Knee Problems in Children

Knee pain in children is common and there are many causes. It is important that an accurate diagnosis is made to ensure that the appropriate treatment plan is adopted. It is very important to understand that some very serious problems affecting the hip joint can be felt by your child as pain in the thigh or the knee. It is mandatory that the hip is examined and often needs to be X-rayed before continuing to assess the knee.

Some of the more common causes of knee pain are listed below. Dr Uglow has considerable experience in dealing with these conditions.

Anterior Knee Pain

A ‘grab it all term’ that covers problems from the patella (knee cap) and its joint with the femur. This is usually caused by softening of the cartilage during growth (chondromalacia).

Short Hamstrings

Short hamstrings exert excessive pressure through the front of the knee and simple stretches of the hamstring muscles can be very effective in treating pain in the front of the knee.

Patella Instability

This is where the knee cap ‘wobbles’ in its path on the femur or worse the knee cap actually pops out of joint (subluxation or dislocation). This can be very painful and disabling. It is important to ensure that true instability is treated because the joint surface can become damaged anytime that the knee cap pops out of its normal place. When the knee is out straight at rest, there is no tension on the knee cap (patella) and it can easily be moved side to side if you push on it. In some people the knee cap moves excessively and they get an intense feeling that the knee will come out of joint if the knee cap is pushed sideways.

Dislocation of the Patella

Dislocation is where the knee cap can slip out of place and dislocate. This can either happen with little force or as a result of a definite injury. The knee either settles down and heals with no further problem or the patella continues to come out of joint causing notable problems. Physiotherapy is a very important part of treating patella dislocation and instability. The patella relies on the shape of the bones of the knee and the soft tissues around the knee to keep it in place. The muscles can get weak which makes the problem worse and they need to made as strong as possible to help keep the patella in place. If you have a patella that keeps coming out or feels like it is giving way then you will need to have investigations to look at the shape of the knee. X-rays and MRI scans are usually needed to do this. There are a number of underlying causes that contribute to the patella being unstable and these will be assessed and if physiotherapy has not resolved the problem surgery is likely to be needed to keep the patella in the right place. Exactly what is needed depends on your particular anatomy and age. Dr Uglow will discuss the reasons why your knee cap is unstable and what needs to be done to help it stay in place. Treatment is very important because if the patella continues to dislocate, damage can occur to the cartilage on the back of the knee cap and this will ultimately lead to arthritis if not resolved.

Osteochondral defect (OCD)

Osteochondral defect (OCD): a focal area of the joint surface can become soft and the joint is vulnerable and may split if not protected or treated.

Meniscal Injury

The meniscus is a cartilage in the joint and there is one on each side of the joint which can become torn if injured. This can be a very difficult problem with long term consequences so if pain persists in your child’s knee it is important that this condition is excluded.

Osgood-Schlatters

This is a painful problem that is actually quite innocent but persistent. It is effectively a tendonitis where the patella tendon joins onto the tibia just below the knee. A swelling is quite obvious and children are worse with any impact such as jumping and sprinting etc.