Characteristic Pattern and Management of Intra-articular Knee Lesions in Different Pediatric Age Groups

Abstract

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.

Patellar fractures in children

“…The most ideal treatment method seems to be the rigid internal ixation of the fracture with emphasis on anatomical reduction and the realignment of the joint cartilage [4]. When bone fragments are small, internal ixation must be performed by a tension band [4,19]. The stability of internal ixation can be augmented by suturing medial and lateral retinacula which is very important.…”

Osteochondral Injuries of the Knee in Pediatric Patients

“…Most acute traumatic knee injuries in the pediatric population result in extra-articular soft tissue injury. 16 When a hemarthrosis is detected following knee trauma, this is often the result an intra-articular injury. 1,2,16,17 Thorough history and physical examination is paramount to determine the suspected injury pattern; however, this is often limited by the child's guarding and inability to accurately describe the mechanism of injury or convey current symptoms.…”

Extensor Mechanism Injury in the Pediatric Population—A Clinical Review

“…Therefore, it has been suggested that an MRI be obtained in patients with suspicion for injury with normal appearing radiographs. [42][43][44] Patella injury can be missed and the diagnoses be delayed from weeks to even years. 39,45…”