Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children

Abstract

The aim of this study was to select children with pathological lesions of the intra-articular structures from children with identical complaints but with no pathological intra-articular changes. The younger the child, the more difficult it is to make the diagnosis, and the expected distribution of pathology changes increasingly. This is particularly stressed in children aged younger than 13 years. Synovial inflammatory alterations are more frequent, and osteochondral and chondral fractures appear to be more problematic than meniscal and cruciate ligament lesions. Before establishing the indication for knee arthroscopy it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. The indication for knee arthroscopy is considered in cases when complaints persist after conservative treatment, a lesion of intra-articular segments is suspected, and the pathological condition is deemed arthroscopically treatable. Arthroscopy before conservative treatment is justified only in acute cases.

Bilateral patellar tendon rupture in a child: a case report

“…In childhood, the most common reasons of hemarthrosis are metaphyseal fractures or sleeve fractures, patellar dislocation, bruise fractures, osteochondral or condral pathologies and synovial ruptures. However it is reported that MRI and even arthroscopy can fail to accurately evaluate particularly chondral pathologies and bruise fractures in children with hemarthrosis [13, 30]. On the left side of our case, there was hemarthrosis but we couldnot find any accompanying lesion in radiographic and MRI assessments.…”

“…It is believed that under 14 years of age, arthroscopy or arthrotomy is only indicated if therapeutic repair is expected to be achieved in hemarthrosis [29]. Arthroscopic evaluation is required particularly in cases of prolonged knee complaints suspected of having an intraarticular cause [13]. Because we did not find any special intraarticular pathology which needed therapeutic attempt, we did not perform an arthroscopic evaluation for the left knee.…”

Partielle Quadrizepssehnenruptur bei einem sechsjährigen Jungen

“…Die Diagnose einer Kniebinnenläsion kann je nach Fragestellung durch konventionelles Röntgen, CT, Ultraschall oder MRT gestellt werden [3,18]. Allgemeine Empfehlungen zur Kniegelenkarthroskopie beim Kind sind selten [8,15]. Eine Indikation zur Kniegelenkarthroskopie beim Kleinkind stellt beispielsweise die septische Arthritis dar [8].…”