Knee pain arises from a problem in the hip until proven otherwise. Hip problems are more common and usually more important.
The knee cartilage and ligament problems that adults have are rare in children except older teenagers, but these are the problems that parents will often be concerned about. The common injuries in children are patello-femoral and physeal (type I and II distal femoral; ligament avulsions of the upper tibia). Articular damage, such as osteochondral fractures, can occur during a patello-femoral injury.
Anterior knee pain in the absence of injury is common amongst teenagers, especially girls, and is usually self-limiting. Physiotherapy usually helps a great deal. Sometimes a congenital dysplasia of the patello-femoral joint causes instability and pain, but again this usually responds to physiotherapy even if a dislocation has occurred. Surgery does have a place, however, and it is not always best to wait until skeletal maturity. These decisions require a careful clinical assessment and analysis of MRI and other images.
Boys are more often affected by Osgood-Schlatter’s Disease. This is a sport or dance related inflammation of the tibial tuberosity and can be quite troublesome. Many affected children will choose to carry on with the provocative sport in spite of symptoms; the pain and swelling are usually at their worst after the game – the so-called hangover pain. The child points exactly to the swollen tibial tuberosity and the exquisite tenderness here is the only sign on examination. Hip and knee examination is otherwise normal. Symptomatic treatment is all that is required. There are several other similar conditions, affecting for example the heel or the in-step of the foot, or the pelvis just above the hip joint.
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