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Current Reviews in Musculoskeletal Medicine

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01-06-2021 | Osteochondrosis Dissecans | Non-Operative Management of Anterior Knee Pain (M Fredericson and T Besier, Section Editors)

Narrative Review — Knee Pain in the Pediatric Athlete

Authors: Anne Kuwabara, Emily Kraus, Michael Fredericson

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2021

Abstract

Purpose of review

This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations.

Recent findings

Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures.

Summary

Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.

U.S. Department of Health and Human Services. National Youth Sports Strategy. Washington, DC. U.S. Department of Health and Human Services; 2019. https://health.gov/sites/default/files/2019-10/National_Youth_Sports_Strategy.pdf. Accessed November 12, 2020.

Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med. 2006;16:500–13.CrossRef

Gage BE, McIlvain NM, Collins CL, et al. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 2012;19:378–85.CrossRef

Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee. 2006;13:184–8.CrossRef

DiFiori JP, Benjamin HJ, Brenner J, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Clin J Sport Med. 2014;24:3–20.CrossRef

Jayanthi NA, LaBella CR, Fischer D, et al. Sports-specialized intensive training and the risk of injury in young athletes: a clinical case-control study. Am J Sports Med. 2015;43:794–801.CrossRef

Whittaker JL, Toomey CM, Nettel-Aguirre A, et al. Health-related Outcomes after a Youth Sport–related Knee Injury. Medicine & Science in Sports & Exercise. 2019;51(2):255–63. https://doi.org/10.1249/MSS.0000000000001787.CrossRef

Smith JM, Varacallo M. Osgood Schlatter Disease. In: StatPearls. StatPearls Publishing; 2020. Accessed December 6, 2020. http://www.ncbi.nlm.nih.gov/books/NBK441995/

Kose O. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children? Skeletal Radiol. 2010;39(4):359–61.CrossRef

10.

Yanagisawa S, Osawa T, Saito K, Kobayashi T, Tajika T, Yamamoto A, et al. Assessment of Osgood-Schlatter disease and the skeletal maturation of the distal attachment of the patellar tendon in preadolescent males. Orthop J Sports Med. 2014;2(7):2325967114542084.CrossRef

11.

Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 3rd ed: Elsevier; 2018.

12.

Hirano A, et al. Magnetic Resonance Imaging of Osgood-Schlatter Disease: The Course of the Disease. Skeletal Radiology. 2002;31(6):334–42. https://doi.org/10.1007/s00256-002-0486-z.CrossRefPubMed

13.

Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh H. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter Disease. Pediatrics. 2011;128(5):e1121–8.CrossRef

14.

Hagner W, Sosnowski S, Kaziñski W, Frankowski S. A case of Sinding-Larsen-Johansson and Osgood-Schlatter disease in both knees. Chir Narzadow Ruchu Ortop Pol. 1993;58(1):13–5.PubMed

15.

Valentino M, Quiligotti C, Ruggirello M. Sinding-Larsen-Johansson Syndrome: A Case Report. Journal of Ultrasound. 2012. https://doi.org/10.1016/j.jus.2012.03.001.

16.

Bruns J, Werner M, Habermann C. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint. Cartilage. 2018;9(4):346–62. https://doi.org/10.1177/1947603517715736.CrossRefPubMed

17.

Kessler J, Nikizad H, Shea KG, Jacobs JC, Bebchuk JD, Weiss JM. The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents. Am J Sports Med. 2014;42:320–6.CrossRef

18.

Conrad JM, Stanitski CL. Osteochondritis dissecans: Wilson's sign revisited. Am. J. Sports Med. 2003;31:777–8.CrossRef

19.

Hefti F, Beguiristain J. Krauspe Ret al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B. 1999;8(4):231–45.PubMed

20.

Flores DV, Mejía Gómez C, Pathria MN. Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain. Radiographics. 2018;38(7):2069–101. https://doi.org/10.1148/rg.2018180048.CrossRefPubMed

21.

Kim SJ, Choe WS. Arthroscopic findings of the synovial plicae of the knee. Arthroscopy. 1997 Feb;13(1):33–41.CrossRef

22.

Stubbings N, Smith T. Diagnostic test accuracy of clinical and radiological assessments for medial patella plica syndrome: a systematic review and meta-analysis. Knee. 2014 Mar;21(2):486–90.CrossRef

23.

Rovere GD, Adair DM. Medial synovial shelf plica syndrome. Treatment by intraplical steroid injection. Am J Sports Med. 1985 Nov-Dec;13(6):382–6. https://doi.org/10.1177/036354658501300603.CrossRefPubMed

24.

Schindler OS. 'The Sneaky Plica' revisited: morphology, pathophysiology and treatment of synovial plicae of the knee. Knee Surg Sports Traumatol Arthrosc. 2014 Feb;22(2):247–62.CrossRef

25.

Kim JG, Han SW, Lee DH. Diagnosis and treatment of discoid meniscus. Knee Surg Relat Res. 2016;28:255–62.CrossRef

26.

Kocher MS, Logan CA, Kramer DE. Discoid lateral meniscus in children: diagnosis, management, and outcomes. J Am Acad Orthop Surg. 2017;25:736–43.CrossRef

27.

Kocher MS, Klingele K, Rassman SO. Meniscal disorders: normal, discoid, and cysts. Orthop Clin North Am. 2003;34:329–40.CrossRef

28.

Siow HM, Cameron DB, Ganley TJ. Acute knee injuries in skeletally immature athletes. Phys Med Rehabil Clin N Am. 2008;19:319–45 ix.CrossRef

29.

Bellisari G, Samora W, Klingele K. Meniscus tears in children. Sports Med Arthrosc Rev. 2011;19:50–5.CrossRef

30.

