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Semin Musculoskelet Radiol 2014; 18(05): 489-497
DOI: 10.1055/s-0034-1389266
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Pediatric Knee: Diagnosis and Management of Ligament Injuries

Helmut Wegmann
1   Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
,
Sebastian Tschauner
2   Department of Pediatric Radiology, Medical University of Graz, Graz, Austria
,
Georg Singer
1   Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
,
Robert Marterer
2   Department of Pediatric Radiology, Medical University of Graz, Graz, Austria
,
Robert Eberl
1   Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
,
Erich Sorantin
2   Department of Pediatric Radiology, Medical University of Graz, Graz, Austria
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Publikationsdatum:
28. Oktober 2014 (online)

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Abstract

In the last few decades, sports injuries in pediatric and adolescent athletes have increased dramatically, with ∼ 38 million young athletes participating in organized sports annually in the United States. Starting at the age of 2 years, an increase of the incidence of knee injuries until adulthood with a peak at 6 and at 13 years of age has been observed. Due to a physiologic laxity of the ligaments, ligament injuries are uncommon in these patients, but they are getting more frequent. In the growing knee, open physis are the points of minor resistance. Therefore apophyseal injuries of the pediatric knee are more common. Diagnostics and treatment of ligament injuries of the pediatric and adolescent knees are challenging. This article presents an overview of ligament injuries in the pediatric and adolescent knee, their diagnostic work-up, and their treatment in the growing patient.

