Anterior Knee Pain In Adolescents Research Articles

Relationship between the Articular Cartilage Thickness of the Patella and Trochlea in Trochlear Dysplasia Compared to Normal Knees

Abstract Introduction: Anterior knee pain is not an uncommon problem. A plethora of pathologies can cause anterior knee pain. Patellofemoral maltracking (trochlear dysplasia) is not an uncommon cause of anterior knee pain in adolescents and young adults. Aim: We hypothesize that there is an alteration of articular cartilage of the patella and trochlear in trochlear dysplasia. Materials and Methods: Magnetic resonance images of 86 knee joints were reviewed independently by two musculoskeletal radiologists. Standard magnetic resonance imaging (MRI) sequences were used in this study. Based on the Dejour classification for trochlear dysplasia, the patients were divided into normal, Type A, B, C, and D. The articular cartilage thickness of the patella and trochlea was measured and compared between the groups. Results: Out of the 86 MRI scans of the knees which were reviewed, 32 patients were male and 54 were female. The mean patient age was 21.9 years (range = 10–40). Sixty-six knee joints had trochlear dysplasia, with 15 patients classified into Dejour Type A, 13 in Type B, 31 in Type C, and 7 in Type D. There was no significant difference in the articular cartilage thickness of the lateral facet of the patella between all groups (ANOVA F = 1.43, P = 0.23). Conclusion: There was no significant difference in the articular cartilage thickness in the lateral facet of the patella and trochlea in patients with normal knee joints compared to those with trochlear dysplasia of Type A–D.

The Influence of the Q-Angle and Muscle Strength on Idiopathic Anterior Knee Pain in Adolescents.

Background and Objectives: Idiopathic anterior knee pain is a common condition in adolescents and is mostly of unknown cause. The aim of this study was to examine the influence of the Q-angle and muscle strength on idiopathic anterior knee pain. Materials and Methods: Seventy-one adolescents (41 females and 30 males) diagnosed with anterior knee pain were included in this prospective study. The extensor strength in the knee joint and the Q-angle were monitored. The healthy extremity was used as a control. The Student's paired sample t-test was applied for testing the difference. Statistical significance was set at 0.05. Results: There was no statistically significant difference in the Q-angle value between the idiopathic AKP and the healthy extremity (p > 0.05) within the entire sample. A statistically significant higher Q-angle of the idiopathic AKP knee (p < 0.05) was obtained in the female subgroup. No statistically significant difference (p > 0.05) was found in the male subgroup. Within the male subgroup, the strength of the extensors within the knee joint of the healthy extremity had statistically significant higher values than the strength of these muscles in the affected extremity (p < 0.05). Conclusion: A greater Q-angle is a risk factor linked to anterior knee pain within the female population. Decreased muscle strength of knee joint extensors is a risk factor linked to anterior knee pain in both sex subgroups.

Cross-Sectional Risk Factors of Anterior Knee Pain in Adolescents.

Background: Anterior knee pain is a common complaint amongst adolescents, which can both be persistent, and in some cases, disabling. This study investigated a series of potential risk factors potentially linked to the onset of anterior knee pain.Methods: Questionnaires were distributed amongst 367 10–15 years-olds enrolled in the local school board. These surveys included questions on sex, age, sport participation, and history of anterior knee pain verified by a physician. Bivariate correlations and a binomial logistic regression were conducted. Overall rate of AKP in the population studied was 7.4%. The results indicated that past history of knee pain, age, and increased sports participation significantly correlated with increased risk of AKP. AKP was significantly more common in females than males. While sex, height, age, overall sport participation, participation in specific sports, and history of knee injury all contributed to the binomial model.

Comparison of Radiological Parameters between Normal and Patellar Dislocation Groups in Korean Population: A Rotational Profile CT-Based Study.

