KNEE INJURIES

Strains

Tendonitis

When a tendon is irritated or inflamed, tendonitis happens.  To clarify, it is often caused by overuse or poor training (such as lack of strength exercises or stretching).  For example, 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

Especially in sports where kids have sudden changes in speed or make side-to-side movements, damage to the menisci is a very common sports injury.  Further, meniscal injuries can occur together with severe sprains, especially those involving the ACL.  Moreover, 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 appears like a cracked, broken, or shattered bone. Therefore, children may have trouble moving the bone and are likely to experience a lot of pain.  For example, a patellar dislocation happens when the patella moves 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.  Nevertheless, 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, called osteochondritis dissecans (OCD).  When this occurs, 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.  Clearly, this causes pain and aching, especially when a person walks upstairs 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.  This is 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.  Generally, pain is relieved with rest and an aggressive quadricep stretching exercise routine.

Diagnosis

Knee injuries in children, including fractures, sprains, strains, and dislocations, are relatively common and require accurate diagnosis to determine the appropriate treatment. These injuries can result from various causes, including sports-related incidents, accidents, or overuse. This report outlines the diagnostic procedures used by healthcare professionals to assess and diagnose knee injuries in children.

Clinical Assessment:

The diagnosis of knee injuries in children typically begins with a clinical assessment by a healthcare provider, often a pediatrician or pediatric orthopedic specialist. During this assessment, the following steps are taken:

• Medical History: The healthcare provider will obtain a detailed medical history, including information about the injury, its mechanism, and any prior knee-related issues.
• Physical Examination: A thorough physical examination of the child’s knee is performed. This includes assessing for tenderness, swelling, deformity, and changes in skin color or temperature. The provider will also evaluate the child’s range of motion and joint stability.

Imaging Studies:

Imaging is a crucial component of diagnosing knee injuries in children. The choice of imaging modality depends on the suspected injury type and its severity. Common imaging techniques include:

• X-rays: X-rays are typically the initial imaging study used to assess for fractures, dislocations, or abnormal alignment of the knee joint. They provide a clear view of the bone structures.
• Magnetic Resonance Imaging (MRI): MRI is employed when soft tissue injuries, such as ligament tears or cartilage damage, are suspected. It offers detailed images of the knee’s soft tissues.
• Ultrasound: Doctors will use ultrasound in younger children to assess soft tissue injuries. It is non-invasive and does not involve radiation.

Additional Diagnostic Tools:

In some cases, doctors may recommend additional diagnostic tests:

• Arthroscopy: Arthroscopy is a minimally invasive procedure in which a thin, flexible tube with a camera (arthroscope) is inserted into the knee joint to directly visualize and assess the extent of the injury. Thus, it is particularly valuable for evaluating complex or internal injuries.

Laboratory Tests:

Blood tests or joint fluid analysis are generally not routine for diagnosing knee injuries, but doctors may conduct this test if an infection or an underlying systemic condition appears likely.

How to Prevent Knee Injuries

Preventing knee injuries involves a combination of the right gear, proper techniques, and consistent physical conditioning. Here’s a breakdown of how you can help minimize the risk:

1. Equip Properly

• Start with the essentials. Ensure that athletes are equipped with quality knee pads and shin guards, which are crucial for protecting the knees from impact during sports activities. Choose supportive athletic shoes that fit well and are in good condition, as they provide essential support and cushioning.

2. Practice Safe Movements

• Education on movement can be pivotal. Teach proper techniques such as bending the knees when landing from jumps and using a crouching position while swiftly changing directions. This can significantly reduce the risk of common injuries, like tearing an ACL.

3. Warm Up and Cool Down

• Incorporate a structured warm-up routine before engaging in any physical activity. This could include light jogging or dynamic stretches to get the body ready. Equally important is cooling down afterward with exercises like static stretching to help muscles recover.

4. Consistent Conditioning

• Encourage ongoing strength training exercises to build muscular support around the knee joints. Activities like yoga or regular stretching are also beneficial, enhancing flexibility and further reducing injury risk.

5. Year-round Activity

• Maintaining a baseline level of activity throughout the year, irrespective of organized sports seasons, ensures that muscles and joints remain robust and resilient. This can include anything from casual hiking to recreational sports, promoting overall joint health.

Implementing these strategies creates a comprehensive approach to safeguarding knees against injuries, ensuring long-term athletic capability and overall well-being.

