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Knee Injuries
Ligament
Injury
The knee is the largest joint in the body. Two ligaments in the front
and back, the anterior cruciate ligament (ACL) and the posterior cruciate
ligament (PCL), give the knee its stability. According to the American
Academy of Orthopaedic
Surgeons, over 6 million people and other athletes
visit orthopedic physicians for knee problems each year. Kids can develop
knee problems during sports or rough contact. Gymnasts, dancers and
athletes are at risk for knee ligam ent injury. The AAOS indicates that
sports and activities which involve changing directions quickly, jumping,
or slowing down while running or going downhill increase the risk to
children of straining their ACL. Your child may not experience pain
immediately, but a popping noise preceding swelling may indicate an
injury to the ACL. A complete tear may require reconstruction. Treatment
for your child may include operative and non-operative choices, based
on activity levels and type of injury.
The
PCL is injured less often than the ACL. However, common injuries to
the PCL ligament include a blow to the knee or hyperextension (i.e.
missing a step while walking downstairs). In most cases, surgery is
not necessary, unless a piece of the shinbone is pulled away with the
ligament.
Anterior Knee Pain
One of the most common pains in the adolescent or pre-adolescent is anterior knee pain (pain in the front of the knee). It can be caused by a number of problems, and should be addressed by a pediatric orthopedic surgeon, who can evaluate all of the potential causes, and be able to treat them without delay. Although adolescents can be large or tall, their bones and joints are still immature, and they must be treated with respect to the open growth plates (the areas around the knee that are still made of cartilage). Many of the causes of pain can be attributed to the adolescent growth spurt, usually occurring between the ages of 9 and 14. Many of these problems can be treated with modalities aimed at stretching and rebalancing the joints, without the need for surgical intervention. Many are due to overuse, which can also be treated conservatively with a specialized pediatric sports rehab program, followed by incorporation of the trainer or coach into the return to sport.
Patello-Femoral Joint Syndrome
Patello-femoral joint (the joint between the knee cap and the anterior femur) syndrome is a major cause of anterior knee pain in this age group. It is a  “syndrome” because a number of factors are involved with the dysfunction of the joint, including muscle imbalance, weak hip flexors, relatively weak quadriceps muscles, and hamstring tightness. Subtle congenital deformities must also be recognized in order to correctly treat these conditions, so your child will not get treatment tailored to adults. Popping of the knee can be caused by too much motion in this joint, causing subluxation or hypermobility with significant symptoms that are often misdiagnosed as “growing pains”. If surgical intervention is needed, it should be done avoid the growth plates, which is different than the treatment in adults.
Traumatic Patellar Dislocations
Traumatic patellar dislocations are common in young athletes, especially females, with the typical mechanism a rotation of the leg or body around a fixed foot (plant-and-twist). The quadriceps muscles, because they are a large muscle group, contract with a significant force, tearing the tissue on the inside of the knee as the kneecap dislocates to the outside. The torn tissue usually does not tighten on it’s own significantly, and treatment is needed to regain stability to this joint, or repeated dislocations may ensue, even with more minor activity.
Patellofemoral Pain
If your child complains of pain at the front of the knee during vigorous activity,
he or she may be experiencing patellofemoral pain. According to the American
Orthopaedic Society for Sports Medicine, the kneecap can come out of alignment
under the stress of a connecting tendon. When this happens, the soft tissue
around the knee may inflame or the cartilage can wear abnormally, causing discomfort.
Your child's orthopedist may recommend stretches and exercises for the knee,
rest and medication, or a brace. In extreme cases, the knee must be surgically
realigned.
Osteochondral
Grafting
The
latest advance for joint injury treatment involves restoring lost or
damaged cartilage by replacing it with tissue. Osteochondral grafting
is one such technique and is primarily used in knee injuries. The development
of osteochondral grafting is encouraging news because it paves the
way
for a quicker, smoother, more successful return to full activity for
those suffering torn ACL ligaments or related injuries to the ankle,
hip and knee.
Articular
cartilage acts as a coating of tissue on the end of bones, enabling
the joints to move easily and smoothly. When articular cartilage is
damaged or injured, its fragile nature does not allow it to heal quickly,
and bones may begin to scrape against each other, causing pain and/or
limited movement.
Osteochondral
grafting involves transporting normal, healthy bone and cartilage to
the site of injury. The harvested material can either be the patient’s
own (autograft) or it may come from an outside source (allograft). Allograft
procedures are typically used for more sizeable injuries and must be
able to “match” the tissue of the patient who is receiving
the transplant. Minimally invasive techniques are now being used for
osteochondral grafting, which can reduce the size of incisions and
the
recovery time involved.
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