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Pediatric Orthopedic surgeons width="1024" height="188"

KNEE INJURIES

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

“Some things are better treated early while growth potential continues.”

Knee Injuries

Child 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.  So, it’s not unusual for kids to fracture, sprain, strain, or dislocate the kneecap or knee joint.  Especially,  while playing sports, like soccer, or just playing outside with friends.  While most kids just need a few days to recover from a knee injury, severe cases can require surgery.   Unfortunately, surgery will cause a longer recovery before kids are walking, running, and back on the playing field again.

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 a children’s specialist and care right away.  In the event of surgery, children need an orthopedic surgeon who understands the importance of growth plates in growing children.  Additionally, our doctors have performed more than 6,000 surgeries and specialize in the treatment of children.

How the Knee works

To understand how injuries happen, it helps to know how the knee works.  First, 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 appears at the ends of the femur (thighbone) and the tibia (shinbone) and the patella (kneecap) provides protection.  Also, the ends of the femur and tibia and the back of the patella are covered in articular cartilage.  This 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.  Furthermore, each knee has two menisci: the inside (medial) meniscus and the outside (lateral) meniscus.

In the knee, there are four strong ligaments 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.  Also, 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.  For your information, the quadriceps help straightens the leg and the hamstrings help bend the knee.

In addition, several tendons (cables of strong tissue that connect muscles to bones) work together to help move the knee.  For instance, the tendons in the knee are the quadriceps tendon, the patellar tendon, and the hamstring tendons.  To allow the leg to extend, all of these work together.  

QUESTIONS AND ANSWERS

What causes knee injuries in children?
  • Sports Injuries: Participation in sports and physical activities can lead to knee injuries, including ligament sprains, meniscus tears, and fractures.
  • Trauma: Falls, accidents, or direct blows to the knee can result in injuries such as fractures, dislocations, or soft tissue damage.
  • Overuse: Repetitive movements and overuse of the knee joint can lead to conditions like patellofemoral pain syndrome or Osgood-Schlatter disease.
How can parents manage knee injuries in children at home?
  • Rest: Encourage the child to rest and avoid putting weight on the injured knee. Use crutches or assistive devices if necessary.
  • Ice: Apply ice to the injured area for 15-20 minutes every 2-3 hours to reduce swelling and pain. Always wrap the ice pack in a cloth to avoid direct skin contact.
  • Compression: Use an elastic bandage or knee brace to provide support and reduce swelling.
  • Elevation: Elevate the injured leg above heart level when resting to further reduce swelling.
  • Pain Relief: Over-the-counter pain relievers like acetaminophen or ibuprofen may be used under the guidance of a healthcare professional.
When should I seek medical attention for a child's knee injury?
  • If the injury appears severe, involves visible deformity, or if the child cannot bear weight on the affected leg, parents should seek immediate medical attention for their child.
  • If the pain and swelling do not improve or worsen within a day or two, consult a healthcare provider for an evaluation.
  • Doctors should examine and evaluate children with persistent or recurrent knee pain that interferes with daily activities or limits joint mobility,
  • Doctors should examine and evaluate children with knee injuries accompanied by other concerning symptoms, such as numbness, tingling, or changes in skin color.

It’s important to remember that children’s knee injuries can vary in severity and treatment.  This is why our doctors tailor treatment to each child’s specific injury and the child’s age and overall health. Consultation with a healthcare provider, such as a pediatric orthopedic specialist, becomes crucial for a proper diagnosis and to determine the most appropriate treatment and rehabilitation plan for the child’s specific condition.

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Falls and knee Injuries

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

Common Injuries Among Children Include:

Sprains

Knee sprains usually involve damage to the ACL and/or MCL.  Also, 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

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

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.

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:

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.

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 MRI, 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 Arlington, Dallas, 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

 

“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

Call 214-556-0590 to make an appointment.

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