PDF herunterladen
J Knee Surg 2018; 31(05): 392-398
DOI: 10.1055/s-0038-1632376
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anterior Knee Pain in Children and Adolescents: Overview and Management

Steven Slotkin
1   Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
,
Andrew Thome
2   Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island
,
Cassandra Ricketts
3   Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
,
Andrew Georgiadis
4   Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, Saint Paul, Minnesota
,
Aristides I. Cruz Jr
2   Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island
,
Mark Seeley
5   Department of Orthopaedics, Geisinger Medical Center, Danville, Pennsylvania
› Institutsangaben
Weitere Informationen

Publikationsverlauf

21. Dezember 2017

07. Januar 2018

Publikationsdatum:
28. Februar 2018 (online)

    Lizenzen und Reprints

Abstract

Anterior knee pain (AKP) is a common presenting complaint for pediatricians and orthopaedic surgeons and is often seen in young athletes. AKP is multifactorial and has a broad differential diagnosis. The growth changes, biomechanics, and anatomy around the knee add to the complexity of diagnosis and treatment of AKP. Common causes of AKP include Osgood–Schlatter's disease, patellar tendinitis, and patellofemoral instability. In the diagnosis of AKP, it is important to rule out serious and morbid causes of pain, including infection and tumor. It is crucial to complete a detailed history and physical examination and obtain appropriate imaging studies. In general, the majority of patients will respond to nonoperative measures targeted to correct neuromuscular control and kinetic chain dysfunction.

Keywords

pediatrics - knee pain - patellofemoral instability - patellofemoral syndrome - Osgood–Schlatter's disease
 