PurposePatellofemoral instability is a common cause of anterior knee pain in adolescents and young adults. Most normal and pathological values for diagnosing patellofemoral instability are based on Western literature. We conducted this radiological study to determine normal values for different patellofemoral parameters in a Korean population and to evaluate their usefulness in diagnosis.Materials and MethodsWe retrospectively reviewed the rotational profile computerized tomography (CT) scans of the patellar dislocation and control groups. Trochlear, patellar, rotational profile, and trochleo-patellar alignment parameters were compared between the groups. Receiver operating characteristic curves were drawn for significant parameters, and sensitivity and specificity were calculated for the cut-off values.ResultsThere were 48 patients in the patellar dislocation group and 87 patients in the control group. In the control group and patellar dislocation group, the mean sulcus angle was 132.5° and 143.3°, respectively, trochlear depth was 6.04 mm and 3.6 mm, bisect offset was 56.4% and 99.9%, lateral patellar tilting was 9.8° and 19.2°, patellar facet asymmetry was 63.5% and 45.16%, and the tibial tuberosity-trochlear groove (TT-TG) distance was 10.91 mm and 27.16 mm, respectively.ConclusionsThe trochlear depth, bisect offset, patella tilting, and TT-TG distance were parameters that significantly contributed to patellar instability. Rotational profile CT can be considered a good diagnostic tool to assess all these parameters that help to identify anatomical aberration resulting in patellofemoral instability, thereby helping in formulating the most effective treatment plan.

Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: A case control study

BackgroundThere is a lack of information about the association between patellofemoral osteoarthritis (PFOA) and both adolescent anterior knee pain (AKP) and previous patellar dislocations. MethodsThis case-control study involved 222 participants from our knee arthroplasty database answering a questionnaire. One hundred and eleven patients suffering from PFOA were 1:1 matched by gender with a unicompartmental tibiofemoral arthritis control group. Multivariate correlation and binary logistic regression analysis were performed, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. ResultsAn individual is 7.5 times more likely to develop PFOA if they have suffered from adolescent AKP (OR 7.5, 95% CIs 1.51 to 36.94). Additionally, experiencing a patellar dislocation increases the likelihood of development of PFOA, with an adjusted odds ratio of 3.2 (95% CIs 1.25 to 8.18). A 44-year difference in median age of first dislocation was also observed between the groups. ConclusionThis should bring into question the traditional belief that adolescent anterior knee pain is a benign pathology. Patellar dislocation is also a significant risk factor. These patients merit investigation, we encourage clinical acknowledgement of the potential consequences when encountering patients suffering from anterior knee pain or patellar dislocation.

Resection of the infrapatellar plica for adolescent anterior knee pain: successful treatment with long-term follow-Up

Resection of the infrapatellar plica for adolescent anterior knee pain: successful treatment with long-term follow-Up

Patellar Osteoid Osteoma as a Cause of Anterior Knee Pain in Adolescents: A Case Report and Literature Review

Anterior Knee Pain (AKP) is an important cause of complaint in adolescents which can suggest many possible diseases. Scientific literature concerning this complex symptom is wide and diversified. We report a rare case of patellar osteoid osteoma which affected a thirteen-year-old female who had suffered from anterior left knee pain for almost six months. The diagnosis was suspected from an accurate anamnesis, a careful clinical examination, and confirmed by imaging. Several minimally invasive techniques can be employed to treat osteoid osteoma. However, we consider CT-guided percutaneous drilling the safest and most effective procedure in case of patellar location. Despite its rarity, patellar osteoid osteoma ranges in the differential diagnosis for all patients suffering from AKP.

