KNEE PROBLEMS IN CHILDREN

“He can do everything else a boy of his age is able to do. It’s wonderful to see him so happy again.”

Ligament problems in children

If an adult damages their anterior cruciate ligament (ACL), the tear (rupture) usually occurs at the top part of the ligament where it attaches to the femur or thigh bone ligament. In children and young people, the attachment of the ligament to the bone is a weak point and the ligament can be completely separated from the bone, with a fragment of bone still attached to it. This is common in anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries which often happen during sports such as netball, hockey, football or skiing.

Adrian has pioneered a number of new procedures for treating ACL injuries in children and, in some cases, it may now be possible to re-attach the torn ligament using keyhole surgery. This is usually easier to do in the first 6- 8 weeks following an injury, although in some cases repairs have been carried out up to 10 years later.

However, while up to 95% of ACL tears in young children are repairable, this is unfortunately not the case for adults where most people – around 75% of cases – are not able to benefit from this type of surgery and need to have ACL reconstruction surgery instead.

Anterior cruciate ligament (ACL) injuries in children

ACL injuries are increasingly common in children for a variety of reasons – many children are heavier, and more are taking part in extreme sports such as skiing and snowboarding.

Traditionally, ACL surgery meant a recovery time of up to a year, whereas new procedures developed by Adrian for ACL surgery on children have reduced this to around four months. New techniques also minimise the risk of growth disturbance which is a major concern when operating on young children.

PCL injuries in children

If an adult is injured and damages their PCL, the tear (rupture) usually occurs in the middle of the ligament. However, in children and young people, the attachment of the ligament to the bone is a weak point and the ligament can be completely separated from the bone, with a fragment of bone still attached to it. Adrian will be able to advise you about whether it will be possible to repair the injury, or whether it will require PCL surgery.

Osteochondritis

This group of conditions, which causes pain and disability, affects the growing skeleton of a child or adolescent and the surfaces of the joints (cartilage) in the knee. The diseases interrupt the blood supply to a bone which results in bone death (necrosis) and later regrowth of the bone.

Who is most at risk of osteochondritis?

Children and teenagers who take part in sport are more likely to develop the condition and it’s also more common in boys.

What are the symptoms of osteochondritis?

Symptoms include pain, swelling, stiffness and/or weakness in the joint. There may also be a feeling of the joint ‘popping’ and, in some cases, locking.

How is osteochondritis diagnosed?

Adrian will discuss your child’s symptoms with you and carry out an examination of the knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, he will arrange for them to have an X-ray to confirm the diagnosis. The final diagnosis is made with an MRI scan.

How is it treated?

In most cases, resting and taking the weight off the knee for a period of time will settle things. Adrian may also advise that your child has a course of physiotherapy to strengthen the muscles and tendons around the joint. However, in some cases, he may advise that your child has surgery to fix the bone and cartilage fragment that have partially detached.

Types of osteochondritis include:

  • Osgood-Schlatter disease
    Pain and swelling in the bony lump that lies just below the kneecap can be caused by Osgood-Schlatter disease.
    What causes Osgood-Schlatter disease?
    Osgood-Schlatter disease is caused by a bone at the top of the shin bone becoming affected during a growth spurt. It’s more common if your child takes part in sports that include running and jumping or where there is repeated stress on the knees.
    What are the symptoms of Osgood-Schlatter disease?
    The most common symptom is the formation of a bony growth where the patella tendon joins the shin bone.
    How is Osgood-Schlatter disease diagnosed?
    Adrian will discuss your child’s symptoms with you and carry out an examination of the knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, he will arrange for them to have an X-ray to confirm the diagnosis.
    How is Osgood-Schlatter disease treated?
    In most cases, resting, along with taking painkillers (as prescribed by your doctor) is enough to relieve the symptoms and your child is likely to make a complete recovery by the time he or she stops growing. Surgery is only very rarely necessary. However, children with Osgood-Schlatter syndrome will still have a bony lump on the front of the shin bone, even after surgery.
  • Sinding-Larsen-Johansson syndrome
    This painful condition often affects teenagers during growth spurts.
    What causes Sinding-Larsen-Johansson syndrome?
    It’s caused by repetitive strain on the patella tendon which causes the growth plate to become inflamed and painful. It’s more common in boys aged 10-15. It’s sometimes described as the childhood equivalent to jumper’s knee.
    How is Sinding-Larsen-Johansson syndrome diagnosed?
    Adrian will discuss your child’s symptoms with you and carry out an examination of the knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, he will arrange for them to have an X-ray to confirm the diagnosis.
    How is Sinding-Larsen-Johansson syndrome treated?
    In most cases, resting, along with taking painkillers (as prescribed by your doctor) is enough to relieve the symptoms and your child is likely to make a complete recovery by the time he or she stops growing. Surgery is only recommended in around 5% of cases.

GET IN TOUCH

Adrian sees patients in Harley Street, London, Hampshire and Windsor.

To find out more or to book an appointment, complete this form, call us on + 44 (0) 203 397 7779 or email



Read about Adrian’s pioneering work on children’s knee surgery