  • References

  • 1 Fulkerson JP, Arendt EA. The female knee--anterior knee pain. Conn Med 1999; 63 (11) 661-664
    PubMedGoogle Scholar
  • 2 Devereaux MD, Lachmann SM. Patello-femoral arthralgia in athletes attending a Sports Injury Clinic. Br J Sports Med 1984; 18 (01) 18-21
    CrossrefPubMedGoogle Scholar
  • 3 DeHaven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med 1986; 14 (03) 218-224
    CrossrefPubMedGoogle Scholar
  • 4 Myer GD, Ford KR, Barber Foss KD. , et al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon) 2010; 25 (07) 700-707
    CrossrefPubMedGoogle Scholar
  • 5 Gorman McNerney ML, Arendt EA. Anterior knee pain in the active and athletic adolescent. Curr Sports Med Rep 2013; 12 (06) 404-410
    CrossrefPubMedGoogle Scholar
  • 6 Kodali P, Islam A, Andrish J. Anterior knee pain in the young athlete: diagnosis and treatment. Sports Med Arthrosc Rev 2011; 19 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 7 Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J, Rodríguez-Vázquez JF, Mérida-Velasco JR, Jiménez-Collado J. Development of the human knee joint. Anat Rec 1997; 248 (02) 269-278
    CrossrefPubMedGoogle Scholar
  • 8 Clark CR, Ogden JA. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am 1983; 65 (04) 538-547
    CrossrefPubMedGoogle Scholar
  • 9 Gardner E, O'Rahilly R. The early development of the knee joint in staged human embryos. J Anat 1968; 102 (Pt 2): 289-299
    PubMedGoogle Scholar
  • 10 Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J, Mérida-Velasco JR, Rodríguez-Vázquez JF, Jiménez-Collado J. Development of the human knee joint ligaments. Anat Rec 1997; 248 (02) 259-268
    CrossrefPubMedGoogle Scholar
  • 11 Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002; 30 (03) 447-456
    CrossrefPubMedGoogle Scholar
  • 12 Dye SF, Stäubli HU, Biedert RM, Vaupel GL. The mosaic of pathophysiologycausing patellofemoral pain: therapeutic implications. Oper Tech Sports Med 1999; 7 (02) 46-54
    CrossrefPubMedGoogle Scholar
  • 13 Fulkerson JP. Anterolateralization of the tibial tubercle. Tech Orthop 1997; 12 (03) 165-169
    CrossrefPubMedGoogle Scholar
  • 14 Thomeé R, Renström P, Karlsson J, Grimby G. Patellofemoral pain syndrome in young women. I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports 1995; 5 (04) 237-244
    PubMedGoogle Scholar
  • 15 Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg Br 1984; 66 (05) 685-693
    PubMedGoogle Scholar
  • 16 Galanty HL, Matthews C, Hergenroeder AC. Anterior knee pain in adolescents. Clin J Sport Med 1994; 4: 176-181
    PubMedGoogle Scholar
  • 17 Post WR. Clinical evaluation of patients with patellofemoral disorders. Arthroscopy 1999; 15 (08) 841-851
    CrossrefPubMedGoogle Scholar
  • 18 Post WR, Fulkerson J. Knee pain diagrams: correlation with physical examination findings in patients with anterior knee pain. Arthroscopy 1994; 10 (06) 618-623
    CrossrefPubMedGoogle Scholar
  • 19 Kocher MS, Bishop JA, Weed B. , et al. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics 2004; 113 (04) e322-e325
    CrossrefPubMedGoogle Scholar
  • 20 Dupont JY. Synovial plicae of the knee. Controversies and review. Clin Sports Med 1997; 16 (01) 87-122
    CrossrefPubMedGoogle Scholar
  • 21 Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974; 56 (07) 1391-1396
    CrossrefPubMedGoogle Scholar
  • 22 Grelsamer RP, Bazos AN, Proctor CS. Radiographic analysis of patellar tilt. J Bone Joint Surg Br 1993; 75 (05) 822-824
    CrossrefPubMedGoogle Scholar
  • 23 Biedert RM, Gruhl C. Axial computed tomography of the patellofemoral joint with and without quadriceps contraction. Arch Orthop Trauma Surg 1997; 116 (1-2): 77-82
    CrossrefPubMedGoogle Scholar
  • 24 Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am 1986; 17 (02) 235-248
    PubMedGoogle Scholar
  • 25 Schutzer SF, Ramsby GR, Fulkerson JP. The evaluation of patellofemoral pain using computerized tomography. A preliminary study. Clin Orthop Relat Res 1986; (204) 286-293
    PubMedGoogle Scholar
  • 26 Jones RB, Barlett EC, Vainright JR, Carroll RG. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain. Skeletal Radiol 1995; 24 (07) 505-509
    PubMedGoogle Scholar
  • 27 Natri A, Kannus P, Järvinen M. Which factors predict the long-term outcome in chronic patellofemoral pain syndrome? A 7-yr prospective follow-up study. Med Sci Sports Exerc 1998; 30 (11) 1572-1577
    CrossrefPubMedGoogle Scholar
  • 28 Rathleff MS, Roos EM, Olesen JL, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med 2015; 49 (06) 406-412
    CrossrefPubMedGoogle Scholar
  • 29 Ernst GP, Kawaguchi J, Saliba E. Effect of patellar taping on knee kinetics of patients with patellofemoral pain syndrome. J Orthop Sports Phys Ther 1999; 29 (11) 661-667
    CrossrefPubMedGoogle Scholar
  • 30 Ford DH, Post WR. Open or arthroscopic lateral release. Indications, techniques, and rehabilitation. Clin Sports Med 1997; 16 (01) 29-49
    CrossrefPubMedGoogle Scholar
  • 31 Fulkerson JP. Patellofemoral pain disorders: evaluation and management. J Am Acad Orthop Surg 1994; 2 (02) 124-132
    CrossrefPubMedGoogle Scholar
  • 32 Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 1983; (177) 176-181
    PubMedGoogle Scholar
  • 33 Demirag B, Ozturk C, Yazici Z, Sarisozen B. The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. J Pediatr Orthop B 2004; 13 (06) 379-382
    CrossrefPubMedGoogle Scholar
