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
› Author Affiliations
Further Information

Publication History

21 December 2017

07 January 2018

Publication Date:
28 February 2018 (online)

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.

 
  • References

  • 1 Fulkerson JP, Arendt EA. The female knee--anterior knee pain. Conn Med 1999; 63 (11) 661-664
  • 2 Devereaux MD, Lachmann SM. Patello-femoral arthralgia in athletes attending a Sports Injury Clinic. Br J Sports Med 1984; 18 (01) 18-21
  • 3 DeHaven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med 1986; 14 (03) 218-224
  • 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
  • 5 Gorman McNerney ML, Arendt EA. Anterior knee pain in the active and athletic adolescent. Curr Sports Med Rep 2013; 12 (06) 404-410
  • 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
  • 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
  • 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
  • 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
  • 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
  • 11 Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002; 30 (03) 447-456
  • 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
  • 13 Fulkerson JP. Anterolateralization of the tibial tubercle. Tech Orthop 1997; 12 (03) 165-169
  • 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
  • 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
  • 16 Galanty HL, Matthews C, Hergenroeder AC. Anterior knee pain in adolescents. Clin J Sport Med 1994; 4: 176-181
  • 17 Post WR. Clinical evaluation of patients with patellofemoral disorders. Arthroscopy 1999; 15 (08) 841-851
  • 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
  • 19 Kocher MS, Bishop JA, Weed B. , et al. Delay in diagnosis of slipped capital femoral epiphysis. Pediatrics 2004; 113 (04) e322-e325
  • 20 Dupont JY. Synovial plicae of the knee. Controversies and review. Clin Sports Med 1997; 16 (01) 87-122
  • 21 Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974; 56 (07) 1391-1396
  • 22 Grelsamer RP, Bazos AN, Proctor CS. Radiographic analysis of patellar tilt. J Bone Joint Surg Br 1993; 75 (05) 822-824
  • 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
  • 24 Schutzer SF, Ramsby GR, Fulkerson JP. Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am 1986; 17 (02) 235-248
  • 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
  • 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
  • 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
  • 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
  • 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
  • 30 Ford DH, Post WR. Open or arthroscopic lateral release. Indications, techniques, and rehabilitation. Clin Sports Med 1997; 16 (01) 29-49
  • 31 Fulkerson JP. Patellofemoral pain disorders: evaluation and management. J Am Acad Orthop Surg 1994; 2 (02) 124-132
  • 32 Fulkerson JP. Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop Relat Res 1983; (177) 176-181
  • 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
  • 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
  • 35 Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr 2007; 19 (01) 44-50
  • 36 Yen YM. Assessment and treatment of knee pain in the child and adolescent athlete. Pediatr Clin North Am 2014; 61 (06) 1155-1173
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 44 Amis AA. Current concepts on anatomy and biomechanics of patellar stability. Sports Med Arthrosc Rev 2007; 15 (02) 48-56
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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