Keywords

pediatric - adolescent - knee - ligament injury - diagnostic
 

  • References

  • 1 Frank JS, Gambacorta PL. Anterior cruciate ligament injuries in the skeletally immature athlete: diagnosis and management. J Am Acad Orthop Surg 2013; 21 (2) 78-87
    CrossrefPubMedSuche in Google Scholar
  • 2 Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med 2003; 33 (1) 75-81
    CrossrefPubMedSuche in Google Scholar
  • 3 Sanchis-Gimeno JA, Casas-Roman E, Garcia-Campero C, Hurtado-Fernandez R, Aparicio-Bellver L. Anatomical location of athletic injuries during training: a prospective two year study in 2701 athletes. Br J Sports Med 2005; 39 (7) 467
    PubMedSuche in Google Scholar
  • 4 Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med 2006; 16 (6) 500-513
    CrossrefPubMedSuche in Google Scholar
  • 5 Strouse PJ. MRI of the knee: key points in the pediatric population. Pediatr Radiol 2010; 40 (4) 447-452
    CrossrefPubMedSuche in Google Scholar
  • 6 Sanchez R, Strouse PJ. The knee: MR imaging of uniquely pediatric disorders. Magn Reson Imaging Clin N Am 2009; 17 (3) 521-537 , vii
    CrossrefPubMedSuche in Google Scholar
  • 7 Bulloch B, Neto G, Plint A , et al; Pediatric Emergency Researchers of Canada. Validation of the Ottawa Knee Rule in children: a multicenter study. Ann Emerg Med 2003; 42 (1) 48-55
    CrossrefPubMedSuche in Google Scholar
  • 8 De Maeseneer M, Debaere C, Desprechins B, Osteaux M. Popliteal cysts in children: prevalence, appearance and associated findings at MR imaging. Pediatr Radiol 1999; 29 (8) 605-609
    CrossrefPubMedSuche in Google Scholar
  • 9 Lang IM, Hughes DG, Williamson JB, Gough SG. MRI appearance of popliteal cysts in childhood. Pediatr Radiol 1997; 27 (2) 130-132
    CrossrefPubMedSuche in Google Scholar
  • 10 Strouse PJ, Koujok K. Magnetic resonance imaging of the pediatric knee. Top Magn Reson Imaging 2002; 13 (4) 277-294
    CrossrefPubMedSuche in Google Scholar
  • 11 Busch MT, Fernandez MD, Aarons C. Partial tears of the anterior cruciate ligament in children and adolescents. Clin Sports Med 2011; 30 (4) 743-750
    CrossrefPubMedSuche in Google Scholar
  • 12 Carrino JA, Schweitzer ME. Imaging of sports-related knee injuries. Radiol Clin North Am 2002; 40 (2) 181-202
    CrossrefPubMedSuche in Google Scholar
  • 13 Kocher MS, Mandiga R, Klingele K, Bley L, Micheli LJ. Anterior cruciate ligament injury versus tibial spine fracture in the skeletally immature knee: a comparison of skeletal maturation and notch width index. J Pediatr Orthop 2004; 24 (2) 185-188
    CrossrefPubMedSuche in Google Scholar
  • 14 Benjamin HJ. The female adolescent athlete: specific concerns. Pediatr Ann 2007; 36 (11) 719-726
    CrossrefPubMedSuche in Google Scholar
  • 15 Prince JS, Laor T, Bean JA. MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. AJR Am J Roentgenol 2005; 185 (3) 756-762
    CrossrefPubMedSuche in Google Scholar
  • 16 McCarroll JR, Rettig AC, Shelbourne KD. Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 1988; 16 (1) 44-47
    CrossrefPubMedSuche in Google Scholar
  • 17 Aichroth PM, Patel DV, Zorrilla P. The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg Br 2002; 84 (1) 38-41
    CrossrefPubMedSuche in Google Scholar
  • 18 Gabos PG, El Rassi G, Pahys J. Knee reconstruction in syndromes with congenital absence of the anterior cruciate ligament. J Pediatr Orthop 2005; 25 (2) 210-214
    CrossrefPubMedSuche in Google Scholar
  • 19 Stanitski CL, Harvell JC, Fu F. Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop 1993; 13 (4) 506-510
    CrossrefPubMedSuche in Google Scholar
  • 20 Sanders TG, Miller MD. A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the shoulder. Am J Sports Med 2005; 33 (7) 1088-1105
    CrossrefPubMedSuche in Google Scholar
  • 21 Robertson PL, Schweitzer ME, Bartolozzi AR, Ugoni A. Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology 1994; 193 (3) 829-834
    CrossrefPubMedSuche in Google Scholar
  • 22 Lee K, Siegel MJ, Lau DM, Hildebolt CF, Matava MJ. Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology 1999; 213 (3) 697-704
