As more and more children and teens participate in organized sports at a younger age, it is no surprise that knee injuries are on the rise. A pediatric orthopedic surgeon from UCLA School of Medicine recently reviewed four specific injuries that might be of interest to you in your report. These include: 1) anterior cruciate ligament (ACL) injury, 2) symptomatic discoid lateral meniscus, 3) juvenile osteochondritis dissecans, and 4) traumatic patellofemoral instability.
The injuries themselves are unique in that they affect a knee that is not skeletally mature. This refers to the middle-school age group who have not completed their full growth. Prevention of long-term complications such as stiffness and growth arrest are special concerns that must be addressed during treatment.
Let’s take a brief look at each of these four knee injuries in the youth athlete. In youths, anterior cruciate ligament ACL injuries can create knee joint instability, damage to the meniscus (knee cartilage), and chondral injury (damage to the bone). The ACL is one of two ligaments that criss-cross inside the knee. Together, these two ligaments stabilize and hold the knee together. When the ACL is torn during pivoting activities of the leg in this age group, two things can happen.
First, the place where the growth plate and bone meet (called the condroepiphyseal attachment) is damaged. This, in turn, can cause a fracture of the tibial spine (place where the ACL attaches to the bone). And like all fractures, the bone can be separated and displaced (shifted).
Next, injury to the discoid lateral meniscus is only treated when there are painful symptoms with snapping or clunking of the knee and/or loss of full knee extension. Children affected most often by this type of injury are usually under the age of 10. As with adults, the current thinking on this injury is NOT to remove the torn cartilage. Instead, the tissue is repaired as much as possible in order to prevent arthritic changes later.
Juvenile osteochondritis dissecans (OCD) is the third condition of interest. OCD is a problem that affects the knee at the end of the big bone of the thigh (the femur). The area of bone just under the cartilage surface is injured, leading to damage to the blood vessels of the bone. Without blood flow, the area of damaged bone actually dies. This area of dead bone is referred to as the osteochondritis lesion.
Treatment of OCD can be nonsurgical with immobilization and change in activity until healing is seen on X-rays. When healing doesn’t occur, the surgeon can drill tiny holes in the joint surface to cause bleeding and stimulate healing. If the joint cartilage is broken off with a bit of bone still attached, it may be necessary to reattach the fragment or remove it and fill in the hole left behind. Treatment really depends on the patient’s age and skeletal maturity, how long the condition has been present, and how stable (or unstable) the lesion is.
And finally, the last of our four knee disorders: traumatic patellofemoral instability. This refers to a chronically dislocating knee cap. Most of the youths who suffer this problem have some type of anatomic abnormality that puts them at risk for this condition. Most of these cases have to be treated conservatively without surgery because a good method of surgical repair has not been discovered yet. Techniques for successful reconstruction of ligaments around the knee cap are being investigated.
You can find much more information about pediatric knee problems on our website (www.eorthopod.com/public). The information we have provided here and additional information available on the website should give you plenty to work with. Good luck with your report!