Physical Therapy in Prevention

Physical therapy plays a crucial role in safeguarding young athletes from knee injuries by addressing two key areas: movement techniques and muscle strength. By teaching girls to land and jump correctly, therapists can significantly reduce the risk of injury. This retraining helps in developing safer, more effective ways to move during sports activities.

In addition to improving techniques, physical therapy emphasizes enhancing the strength of the hips and thighs. This muscular reinforcement is vital since these areas support and stabilize the knees, providing an added layer of protection. With targeted exercises, young athletes can build resilience, reducing the likelihood of injuries that could sideline them from their favorite sports.

Through this dual approach, physical therapy not only supports injury prevention but also contributes to an athlete’s overall performance and confidence.

Treatment of Knee Injuries

Knee injuries in children, encompassing fractures, sprains, strains, and dislocations, require careful management to ensure optimal recovery. Specifically, these injuries can result from various causes, including sports-related accidents, falls, or overuse. Importantly, the following outlines the treatment strategies employed by healthcare professionals to address knee injuries in children, considering the type and severity of the injury.  The choice of treatment for knee injuries in children depends on the specific injury type, its severity, the child’s age, and overall health. So, treatment options may include:

Conservative Management:

If your child’s knee hurts, it’s crucial to pinpoint the cause to provide effective treatment. Start by consulting a doctor to determine the underlying issue. A professional evaluation ensures that any specific conditions or injuries are properly addressed, which is vital for your child’s recovery and well-being.

In the meantime, you can manage the symptoms at home with the following steps:

Rest, Ice, Compression, Elevation (RICE):

• The RICE protocol is often the first-line approach for mild knee injuries, such as sprains and strains.
• Rest: The child is advised to avoid putting weight on the injured leg and to rest the affected knee.
• Ice: Application of ice for 15-20 minutes every 2-3 hours helps reduce swelling and alleviate pain.
• Compression: Doctors may recommend an elastic bandage or knee brace for support and to reduce swelling.
• Elevation: Elevating the injured leg above heart level when resting can further reduce swelling.

These steps can offer temporary relief and support your child’s comfort while awaiting a professional diagnosis. Remember, understanding the root cause of the knee pain is essential for ensuring that your child receives the most appropriate care and avoids further complications.

Immobilization:

• In cases involving mild to moderate fractures, doctors may recommend a brace, splint, or cast to immobilize the knee joint.
• Immobilization helps stabilize the injured area, allowing it to heal properly.

Physical Therapy:

• Physical therapy plays a crucial role in restoring knee function, improving strength, and promoting flexibility.
• Physical therapists guide the child through exercises tailored to their specific injury, age, and overall condition.

Surgical Intervention:

Open Reduction and Internal Fixation (ORIF):

• Severe fractures that are displaced may require surgery to realign and stabilize the fractured bones using screws, plates, or pins.

Arthroscopy:

• Arthroscopic procedures involve the use of a minimally invasive camera and instruments to diagnose and treat conditions within the knee joint.
• Arthroscopy is particularly valuable for addressing ligament injuries or cartilage damage.

Follow-Up Care:

Following treatment, a crucial aspect of care is post-injury follow-up:

• Healthcare providers monitor the child’s progress and recovery.
• Doctors may request additional imaging studies, such as X-rays or MRIs, to assess the healing process.
• As always, doctors may make adjustments to the treatment plan as needed.

Why You Should Bring Your Child to the Doctors at Medical City Children’s Orthopedics and Spine Specialists

Knee injuries in children, including fractures, sprains, strains, and dislocations, require a personalized approach to treatment. By considering the type and severity of the injury, the child’s age, and overall health, healthcare providers can develop a tailored treatment plan to promote healing and recovery. Timely and appropriate care is essential to help children regain their knee function and mobility, minimize long-term complications, and enable them to resume their daily activities. The long-term outlook for children with knee injuries can vary widely based on the nature and severity of the injury and the effectiveness of treatment. It is crucial for parents, caregivers, and healthcare providers to work together to ensure the child’s rehabilitation and recovery.

Finally, our physicians at Medical City Children’s Orthopedic and Spine Specialists, with offices in  Dallas,  Arlington,  Flower Mound,  Frisco, and McKinney, TX,  have experience and expertise in the treatment of children with knee injuries and fractures. You have access to see a specialist, and should your child need surgery, your child will have quick access to an operating room at one of the best hospitals in the United States.  Our board-certified physicians specialize in the treatment of children and adolescents. Give your child the very best care and attention they deserve.

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Footnote:

American Academy of Orthopaedic Surgeons: Knee Injuries