Saavedra M, et al. Discoid Meniscus: Current Concepts. EFORT Open Reviews. 2020;5(7):371–9. https://doi.org/10.1302/2058-5241.5.190023.CrossRefPubMedPubMedCentral

31.

Andrish JT. Meniscal injuries in children and adolescents: Diagnosis and management. J Am Acad Orthop Surg. 1996;4(5):231-237.10795058.CrossRef

32.

Sweeney E, Rodenberg R, MacDonald J. Overuse Knee Pain in the Pediatric and Adolescent Athlete. Current Sports Medicine Reports. 2020;19(11):479–85. https://doi.org/10.1249/JSR.0000000000000773.CrossRefPubMed

33.

Popkin CA, Bayomy AF, Trupia EP, Chan CM, Redler LH. Patellar Instability in the Skeletally Immature. Curr Rev Musculoskelet Med. 2018;11(2):172–81. https://doi.org/10.1007/s12178-018-9472-5.CrossRefPubMedPubMedCentral

34.

Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004 Jul-Aug;32(5):1114–21.CrossRef

35.

Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med. 2010 Oct;38(10):1997–2004.CrossRef

36.

Grimm NL, Levy BJ, Jimenez AE, Crepeau AE, Lee PJ. Traumatic Patellar Dislocations in Childhood and Adolescents. Orthop Clin North Am. 2020 Oct;51(4):481–91. https://doi.org/10.1016/j.ocl.2020.06.005.CrossRefPubMed

37.

Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19–26. https://doi.org/10.1007/BF01552649.CrossRefPubMed

38.

Kramer D, Pace JL. Acute Traumatic and Sports-Related Osteochondral Injury of the Pediatric Knee. Orthopedic Clinics of North America. 2012 Apr;43(2):227–36.CrossRef

39.

Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. Patellar Instability. In: StatPearls. StatPearls Publishing; 2020. Accessed December 9, 2020. http://www.ncbi.nlm.nih.gov/books/NBK482427/

40.

Kazley JM, Banerjee S. Classifications in Brief: The Dejour Classification of Trochlear Dysplasia. Clin Orthop Relat Res. 2019;477(10):2380–6. https://doi.org/10.1097/CORR.0000000000000886.CrossRefPubMedPubMedCentral

41.

Thevenin-Lemoine C, Ferrand M, Courvoisier A, Damsin JP, Ducou le Pointe H, Vialle R. Is the Caton-Deschamps index a valuable ratio to investigate patellar height in children? J Bone Joint Surg Am. 2011;93(8):e35. https://doi.org/10.2106/JBJS.J.00759.CrossRefPubMed

42.

Liu JN, Steinhaus ME, Kalbian IL, Post WR, Green DW, Strickland SM, et al. Patellar instability management: a survey of the international patellofemoral study group. Am J Sports Med. 2018;46(13):3299–306.CrossRef

43.

Cowan SM, Bennell KL, Hodges PW. Therapeutic patellar taping changes the timing of vasti muscle activation in people with patellofemoral pain syndrome. Clin J Sport Med. 2002;12(6):339–47. https://doi.org/10.1097/00042752-200211000-00004.CrossRefPubMed

44.

Menetrey J, Putman S, Gard S. Return to sport after patellar dislocation or following surgery for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2320–6. https://doi.org/10.1007/s00167-014-3172-5.CrossRefPubMedPubMedCentral

45.

Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc. 1999;7(4):243–5.CrossRef

46.

Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma. 1992 Apr;32(4):464–7.CrossRef

47.

Guy SP, Marciniak JL, Tulwa N, Cohen A. Bilateral sleeve fracture of the inferior poles of the patella in a healthy child: case report and review of the literature. Adv Orthop. 2011;2011:428614.CrossRef

48.

Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br. 1979;61:165–8.CrossRef

49.

Grogan DP, Carey TP, Leffers D, Ogden JA. Avulsion fractures of the patella. J Pediatr Orthop. 1990 Nov-Dec;10(6):721–30.CrossRef

50.

Boushnak MO, Moussa MK, Ali AAA, Mohsen ZH, Chamseddine A. Patellar Sleeve Fracture in an Eight-Year-Old Girl. Curēus. 2020;12(9):e10345-e10345.

51.

Ditchfield A, Sampson MA, Taylor GR. Case reports. Ultrasound diagnosis of sleeve fracture of the patella. Clin Radiol. 2000 Sep;55(9):721–2.CrossRef

52.

Gottsegen CJ, Eyer BA, White EA, Learch TJ, Forrester D. Avulsion fractures of the knee: imaging findings and clinical significance. RadioGraphics. 2008;28:1755–70. https://doi.org/10.1148/rg.286085503.CrossRefPubMed

53.

Lin SY, Lin WC, Wang JW. Inferior sleeve fracture of the patella. J Chin Med Assoc. 2011 Feb;74(2):98–101.CrossRef

54.

Kaar TK, Murray P, Cashman WF. Transosseous suturing for sleeve fracture of the patella: case report. Ir J Med Sci. 1993;162:148–9.CrossRef

Title: Narrative Review — Knee Pain in the Pediatric Athlete
Authors: Anne Kuwabara
Emily Kraus
Michael Fredericson
Publication date: 01-06-2021
Publisher: Springer US
Keywords: Osteochondrosis Dissecans
Morbus Osgood-Schlatter
Published in: Current Reviews in Musculoskeletal Medicine / Issue 3/2021
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-021-09708-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Narrative Review — Knee Pain in the Pediatric Athlete

Abstract

Purpose of review

Recent findings

Summary

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Springer Medicine

Abstract

Purpose of review

Recent findings

Summary

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