Posttraumatic hemarthrosis of the knee joint usually leads to arthroscopy. In a retrospective study we defined an age-specific spectrum of injuries and, subsequently, assigned an age-dependent diagnostic management for children up to 16 years. From January 1986 to December 1996, 1,273 patients up to 16 years of age with knee trauma presented to the emergency department. Overall, soft-tissue lesions prevailed (82%). Hemarthrosis occurred in only 18.0%. The patients were classified in three groups: group 1 (528 children younger than 10 years of age) with hemarthrosis in only 5.7% (mainly metaphyseal fractures and patellar dislocations), group 2 (207 preadolescents from 11 to 12 years of age) with hemarthrosis in 17.9% (patellar dislocations and fractures), and group 3 (538 adolescents between the age of 13 and 16 years) with hemarthrosis in 30.3% (main findings were intra-articular fractures and patellar dislocations, additionally, 16 ligamentous and two meniscal lesions). Correspondingly, physical examination, conventional radiography, and magnetic resonance imaging (most appropriate diagnostic tool for patellar dislocation) were sufficient to reveal injuries in children up to 13 years of age. Arthroscopy was predominantly justified in those older than 13 years of age, but only if it leads to therapeutic consequences.
In children, compulsory arthroscopy for hemarthrosis after knee trauma is not justified because ligamentous and meniscal damage is rare. In a prospective study, we analyzed the diagnostic value of radiography, magnetic resonance imaging (MRI), and arthroscopy in 51 patients up to 14 years of age with acute knee trauma. Plain radiography revealed 16 osseous lesions (5 metaphyseal, 3 patellar, 4 physeal fractures, 3 avulsions of the tibial spine, and 1 osseous ligamentous tear). In 29 patients, the cause of hemarthrosis remained unclear. All patients were evaluated by MRI. A diagnosis could be assigned to all 29 patients. MRI demonstrated lesions in 38 patients. In addition, the following lesions were discovered: 8 patellar dislocations, 13 bruises, 1 rupture of the anterior cruciate ligament, 1 osteochondritis dissecans, and 13 joint effusions. In 13 patients, MRI was followed by arthroscopy to confirm the diagnosis. Both, MRI and arthroscopy missed two osteochondral fractures. In addition, three chondral lesions were not picked up by MRI. MRI is a reliable tool for assessing the extent of knee lesions in children.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.