A censervative programme for treatment of anterior knee pain in adolescents

Objective. The purpose of this study was to determine the effectiveness of a 2½-week conservative rehabilitation programme in addressing anterior knee pain in adolescents. Design. Subjects were randomly allocated to a control group (N=12) and an experimental group (N=18). The experimental group was subjected to a 2½-week strength, flexibility and neuromuscular rehabilitation programme. Both groups were tested before and after the 2½ weeks and the experimental group also 1 month after the post-test. Results. The experimental group reported significant (p

A censervative programme for treatment of anterior knee pain in adolescents

Objective. The purpose of this study was to determine the effectiveness of a 2½-week conservative rehabilitation programme in addressing anterior knee pain in adolescents. Design. Subjects were randomly allocated to a control group (N=12) and an experimental group (N=18). The experimental group was subjected to a 2½-week strength, flexibility and neuromuscular rehabilitation programme. Both groups were tested before and after the 2½ weeks and the experimental group also 1 month after the post-test. Results. The experimental group reported significant (p

Introduction

There is a lack of information about the association between patellofemoral osteoarthritis (PFOA) and both adolescent anterior knee pain (AKP) and previous patellar dislocations.This case-control study involved 222 participants from our knee arthroplasty database answering a questionnaire. One hundred and eleven patients suffering from PFOA were 1:1 matched by gender with a unicompartmental tibiofemoral arthritis control group. Multivariate correlation and binary logistic regression analysis were performed, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated.An individual is 7.5 times more likely to develop PFOA if they have suffered from adolescent AKP (OR 7.5, 95% CIs 1.51 to 36.94). Additionally, experiencing a patellar dislocation increases the likelihood of development of PFOA, with an adjusted odds ratio of 3.2 (95% CIs 1.25 to 8.18). A 44-year difference in median age of first dislocation was also observed between the groups.This should bring into question the traditional belief that adolescent anterior knee pain is a benign pathology. Patellar dislocation is also a significant risk factor. These patients merit investigation, we encourage clinical acknowledgement of the potential consequences when encountering patients suffering from anterior knee pain or patellar dislocation.

Adolescent Anterior Knee Pain

A great many physicians believe that anterior knee pain cannot be broken down into its component pathologic processes. This is incorrect. If one knows the sites that are capable of generating pain and knows how to test those sites, localizing the involved sites is not difficult. It is more work to learn which pathologic processes occur in clusters and why each process evolves. Treatment begins to make sense and, perhaps even more important, the failure of certain treatments begins to make sense. A stepwise approach to obtaining the right history followed by an examination that identifies the sites of pain leads to appropriate diagnoses. Usually, adolescent anterior knee pain turns out to be Sinding-Larsen-Johansson, Osgood-Schlatter, patellofemoral, fat pad, or plica syndrome or a combination of these syndromes. Other syndromes are less common. Treatment frequently requires reducing or redistributing patellofemoral joint reactive forces by one or more of several techniques.

Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?

Adolescent anterior knee pain has traditionally been described as running a benign and self-limiting course. Studies more recently have questioned this supposition. This study aimed to assess how many patients who had undergone patellofemoral arthroplasty for isolated patellofemoral arthritis had previously suffered from adolescent anterior knee pain, knee instability and trauma. This group was then compared to a control group of medial unicompartmental arthroplasty patients. Both groups were surveyed by postal questionnaire, with a >75% response rate from each group. 22% of the patellofemoral arthroplasty group described adolescent or early adulthood anterior knee pain as compared to 6% in the medial unicompartmental arthroplasty group ( p<0.001). Patients in the patellofemoral group had also suffered significantly more patellofemoral instability and trauma than the medial unicompartmental group ( p<0.001 and p=0.02, respectively). A significant number of patients with patellofemoral arthritis have described preceding anterior knee pain in their adolescence and early adult years, raising the question as to whether anterior knee pain may be one of the contributing factors to patellofemoral osteoarthritis in later years.