    CrossrefPubMedSuche in Google Scholar
  • 23 Mink JH, Levy T, Crues III JV. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology 1988; 167 (3) 769-774
    CrossrefPubMedSuche in Google Scholar
  • 24 Kaplan PA, Walker CW, Kilcoyne RF, Brown DE, Tusek D, Dussault RG. Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging. Radiology 1992; 183 (3) 835-838
    CrossrefPubMedSuche in Google Scholar
  • 25 Snearly WN, Kaplan PA, Dussault RG. Lateral-compartment bone contusions in adolescents with intact anterior cruciate ligaments. Radiology 1996; 198 (1) 205-208
    CrossrefPubMedSuche in Google Scholar
  • 26 Coursey Jr RL, Jones EA, Chaljub G, Bertolino PD, Cano O, Swischuk LE. Prospective analysis of uncomplicated bone bruises in the pediatric knee. Emerg Radiol 2006; 12 (6) 266-271
    CrossrefPubMedSuche in Google Scholar
  • 27 Hole RL, Lintner DM, Kamaric E, Moseley JB. Increased tibial translation after partial sectioning of the anterior cruciate ligament. The posterolateral bundle. Am J Sports Med 1996; 24 (4) 556-560
    CrossrefPubMedSuche in Google Scholar
  • 28 Robert HE, Casin C. Valgus and flexion deformity after reconstruction of the anterior cruciate ligament in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc 2010; 18 (10) 1369-1373
    CrossrefPubMedSuche in Google Scholar
  • 29 Lipscomb AB, Anderson AF. Tears of the anterior cruciate ligament in adolescents. J Bone Joint Surg Am 1986; 68 (1) 19-28
    PubMedSuche in Google Scholar
  • 30 Simonian PT, Metcalf MH, Larson RV. Anterior cruciate ligament injuries in the skeletally immature patient. Am J Orthop 1999; 28 (11) 624-628
    PubMedSuche in Google Scholar
  • 31 Lubowitz JH. No-tunnel anterior cruciate ligament reconstruction: the transtibial all-inside technique. Arthroscopy 2006; 22 (8) e1-e11
    PubMedSuche in Google Scholar
  • 32 Zobel MS, Borrello JA, Siegel MJ, Stewart NR. Pediatric knee MR imaging: pattern of injuries in the immature skeleton. Radiology 1994; 190 (2) 397-401
    CrossrefPubMedSuche in Google Scholar
  • 33 Kocher MS, DiCanzio J, Zurakowski D, Micheli LJ. Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents. Am J Sports Med 2001; 29 (3) 292-296
    CrossrefPubMedSuche in Google Scholar
  • 34 Sonin AH, Fitzgerald SW, Hoff FL, Friedman H, Bresler ME. MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. Radiographics 1995; 15 (3) 551-561
    CrossrefPubMedSuche in Google Scholar
  • 35 Hayes CW, Brigido MK, Jamadar DA, Propeck T. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics 2000; 20 (Spec No) S121-S134
    CrossrefPubMedSuche in Google Scholar
  • 36 Janousek AT, Jones DG, Clatworthy M, Higgins LD, Fu FH. Posterior cruciate ligament injuries of the knee joint. Sports Med 1999; 28 (6) 429-441
    CrossrefPubMedSuche in Google Scholar
  • 37 Kocher MS, Shore B, Nasreddine AY, Heyworth BE. Treatment of posterior cruciate ligament injuries in pediatric and adolescent patients. J Pediatr Orthop 2012; 32 (6) 553-560
    CrossrefPubMedSuche in Google Scholar
  • 38 Wang CJ. Injuries to the posterior cruciate ligament and posterolateral instabilities of the knee. Chang Gung Med J 2002; 25 (5) 288-297
    PubMedSuche in Google Scholar
  • 39 Stanitski CL. Pediatric and adolescent sports injuries. Clin Sports Med 1997; 16 (4) 613-633
    CrossrefPubMedSuche in Google Scholar
  • 40 Grood ES, Noyes FR, Butler DL, Suntay WJ. Ligamentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am 1981; 63 (8) 1257-1269
    Suche in Google Scholar
  • 41 Müller W. Form and function of the knee. Its relation to high performance and to sports. Am J Sports Med 1996; 24 (6, Suppl): S104-S106
    CrossrefPubMedSuche in Google Scholar
  • 42 Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979; 61 (1) 56-62
    Suche in Google Scholar
  • 43 Ladd PE, Laor T, Emery KH, Salisbury SR, Parikh SN. Medial collateral ligament of the knee on magnetic resonance imaging: does the site of the femoral origin change at different patient ages in children and young adults?. J Pediatr Orthop 2010; 30 (3) 224-230
    CrossrefPubMedSuche in Google Scholar