  • 34 Kujala UM, Kvist M, Heinonen O. Osgood-Schlatter's disease in adolescent athletes. Retrospective study of incidence and duration. Am J Sports Med 1985; 13 (04) 236-241
    CrossrefPubMedGoogle Scholar
  • 35 Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr 2007; 19 (01) 44-50
    CrossrefPubMedGoogle Scholar
  • 36 Yen YM. Assessment and treatment of knee pain in the child and adolescent athlete. Pediatr Clin North Am 2014; 61 (06) 1155-1173
    CrossrefPubMedGoogle Scholar
  • 37 Pihlajamäki HK, Mattila VM, Parviainen M, Kiuru MJ, Visuri TI. Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men. J Bone Joint Surg Am 2009; 91 (10) 2350-2358
    CrossrefPubMedGoogle Scholar
  • 38 Eun SS, Lee SA, Kumar R. , et al. Direct bursoscopic ossicle resection in young and active patients with unresolved Osgood-Schlatter disease. Arthroscopy 2015; 31 (03) 416-421
    CrossrefPubMedGoogle Scholar
  • 39 Pagenstert G, Wurm M, Gehmert S, Egloff C. Reduction osteotomy of the prominent tibial tubercle after Osgood-Schlatter disease. Arthroscopy 2017; 33 (08) 1551-1557
    CrossrefPubMedGoogle Scholar
  • 40 Waterman BR, Belmont Jr PJ, Owens BD. Patellar dislocation in the United States: role of sex, age, race, and athletic participation. J Knee Surg 2012; 25 (01) 51-57
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 41 Howells NR, Eldridge JD. Medial patellofemoral ligament reconstruction for patellar instability in patients with hypermobility: a case control study. J Bone Joint Surg Br 2012; 94 (12) 1655-1659
    CrossrefPubMedGoogle Scholar
  • 42 Fithian DC, Paxton EW, Stone ML. , et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
    CrossrefPubMedGoogle Scholar
  • 43 Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y. Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 2008; 90 (03) 463-470
    CrossrefPubMedGoogle Scholar
  • 44 Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007; 15 (02) 48-56
    CrossrefPubMedGoogle Scholar
  • 45 Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW. Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 2011; 39 (07) 1444-1449
    CrossrefPubMedGoogle Scholar
  • 46 Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL. Magnetic resonance imaging of acute patellar dislocation in children: patterns of injury and risk factors for recurrence. J Pediatr Orthop 2012; 32 (02) 145-155
    CrossrefPubMedGoogle Scholar
  • 47 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (03) 215-220
    CrossrefPubMedGoogle Scholar
  • 48 Shea KG, Polousky JD, Jacobs Jr JC. , et al. The relationship of the femoral physis and the medial patellofemoral ligament in children: a cadaveric study. J Pediatr Orthop 2014; 34 (08) 808-813
    CrossrefPubMedGoogle Scholar
  • 49 Pennock AT, Alam M, Bastrom T. Variation in tibial tubercle-trochlear groove measurement as a function of age, sex, size, and patellar instability. Am J Sports Med 2014; 42 (02) 389-393
    CrossrefPubMedGoogle Scholar
  • 50 Lykissas MG, Li T, Eismann EA, Parikh SN. Does medial patellofemoral ligament reconstruction decrease patellar height? A preliminary report. J Pediatr Orthop 2014; 34 (01) 78-85
    CrossrefPubMedGoogle Scholar
  • 51 Fabricant PD, Ladenhauf HN, Salvati EA, Green DW. Medial patellofemoral ligament (MPFL) reconstruction improves radiographic measures of patella alta in children. Knee 2014; 21 (06) 1180-1184
    CrossrefPubMedGoogle Scholar
  • 52 Thévenin-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 (08) e35
    CrossrefPubMedGoogle Scholar
  • 53 Hopper GP, Leach WJ, Rooney BP, Walker CR, Blyth MJ. Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction?. Am J Sports Med 2014; 42 (03) 716-722
    CrossrefPubMedGoogle Scholar
  • 54 Hing CB, Smith TO, Donell S, Song F. Surgical versus non-surgical interventions for treating patellar dislocation. Cochrane Database Syst Rev 2011; (11) CD008106
    PubMedGoogle Scholar
  • 55 Nelitz M, Dreyhaupt J, Reichel H, Woelfle J, Lippacher S. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: surgical technique and clinical outcome. Am J Sports Med 2013; 41 (01) 58-63
    CrossrefPubMedGoogle Scholar
  • 56 Luhmann SJ, O'Donnell JC, Fuhrhop S. Outcomes after patellar realignment surgery for recurrent patellar instability dislocations: a minimum 3-year follow-up study of children and adolescents. J Pediatr Orthop 2011; 31 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 57 Fulkerson JP, Edgar C. Medial quadriceps tendon-femoral ligament: surgical anatomy and reconstruction technique to prevent patella instability. Arthrosc Tech 2013; 2 (02) e125-e128
    CrossrefPubMedGoogle Scholar
  • 58 Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007; 35 (05) 801-804
    CrossrefPubMedGoogle Scholar
  • 59 Jacobi M, Reischl N, Bergmann M, Bouaicha S, Djonov V, Magnussen RA. Reconstruction of the medial patellofemoral ligament using the adductor magnus tendon: an anatomic study. Arthroscopy 2012; 28 (01) 105-109
    CrossrefPubMedGoogle Scholar
  • 60 Marsh JS, Daigneault JP, Sethi P, Polzhofer GK. Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique. J Pediatr Orthop 2006; 26 (04) 461-465
    CrossrefPubMedGoogle Scholar
  • 61 Parikh SN, Nathan ST, Wall EJ, Eismann EA. Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 2013; 41 (05) 1030-1038
    CrossrefPubMedGoogle Scholar
  • 62 Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G. The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 318-324
    CrossrefPubMedGoogle Scholar