Chronic Knee Pain And Anemia - Basketball

2031 HISTORY: A 13 year old, female middle school basketball player admitted with a five day history of diarrhea and fatigue. Reports about ten dark stools per day. Also reported emesis progressing to hematemesis about two days ago. Since onset of symptoms, patient lost approximately 12 pounds. She was admitted after concerns about marked pallor and lethargy consistent with impending shock. Hemoglobin was 6.9g/dL. Patient reported chronic bilateral knee and hip pain whilst playing basketball. The pain is described as aching just below knees. Had been evaluated by rheumatologist and was being treated with ibuprofen 400 – 800mg every four hours for an unspecified diagnosis. PHYSICAL EXAMINATION: Vitals: Weight 41.4kg, Height 66 in, Pulse 120, RR 24, Blood Pressure 127/75. Tanner Stage II. General: Lethargic, pale adolescent. No evidence of clubbing or signs of heart failure were noted. Examination of hip revealed good range of motion with no evidence of weakness or pain, both knees revealed tenderness, swelling and prominence of the tibial tuberosity. DIFFERENTIAL DIAGNOSIS: Weight loss, hematochezia, pallor and joint pain Gastrointestinal hemorrhage or bleeding secondary to gastritis Systemic Lupus Erythematosis NSAID gastritis Juvenile Rheumatoid arthritis Bilateral Knee Pain Apophyseal Avulsion fracture Idiopathic Adolescent Anterior Knee Pain Syndrome Proximal tibial stress fracture Osgood Schlatter's disease TEST AND RESULTS: Hemoglobin 6.9g/dL. Hemoccult positive. Ova, parasites, bacteria negative in stool, C. difficile negative, H. pylori negative. Meckel scan negative. Abdominal Xray consistent with mild ileus. Endoscopy and colonoscopy revealed chronic gastritis and colitis. Normal hip xrays, films of knees showed some evidence of fragmentation and microavulsions of tibial tuberosity. FINAL WORKING DIAGNOSIS: Acute Gastrointestinal bleed with impending shock due to treatment of bilateral Osgood Schlatter's disease with NSAIDs. TREATMENT AND OUTCOMES: Immediate resuscitation with blood products and fluid. Ensure hemodynamic stability. She required three units of packed red blood cells and subsequently did well and was able to venture into further diagnostic and treatment options. Nonsteroidal anti-inflammatory medication egflibuprofen in monitored doses of 10 to 15mg/kg evert six to eight hours. Ensuring proper use and caution about use on empty stomach. Consider use of Misoprostol. Use of knee pads to protect area. Hamstring and quadriceps flexibility exercises. Referral to Physical therapist. Activity modification. Rest. Return to sports once anemia and fatigue resolve and tolerable pain with activity.

Chronic Knee Pain And Anemia - Basketball

2031 HISTORY: A 13 year old, female middle school basketball player admitted with a five day history of diarrhea and fatigue. Reports about ten dark stools per day. Also reported emesis progressing to hematemesis about two days ago. Since onset of symptoms, patient lost approximately 12 pounds. She was admitted after concerns about marked pallor and lethargy consistent with impending shock. Hemoglobin was 6.9g/dL. Patient reported chronic bilateral knee and hip pain whilst playing basketball. The pain is described as aching just below knees. Had been evaluated by rheumatologist and was being treated with ibuprofen 400 – 800mg every four hours for an unspecified diagnosis. PHYSICAL EXAMINATION: Vitals: Weight 41.4kg, Height 66 in, Pulse 120, RR 24, Blood Pressure 127/75. Tanner Stage II. General: Lethargic, pale adolescent. No evidence of clubbing or signs of heart failure were noted. Examination of hip revealed good range of motion with no evidence of weakness or pain, both knees revealed tenderness, swelling and prominence of the tibial tuberosity. DIFFERENTIAL DIAGNOSIS: Weight loss, hematochezia, pallor and joint pain Gastrointestinal hemorrhage or bleeding secondary to gastritis Systemic Lupus Erythematosis NSAID gastritis Juvenile Rheumatoid arthritis Bilateral Knee Pain Apophyseal Avulsion fracture Idiopathic Adolescent Anterior Knee Pain Syndrome Proximal tibial stress fracture Osgood Schlatter's disease TEST AND RESULTS: Hemoglobin 6.9g/dL. Hemoccult positive. Ova, parasites, bacteria negative in stool, C. difficile negative, H. pylori negative. Meckel scan negative. Abdominal Xray consistent with mild ileus. Endoscopy and colonoscopy revealed chronic gastritis and colitis. Normal hip xrays, films of knees showed some evidence of fragmentation and microavulsions of tibial tuberosity. FINAL WORKING DIAGNOSIS: Acute Gastrointestinal bleed with impending shock due to treatment of bilateral Osgood Schlatter's disease with NSAIDs. TREATMENT AND OUTCOMES: Immediate resuscitation with blood products and fluid. Ensure hemodynamic stability. She required three units of packed red blood cells and subsequently did well and was able to venture into further diagnostic and treatment options. Nonsteroidal anti-inflammatory medication egflibuprofen in monitored doses of 10 to 15mg/kg evert six to eight hours. Ensuring proper use and caution about use on empty stomach. Consider use of Misoprostol. Use of knee pads to protect area. Hamstring and quadriceps flexibility exercises. Referral to Physical therapist. Activity modification. Rest. Return to sports once anemia and fatigue resolve and tolerable pain with activity.