  • 44 Tschauner S, Sorantin E, Singer G , et al. The origin points of the knee collateral ligaments: an MRI study on paediatric patients during growth. Knee Surg Sports Traumatol Arthrosc 2014; ; April 18 ( Epub ahead of print)
    PubMedSuche in Google Scholar
  • 45 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (9) 2000-2010
    CrossrefPubMedSuche in Google Scholar
  • 46 Kovachevich R, Shah JP, Arens AM, Stuart MJ, Dahm DL, Levy BA. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc 2009; 17 (7) 823-829
    CrossrefPubMedSuche in Google Scholar
  • 47 Schweitzer ME, Tran D, Deely DM, Hume EL. Medial collateral ligament injuries: evaluation of multiple signs, prevalence and location of associated bone bruises, and assessment with MR imaging. Radiology 1995; 194 (3) 825-829
    CrossrefPubMedSuche in Google Scholar
  • 48 Grobbelaar N, Bouffard JA. Sonography of the knee, a pictorial review. Semin Ultrasound CT MR 2000; 21 (3) 231-274
    CrossrefPubMedSuche in Google Scholar
  • 49 Frölke JP, Oskam J, Vierhout PA. Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments. Short-term results. Knee Surg Sports Traumatol Arthrosc 1998; 6 (2) 103-106
    CrossrefPubMedSuche in Google Scholar
  • 50 Hillard-Sembell D, Daniel DM, Stone ML, Dobson BE, Fithian DC. Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am 1996; 78 (2) 169-176
    PubMedSuche in Google Scholar
  • 51 Woo SL, Young EP, Ohland KJ, Marcin JP, Horibe S, Lin HC. The effects of transection of the anterior cruciate ligament on healing of the medial collateral ligament. A biomechanical study of the knee in dogs. J Bone Joint Surg Am 1990; 72 (3) 382-392
    CrossrefPubMedSuche in Google Scholar
  • 52 Inoue M, McGurk-Burleson E, Hollis JM, Woo SL. Treatment of the medial collateral ligament injury. I: The importance of anterior cruciate ligament on the varus-valgus knee laxity. Am J Sports Med 1987; 15 (1) 15-21
    CrossrefPubMedSuche in Google Scholar
  • 53 Sankar WN, Wells L, Sennett BJ, Wiesel BB, Ganley TJ. Combined anterior cruciate ligament and medial collateral ligament injuries in adolescents. J Pediatr Orthop 2006; 26 (6) 733-736
    CrossrefPubMedSuche in Google Scholar
  • 54 Recondo JA, Salvador E, Villanúa JA, Barrera MC, Gervás C, Alústiza JM. Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging. Radiographics 2000; 20 (Spec No) S91-S102
    CrossrefPubMedSuche in Google Scholar
  • 55 Wheeler LD, Lee EY, Lloyd DC. Isolated popliteus tendon avulsion in skeletally immature patients. Clin Radiol 2008; 63 (7) 824-828
    CrossrefPubMedSuche in Google Scholar
  • 56 Stäubli HU, Birrer S. The popliteus tendon and its fascicles at the popliteal hiatus: gross anatomy and functional arthroscopic evaluation with and without anterior cruciate ligament deficiency. Arthroscopy 1990; 6 (3) 209-220
    CrossrefPubMedSuche in Google Scholar
  • 57 Harner CD, Höher J, Vogrin TM, Carlin GJ, Woo SL. The effects of a popliteus muscle load on in situ forces in the posterior cruciate ligament and on knee kinematics. A human cadaveric study. Am J Sports Med 1998; 26 (5) 669-673
    PubMedSuche in Google Scholar
  • 58 McConkey JP. Avulsion of the popliteus tendon. J Pediatr Orthop 1991; 11 (2) 230-233
    CrossrefPubMedSuche in Google Scholar
  • 59 Ranawat A, Baker III CL, Henry S, Harner CD. Posterolateral corner injury of the knee: evaluation and management. J Am Acad Orthop Surg 2008; 16 (9) 506-518
    PubMedSuche in Google Scholar
  • 60 Lee J, Papakonstantinou O, Brookenthal KR, Trudell D, Resnick DL. Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skeletal Radiol 2003; 32 (11) 619-627
    CrossrefPubMedSuche in Google Scholar
  • 61 Apsingi S, Eachempati KK, Shah GK, Kumar S. Posterolateral corner injuries of the knee—a review. J Indian Med Assoc 2011; 109 (6) 400-403
    PubMedSuche in Google Scholar
  • 62 Gruel JB. Isolated avulsion of the popliteus tendon. Arthroscopy 1990; 6 (2) 94-95
    CrossrefPubMedSuche in Google Scholar
  • 63 Conroy J, King D, Gibbon A. Isolated rupture of the popliteus tendon in a professional soccer player. Knee 2004; 11 (1) 67-69
    CrossrefPubMedSuche in Google Scholar