Orthopedic Surgeons

KNEE INJURIES

At Medical City Children’s Orthopedic and Spine Specialist, you and your child have access to see a knee specialist at three convenient locations; Dallas, Frisco, and McKinney.

“Some things are better treated early while growth potential is still possible.”

Knee injuries

Little boy with hurt kneeNo parent wants to see their athletic child sitting on the sidelines, but knee injuries put thousands of young athletes on the bench every year. It’s not unusual for kids to fracture, sprain, strain, or dislocate the kneecap or knee joint while playing sports, like soccer, or just playing outside with friends. Most kids just need a few days or weeks of rest to recover from a knee injury. Severe cases can require surgery and a longer recovery before kids are walking and running again and back on the playing field.

If you suspect your child has a knee injury, it’s important to see a physician as soon as possible. At Medical City Children’s Orthopedic and Spine Specialists, you have access to care and access to a physician right away. In the event of surgery, children need an orthopedic surgeon who understands the importance of growth plates in growing children. Our practice has performed more than 5,900 surgeries and specializes in the treatment of children.

How the Knee Works

To understand how injuries happen, it helps to know how the knee works. The knee is the largest joint in the body, and it provides stability and allows the legs to bend, swivel, and straighten. The knee joint is at the ends of the femur (thighbone) and the tibia (shinbone) and is protected by the patella (kneecap). The ends of the femur and tibia and the back of the patella are covered in articular cartilage, which acts as a cushion to keep the femur, patella, and tibia from grinding against each other. On the top of the tibia, extra pads of cartilage called menisci help absorb the body’s weight. Each knee has two menisci: the inside (medial) meniscus and the outside (lateral) meniscus.

There are four strong ligaments in the knee called the Anterior and Posterior Cruciate ligaments (ACL, PCL), and the Medial and Lateral Collateral Ligaments (MCL, LCL). These ligaments help hold the femur and tibia together. The muscles around the knee include the quadriceps, a large muscle at the front of the thigh, and the hamstrings, located at the back of the thigh. The quadriceps help straighten the leg and the hamstrings help bend the knee.

Several tendons (cables of strong tissue that connect muscles to bones) work together to help move the knee. The tendons in the knee are the quadriceps tendon, the patellar tendon, and the hamstring tendons. All work together to allow the leg to extend.

Falls are the most common cause of non-fatal injuries for children from birth to age 19. Each day, about 8,000 kids visit emergency rooms due to falls.

Common orthopedic injuries from falls, sports and other physical activities include:
• Broken bones and dislocations
• Sprains, strains and tears to muscles, tendons and ligaments
• Overuse injuries

“Since the knee is such a complex joint with many moving parts, knee injuries are quite common. Frequent causes of injuries are overuse (from repetitive motions, as in many sports), sudden stops or twists, or direct blows to the knee.” Shyam Kishan, MD

Common Injuries Among Children Include:

Sprains

Knee sprains usually involve damage to the ACL and/or MCL. The most serious sprains involve complete tears of one or more of the knee ligaments. Symptoms of knee sprains include:

  • a popping or snapping sound in the knee at the time of injury
  • pain that seems to come from within the knee, especially with movement
  • not being able to bear weight on that leg
  • swelling
  • the knee feels loose or unstable

Strains

A strain happens when a child partially or completely tears a muscle or tendon. With knee strains, kids may have bruising around the knee in addition to the symptoms mentioned above for sprains.

Tendonitis

Tendonitis happens when a tendon is irritated or inflamed. It is often caused by overuse or poor training (such as lack of strength exercises or stretching). A child with tendonitis might have pain or tenderness when walking or at rest, or when bending, extending, or lifting a leg.

Meniscal Cartilage Tears

Damage to the menisci is a very common sports injury, especially in sports where kids have sudden changes in speed or make side-to-side movements. Meniscal injuries can occur together with severe sprains, especially those involving the ACL. Meniscal injuries can cause tenderness, tightness, and swelling around the front of the knee, as well as locking of the knee. Sometimes, fluid collects around the knee (known as effusion).

Fractures and Dislocations

A fracture is a cracked, broken, or shattered bone. Children may have trouble moving the bone and are likely to be in a lot of pain. A patellar dislocation happens when the patella is knocked off to the side of the knee joint, by twisting or some kind of impact. Sometimes it will go back to its normal position by itself, but it usually needs to be put back in place by a trained physician. Symptoms include swelling and pain in the front of the knee, an abnormal bulge on the side of the knee, and an inability to walk on the leg with the affected knee.

Articular Cartilage Injuries

Sometimes a small piece of bone or articular cartilage softens and/or breaks off from the end of a bone, causing long-term knee pain. This is called osteochondritis dissecans (OCD). Symptoms include pain, swelling, an inability to move the joint, and stiffness, catching (“locked knee”), or popping sensations with knee movement. Chondromalacia patellae happens when the cartilage in the patella softens or wears away because of injury, muscle weakness, or overuse, and the patella and the thighbone may rub together. This causes pain and aching, especially when a person walks up stairs or hills.

Bursitis

A bursa is a sac filled with fluid located over a bony prominence to prevent friction. If a bursa in the knee becomes irritated and swollen from overuse or constant friction, it can develop into a condition called bursitis. Symptoms of bursitis in the knee include warmth, tenderness, swelling, and pain on the front of the kneecap.

Osgood-Schlatter Disease

Osgood-Schlatter disease is a painful disorder caused by repetitive stress on the front end of the tibia where the patellar tendon connects to the bone. Most common in athletes 10 to 15 years old, its symptoms include a bump below the knee joint that’s painful to the touch and painful with activity. Pain is relieved with rest, and an aggressive quadricep stretching exercise routine.

Diagnosis

Most knee exams involve lying down flat on a table while the doctor manipulates the knee to see how stable it is and if any part of the joint hyper-extends or dislocates. Imaging tests like an MRI, X-ray, or CAT scan also might be ordered to confirm a knee injury and determine its severity.

Our physicians at Medical City Children’s Orthopedic and Spine Specialists have experience and expertise in the treatment of knee fractures. You have access to see a specialist and, should surgery be required, access to an operating room right away. Our board-certified physicians specialize in the treatment of children and adolescents and can give your child the care and attention they deserve.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at
four convenient locations: Arlington, Dallas, Frisco and McKinney.