Natural History of Anterior Knee Pain: A 14- to 20-Year Follow-up of Nonoperative Management

We describe a consecutive series of girls with idiopathic anterior knee pain in adolescence and who were treated nonoperatively. At a mean follow-up of 16 years, 22% had no pain, 71% thought that their symptoms were better than at presentation, 88% used analgesics rarely or not at all, and 90% continued to participate regularly in sports. Nevertheless, about one in four of the patients continued to have significant symptoms for < or = 20 years after presentation. No features were identified that predicted those patients in whom symptoms would persist. We conclude that surgical treatment of idiopathic anterior knee pain in adolescents is not justified until a procedure has been shown to provide a better outcome than that reported here or until a way has been found to distinguish the few patients who will not get better spontaneously from the majority who will.

Anterior knee pain in adolescents and young adults.

The problem of anterior knee pain continues to challenge serious students of the knee. Precise measurement techniques for each component of the soft-tissue envelope about the patella remain unknown. The biomechanical contributions of the medialis, the lateral retinaculum, the vastus lateralis obliquus, the iliotibial band, and the quadriceps during strenuous activity have yet to be measured. It is difficult to design studies of knee pain because of the diverse skeletal configurations of patellofemoral joints, unknown degrees of soft-tissue laxity, variations in the alignment of the knee, and other factors. As a result, indications for surgery, and nonoperative treatment, as well as effectiveness of rehabilitation modalities, continue to be debated. Terms used to describe the anterior patellofemoral spectrum vary, making uniform classification difficult.

Anterior Knee Pain Caused by Overactivity

In a prospective study to determine the natural history of anterior knee pain caused by overactivity, 60 (15%) of 390 elite Israeli infantry recruits were found to have anterior pain in 77 knees during 14 weeks of basic training. At 6 years' followup, 3 years after returning to civilian life, half of the knees originally with anterior knee pain were still symptomatic, but in only 8% of the originally symptomatic knees was the pain severe, hindering physical activity. The long term prognosis of anterior knee pain caused by overactivity is much better than that reported previously for anterior knee pain in adolescents, but in a small percentage of cases the pain persists at a level that may prevent participation in exertional activities.

The natural history of anterior knee pain in adolescents: M.J. Sandow and J.W. Goodfellow. J Bone Joint Surg 67B:36–38, (January), 1985

The natural history of anterior knee pain in adolescents: M.J. Sandow and J.W. Goodfellow. J Bone Joint Surg 67B:36–38, (January), 1985

The natural history of anterior knee pain in adolescents.

Anterior knee pain in adolescents is generally recognised as a common but benign self-limiting condition. Although many operative procedures for its treatment have been proposed, there is little statistical evidence that they are more effective than expectant management. A group of 54 adolescent girls has been followed for two to eight years from presentation with anterior knee pain. Although some pain persisted in the majority, in many the symptoms declined in severity. This study provides a baseline for comparison with the results of operative intervention; it is suggested that surgical treatment is unproven and unnecessary.