Injuries and Chronic Conditions of the Knee in Young Athletes

Abstract

1. Alfred Atanda Jr, MD* 2. Deepak Reddy, MD† 3. Jaime A. Rice, MD† 4. Michael A. Terry, MD† 1. *Department of Orthopaedic Surgery, A.I. DuPont Children's Hospital, Wilmington, De 2. †Section of Orthopaedic Surgery, The University of Chicago Hospitals, Chicago, Ill After completing this article, readers should be able to: 1. Recognize the physical findings that are consistent with internal derangement of the knee. 2. Differentiate among bony, ligamentous, and cartilaginous injuries of the knee based on physical findings. 3. Discuss the criteria for orthopedic consultation for a knee injury. 4. Know which types of knee injuries require magnetic resonance imaging for evaluation. Pediatric and adolescent athletes who have sustained knee injuries often present initially to their primary care doctors. Damage to the bone, ligaments, or cartilaginous structures of the knee may occur, depending on the particular mechanism of injury. A history, physical examination, and radiographic studies can narrow the differential diagnosis. The purpose of this article is to provide a case-based review of common knee injuries and chronic knee conditions that affect pediatric and adolescent athletes. We review history and physical findings, epidemiology, appropriate imaging studies, when to refer to a specialist, and treatment options. A 13-year-old boy comes to your office complaining of left knee pain after being injured during a basketball game yesterday. He describes a sudden deceleration with his left foot planted. He had immediate pain and was unable to ambulate. On physical examination, he has moderate joint effusion, with tenderness over his tibial tubercle and an inability to extend his knee actively. His knee is otherwise stable. Neurovascular examination results are normal. Plain lateral radiographs of the knee demonstrate widening and partial detachment of the tibial tubercle (Fig. 1). You diagnose tibial tubercle avulsion fracture. Figure 1. Lateral radiograph showing partial elevation of the tibial tubercle. ### The Condition Tibial tubercle fractures usually result from an indirect force on the knee, such as from sudden deceleration or contraction of the quadriceps muscle. During skeletal growth, the tibial tubercle ossification center undergoes architectural changes as the composition of the cartilage changes. The tubercle growth plate is …