaster cast to 'force' rest may be advised Rarely would we advise surgery on the defect Osteochondroses – Osgood-Schlatter Disease Patient is a 12 year old male who initially presented with a history of left knee pain for 4 months. He claimed to play a lot of basketball and felt that the pain was worse after playing.

Osteochondroses – Osgood-Schlatter Disease : 

No special tests are usually needed as the diagnosis is often clear from the typical symptoms. Imaging can be used to confirm the diagnosis – but we should be careful using imaging since this can further impact the epiphyseal plates. Osteochondroses – Osgood-Schlatter Disease

Osteochondroses – Osgood-Schlatter Disease : 

easing off strenuous or vigorous sport may be sensible for a while until the pain eases consider a complete break from sport for a while if pain remains bad PRICE - ice pack applied below the kneecap for about 5 minutes before and after exercise may prevent some inflammation and pain Consider wearing knee pads during sports such as football and rugby to protect the tender area. Consider exercises to strengthen the quadriceps muscles Osteochondroses – Osgood-Schlatter Disease

Osteochondroses – Sinding-Larsen-Johansson Disease : 

Osteochondroses – Sinding-Larsen-Johansson Disease results from a chronic stress injury with overuse of the patella-patellar tendon junction Mechanism is thought to be persistent traction at the cartilaginous junction of the patella and the patellar ligament/tendon usually at inferior patellar pole Longitudinal sonogram of 14 year old boy with anterior knee pain shows thickening of proximal patellar tendon

Osteochondroses – Sinding-Larsen-Johansson Disease : 

On examination patient experiences inferior patella tenderness, where the patella tendon inserts into the patella. Pain increases with activity and is relieved by rest. Symptoms of pain can last for many years and can lead to an avulsion fracture of the tendon, which can limit the child’s ability to participate in sports. Osteochondroses – Sinding-Larsen-Johansson Disease

Osteochondroses – Sinding-Larsen-Johansson Disease : 

Physiotherapy is the mainstay of treatment, including quadriceps strengthening exercises. Surgery is not usually needed As the skeleton matures, symptoms improve and in this way it is regarded as a self-limiting process but symptoms may last for a year Cases have occurred of a pathological patellar fracture through the site of an old Sinding-Larsen Johansson lesion Osteochondroses – Sinding-Larsen-Johansson Disease

Internal Derangment of the Knee (IDK) : 

Can be caused by plica, meniscal tears and cruciate ligament damage Plica (the most common IDK) Plica on the inner side of the knee, called the "medial plica," is the synovial tissue most prone to irritation and injury When knee is flexed, plica is exposed to direct injury, and it may also be injured in overuse syndromes Plica syndrome has similar characteristics to meniscal tears and patellar tendonitis, and these may be confused Internal Derangment of the Knee (IDK)

Internal Derangment of the Knee (IDK) : 

variable sharp pain located anteriorly, medially, or posteriorly of the patella may be sharp pain on squatting plica may sometimes feels like a thickened band under the inside of the patella Internal Derangment of the Knee (IDK)

Internal Derangment of the Knee (IDK) : 

Symptomatic plica syndrome is best treated by resting the knee joint, NSAIDS or corticosteroids In severe cases arthroscopic “plicaectomy” may be required Internal Derangment of the Knee (IDK)

Significance : 

In recent years there has been a rapid increase in sports participation by the younger athlete Anterior knee pain is a very common symptom An understanding of anterior knee pain, podopediatrics and sports medicine provides the podiatrist/chiropodist with the ability to correctly assess and prevent serious long term damage arising from conditions unique to the developing adolescent athlete. Significance