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Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website
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ANTERIOR KNEE PAIN IN YOUNG CHILDREN AND ADOLESCENTS
There can be many sources of anterior knee pain in young children and adolescents involved in sports activities. The most common problems are associated with the patellofemoral or kneecap joint and the patella tendon. Symptoms related to these areas are frequently brought on by repetitive physical activity, particularly those involving running , jumping, squatting and climbing. These problems are most frequently associated with rapid changes in activities or increases in existing activities such as more repetitions, speed, weight resistance, steepness in terrain and in general performing at a higher level.
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Pain related to kneecap problems:
 Patellofemoral pain syndrome refers to the condition of having pain deep to or around a person's kneecap and this can be caused by overuse, misalignment secondary to anatomical reasons or because of muscle imbalance and can involve one or both knees. Symptoms include pain, usually increased with activity and is frequently associated with swelling and at times crepitus which is a grating sensation.
Chondromalacia patella is an early degeneration of the articular cartilage of the patella and at times the groove that the patella glides in. It is usually diagnosed with an MRI scan or at the time of arthroscopic surgery. This involves irregularity of the joint surfaces with softening of the articular cartilage and if it persists will be termed patellofemoral osteoarthritis. The arthritis can be on the basis of genetics, a traumatic incident such as a blow to the patella, previous fracture or previous dislocation of the patella.
Symptoms related to these problems can be improved usually with modification of activity, performing lower impact, less repetitive sports and may also be helped with strengthening exercises, bracing or taping and with running using shoes with increased cushioning and running on softer surfaces. Significant malalignment problems with the patellofemoral joint may require surgical realignment. Thorough evaluation with examination and imaging studies may be necessary to fully delineate the etiology of anterior knee pain. With children it is important to rule out a hip problem as a possible source of anterior knee pain because referred pain from the hip or back can be misinterpreted as being caused by a primary knee problem.
Pain related to the patella tendon and its attachments:
Patella tendinitis refers to a temporary inflammation of the patella tendon and tendinosis refers to a longer lasting and degenerative process involving the tendon fibers. Both can result in pain with running and jumping and both usually respond to decreasing activity. Symptoms can be improved with modifying activity, using ice and heat and at times anti-inflammatory medications.
Osgood slaughter's disease is a condition that is related to the attachment of the patella tendon to the tibial tubercle which is the prominence at the upper aspect of the tibia or shin bone and in a child is an area of growth called an apophysis. Swelling and tenderness of this area can persist and initially responds to activity limitation, particularly running and jumping. If it progresses it will result in fragmentation of this area of attachment and can result in a permanent prominence. Symptoms can last until adulthood and rarely require surgery.
Sinding-Larsen-Johansson is a condition in which the upper or proximal attachments of the patella tendon to the lower aspect of the patella becomes painful with activity and can also result in some fragmentation of the bone attachment.
Other less common causes of anterior knee pain in young children and adolescents are inflammation of the bursa or fluid sac in front of the knee, various lesions within the knee joint such as a fold of the joint lining called a synovial plica, tendinitis of the quadriceps tendon which is just above the patella and serves as the attachment of the powerful quadriceps muscle and several other rare conditions which need to be ruled out when the cause of anterior knee pain is not readily apparent.
In summary, the more common problems associated with the knee in young and adolescent children athletes are usually treated with modification of activity and exercises with eventual return to full sports activities. It is important to have a complete evaluation performed when anterior knee pain persists as it is important to establish an accurate diagnosis and proceed with an effective treatment plan. Prevention is important and can be accomplished by maintaining a good level of ongoing activity, transitioning gradually into new activities and continuing guidance and coaching. The importance of strengthening exercises, warming up and stretching, taking rest periods and varying activities can never be over emphasized.
If you have questions or wish to schedule an evaluation by one of Cascade Orthopaedics' specialists, please call us at (253) 833-7750.
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice.
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