Acute Knee Injuries in Children and Adolescents

Abstract

ne-third of all musculoskeletal complaints in primary care officesareduetokneepain. 1 Upwardof60millionchildrenaged 6 to 18 years participate in organized sports each year in the US. 2 Parallelingthislevelofparticipationisasignificantnumberofsportsrelated injuries, with the knee being one of the most commonly injured joints: up to 54% of young athletes have knee pain annually. 3 There are anestimated2.5millionsports-relatedkneeinjuriesinadolescentseach year,and60%ofsports-relatedsurgeriesinhighschoolathletesinvolve the knee. [4][5][6] Certain sports are considered high risk, with football, soccer,andbasketballaccountingforthelargestproportionofsports-related kneeinjuriesintheUS. 7 Studiesinhighschoolathleteshaveconsistently foundthatadolescentgirlshaveasignificantlyhigherriskofseriousknee injury compared with boys. 7 Knee injuries can be broken down into 2 basic categories: those due to acute, traumatic events, and those due to cumulative, repetitive microtrauma, or so-called overuse injuries. The presenting history will typically guide the clinician in determining whether the patient is presenting with an acute or overuse injury. Although many acute knee injuries in children and adolescents are contusions and lacerations that are often self-limited, several conditions require specific identification in order to treat them properly and achieve ideal outcomes. 7 This article will review the diagnosis and management of acute knee injuries in children and adolescents, with a focus on specific conditions requiring the treating pediatrician's attention. Discussion General ConsiderationsIn the setting of acute knee trauma, there are a few keys to the physical examination. The knee should be inspected for obvious bony de-formity or opening of the skin. The presence of a knee effusion is one of the most significant physical findings. A knee effusion represents a hemarthrosis and is distinctly different from mere soft tissue swelling. In acute trauma, knee effusions are an indication of a likely severe injury, including fracture, tear to the meniscus, tear of a ligament, or a joint dislocation. Up to 70% of patients aged 9 to 14 years with traumatic effusion have had a serious intra-articular injury, with the 3 most common injuries being lateral patellar dislocation, anterior cruciate ligament (ACL) tears, and fracture. 8 Therefore, an acute traumatic effusion is an indication for radiography and possibly advanced imaging. The clinician must remember that up to 56% of patients presenting with a traumatic effusion may have no visible injury on plain radiographs, and advanced imaging may be indicated. 8 The clinician should assess weight-bearing status and examine gait where possible. If the patient cannot bear weight, it is important to ensure while lying supine that they can do a straight leg raise: demonstrating the ability to actively lift the straight leg off the examining table rules out that the patient has disrupted their extensor mechanism. A thorough neurovascular examination should be done of the leg distal to th...

Orthopaedic Surgery Pediatric Sports Medicine: Characterizing Practice Patterns and Subspecialization

“…However, our data did demonstrate that the knee joint is by far the most operated on, with 98.2% of respondents qualifying as a knee specialist and reporting that the knee constituted a mean of 52.1% of an individual’s practice. This was consistent with the expectations, as 54% of young athletes have knee pain annually9 and knee injuries account for 60% of high school sport–related surgeries performed 10. Of these injuries, the anterior cruciate ligame is the most injured ligament in the knee, and procedures to reconstruct this ligament have increased significantly 11…”

“…This was consistent with the expectations, as 54% of young athletes have knee pain annually 9 and knee injuries account for 60% of high school sport-related surgeries performed. 10 Of these injuries, the anterior cruciate ligame is the most injured ligament in the knee, and procedures to reconstruct this ligament have increased significantly. 11 One of the more surprising findings in this survey was that the hip surgery constituted a similar percentage of an individual's practice as shoulder surgery (13.9% vs. 15.2%).…”

Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review

“…Some injuries occur more often than others. As in adults, the knee and ankle joints are damaged more often than other regions [ 37 , 38 , 39 , 40 , 41 , 42 ].…”

Formononetin improves the inflammatory response and bone destruction in knee joint lesions by regulating the NF‐kB and MAPK signaling pathways

“…Knee injury is a common disease affecting people's health and quality of life in the 21st century, and researchers have found that FMN also plays a beneficial role in improving healing after knee injury. Under normal circumstances, knee joint injury mainly includes joint destruction, dislocation and fracture caused by traumatic violence, or it can occur as a result of degenerative disease caused by long‐term overuse of the joint in older patients (Brittberg et al, 2016; MacDonald et al, 2021). Currently, we typically treat acute knee injury caused by violent trauma with surgical treatment, so drug treatment of chronic or secondary knee injury caused by nonviolent factors such as aging‐related knee strain and posttraumatic OA was the focus of our study (Arden et al, 2021; Takeda et al, 2011).…”

“…With more extensive investigation, the advantages of these medicines have been gradually discovered by researchers (Li et al, 2021;Lyu et al, 2021;Tang et al, 2021). In recent years, FMN, an isofla- (Brittberg et al, 2016;MacDonald et al, 2021).…”