Overload syndromes of the knee in adolescents: Sonographic findings

Abstract

KEYWORDSSonography; Knee; Overload syndromes.Abstract Overload syndromes are caused by repetitive microtrauma, and the knee joint is most frequently affected in adolescents. The reason for this is that the knee joint is engaged in almost all sports activities. Pathologies related to the anterior aspect of the knee are: femoropatellar pain, jumper's knee syndromes, OsgoodeSchlatter disease, Sinding-Larsene Johansson syndrome and patellar stress fractures; to the medial aspect: semimembranous tendon enthesopathy and pes anserinus bursitis; to the lateral aspect: iliotibial band syndrome (runner's knee), popliteus and femoral biceps tendon enthesopathy; to the posterior aspect: fabella syndrome and medial gastrocnemius muscle tendon enthesopathy. Sonography plays a central role in the diagnosis and can also evaluate the evolution of diseases. This method is well accepted by the patients and by their parents, it does not involve exposure to X-rays and it is inexpensive. US imaging should, therefore, be considered a first-line imaging diagnostic technique in functional overuse syndromes of the knee.Sommario Le sindromi da sovraccarico riconoscono come causa principale i microtraumi ripetitivi e il ginocchio è l'articolazione interessata più frequentemente negli adolescenti. La ragione è legata al fatto che il ginocchio è particolarmente sollecitato in tutte le attività fisiche, sia della vita quotidiana sia nelle attività agonistiche. Possono essere interessate varie strutture con conseguenti e diverse patologie, in particolare nel comparto anteriore si realizzano lesioni dell'articolazione femoro-rotulea, del tendine rotuleo (jumper's knee), le sindromi di Osgood-Schlatter e di Sinding-Larsen-Johansson, fratture da stress della rotula; nel comparto mediale la sindrome della plica sinoviale, tendinopatie del tendine del semimembranoso, borsiti della borsa della zampa d'oca; nel comparto laterale la sindrome da frizione della bendelletta ileo-tibiale (runner's knee), tendinopatie del tendine popliteo e del bicipite; nel comparto posteriore patologie legate alla fabella e al tendine del gemello mediale. L'ecografia è in grado porre diagnosi e di valutare il decorso della malattia nella grande maggioranza di queste lesioni, è ben accetta ai pazienti e ai genitori per l'assenza di controindicazioni e di radiazioni ionizzanti, ha costi contenuti ed è pertanto l'esame di scelta nelle sindromi da sovraccarico del ginocchio nell'adolescente. Richiede esperienza e l'integrazione di radiologia tradizionale, TC e RM in alcuni casi quali l'inquadramento delle malformazioni e il disallineamento degli arti inferiori. ª

Baker’s cyst in pediatric patients: Ultrasonographic characteristics

“…The idiopathic form affects children between 2 and 14 years old, twice as common as in males. Usually it is asymptomatic, but may cause discomfort and movement limitation [5,8,9]. In this study a painless popliteal mass or swelling was the most common presenting complaint.…”

“…Pediatric Baker's cyst is often idiopathic, less frequently related to juvenile arthritis or other diseases such as hemophilia [5,9].…”

“…The advantages of MRI derive from the high soft-tissue contrast resolution that results from the technique's multiplanar capability, and that helps to determine the extent and nature of the Baker's cyst [10e12]. In children with juvenile rheumatoid arthritis, MR can demonstrate joint effusion, synovial changes and erosions with sensibility and accuracy [9].…”

“…Diagnosis is based on clinical examination but imaging evaluation is important and ultrasonography is a very helpful technique in the detection of a popliteal mass [9,10]. In current practice Baker's cysts are also, often, detected incidentally on MRI evaluations of the knee [11e13].…”

State-of-the-art ultrasonographic findings in lower extremity sports injuries

“…Sinding-Larsen-Johansson disease is clinically characterized by pain localized at the distal pole of the patella, increasing during flexion combined with loading of the knee joint. Other clinical features include swelling of the infrapatellar soft tissues and functional limitations (3,22). The disease is caused by repetitive microtraumas and excessive prolonged stress occurring on a specific skeletal region that is both mechanically and biologically weak, when the stress exceeds the intrinsic resistance.…”