Knee In Children Research Articles

The Effectiveness of Temporary Hemiepiphysiodesis for Non-idiopathic Coronal Angular Deformity of the Knee in Children: A Comparison of Hinge Eight-Plate and Traditional Eight-Plate.

Temporary hemiepiphysiodesis (TH) is a very common technique for coronal angular deformity of the knee in children, especially non-idiopathic. However, there is currently a dearth of comparative research on the hinge eight-plate (HEP) and traditional eight-plate (TEP). This study aimed to assess the clinical effectiveness and implant-related complication rates of TH using TEP and HEP for non-idiopathic coronal angular deformity, as well as to identify clinical factors affecting correction velocity. We retrospectively observed a consecutive series of patients with non-idiopathic coronal angular deformity of the knee who underwent TH using HEP or TEP and completed the deformity correction process from July 2016 to July 2022. According to the kind of eight plates, we divided those patients into the HEP group and the TEP treatment group. Relevant clinical factors, including the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), screw divergence angle (SDA), angle of plate and screw (APS), hinge angle of HEP (HA), and the knee zone location of the lower extremity mechanical axis, were documented. Additionally, deformity correction velocity, complications, and clinical efficacy were assessed. Categorical variables were analyzed using the chi-squared test, Fisher exact test, or Wilcoxon test, while continuous variables were evaluated using the t-test or analysis of variance (ANOVA). There were 29 patients in the HEP treatment group (seven girls and 22 boys) and 33 patients (12 girls and 21 boys) in the TEP treatment group. In all, 91.86% (79/86 knees) of the genu angular deformities were completely corrected, 6.98% (6/86 knees) had the overcorrection condition, and 10.47% (9/86 knees) had screw loosening. The swayback HEP rate was 11.29% (7/62 HEPs), which was related to the screw loosening in the HEP group (p < 0.001). The overall correction velocities and screw divergence angle change speeds in the HEP group were all significantly faster than those in the TEP group (p < 0.05). The initial APS of the HEP implanted was higher than that of TEP (p < 0.01), and multisite changes of APS during deformity correction of the HEP group were smaller than that of the TEP group. HEP proved to be an appropriate device for TH for non-idiopathic coronal angular deformities of the knee with high correction velocity in children. Avoiding the occurrence of the swayback phenomenon may reduce the complications of HEP.

High Prevalence of Varus Knee Malalignment in Adolescent Football Players-Clinical Lower Leg Axis Measurements of Male Junior Football Players Aged 7 to 18 Years.

Football, as the most popular sport worldwide, has long been under suspicion of causing varus knee alignment as early as adolescence. However, no causal relationship has yet been found. The first step to do so would be to determine the prevalence of lower leg malalignment among male junior football players depending on age, performance level and the number of active seasons played. Leg axis alignment in frontal plane was determined in male junior football players of different age levels between 7 and 18 years by measuring the intercondylar/intermalleolar distance (ICD/IMD) in an upright position. In addition to anthropometric data, multiple sport-specific data such as the start of their football career or training time per week were collected by means of questionnaires (clinical trial registration number: DRKS00020446). 207 male junior football players were included in this survey. The mean age was 12.8 years. Within the group of 15 to 18 year olds, the prevalence of varus knee malalignment was highest at just under a third (32.1%). In the subpopulation that played actively for more than ten seasons, 28.9% showed varus leg axis. Regarding performance level, the highest IMD/ICD values and highest prevalence of varus alignment were found among football players who play on a semi-professional level (16.7%), compared to amateur (11.4%) and high-performance levels (2.8%). Further research is necessary to investigate if this high prevalence of varus knee in children of a higher age and higher playing levels is due to the selection bias of football players with varus knee or a real development of varus knee in individuals.

Fractures around the knee in children : Epiphysiolysis and physeal fractures of the distal femur and proximal tibia

Epiphysiolysis and epiphyseal fractures of the distal femur and proximal tibia are an extremely rare entity, but due to their far-reaching consequences with associated functional restrictions of the knee joint, they must be recognized and treated thoroughly. Complete and correct diagnosis is essential and, diagnostically speaking and in addition to standard x‑rays in two planes, the threshold for cross-sectional imaging examination techniques should be low. Aconservative treatment attempt is possible for undisplaced fractures, but surgical retention and stabilization using wires and screws is usually indicated. Growth disorders often and inevitably occur after such injuries. Clinical monitoring of complications only ends once growth is complete.

Childhood Tumors around the Knee Revisited: Predilection Sites for Most Entities Confirmed.

Background: The diagnostic work-up of musculoskeletal tumors is a multifactorial process. During the early phase, differential diagnoses are made using basic radiological imaging. In this phase, part of the decision making is based on the patient's age, as well as the incidence and predilection sites of different entities. Unfortunately, this information is based on older and fragmented data. In this study, we retrospectively evaluated all soft-tissue and bone tumors around the knee in children treated at our tertiary center in the last 20 years, with the aim of verifying the data used today. Methods: In this retrospective study, the databank of our tertiary center was used to give an overview of treated tumors around the knee in children. Results: We were able to include 224 children with bone and soft-tissue tumors around the knee. The cohort consisted of 184 bone tumors, of which 144 were benign and 40 malignant. The 40 soft-tissue tumors comprised 30 benign and 10 malignant masses. The most common lesions were osteochondromas (88) in the bone and tenosynovial giant-cell tumors (12) in the soft tissue. Conclusions: With this original work, we were able to verify and supplement earlier studies, as well as deepen our insight into these very rare diseases.

The painful knee in children

Knee pain is one of the most common reasons for medical consultation for musculoskeletal problems in the paediatric population. The aetiology is of very variable origin and necessitates aprecise assessment. In addition to athorough anamnesis, clinical and imaging examination methods, as well as laboratory diagnostics are of utmost importance to establish aproper diagnosis and an adequate treatment regimen. This chapter summarises the current diagnostic algorithm for dealing with knee pain in children and adolescents.

Etiology and Nursing Care of Children's Knee Joint Sports Injury Diseases

The objective is to explore the etiology, diagnosis, treatment, and prevention of children's knee joint sports injury. The medical records of hospitalized children with sports injuries from 2019 to 2021 were retrospectively analyzed. The total number of hospitalized children with knee joint sports injury increased from 27 in 2019 to 46 in 2021. The main diseases are meniscus injury, dislocation of patella, avulsion fracture of tibial intercondylar crest, ligament injury, articular cartilage injury, and other diseases. Children's sports injuries occur in different ages groups, with the highest incidence in the age group of 7-14, and the incidence rate of boys is about 1.5 times that of girls. Moreover, the number of knee joint sports injury diseases in children is increasing, especially for school-age children. Low energy injury is the most common cause of injury, but high energy injury may lead to serious knee joint function damage, which should be paid great attention.

Correction of angular deformities of knee in children using guided growth technique 8-plates

Background: Angular deformities of the knee, a common problem in the early years of life are frequently encountered in paediatric orthopaedics not only because of very high incidence of these deformities but also because of major parental concern in the present highly demanding sports oriented society. The purpose of this study was to discuss the role of 8-plate hemi-epiphysiodesis to correct angular deformities of the knee joint. Materials and methods: The study had total of 25 children with total 45 knees having varus or valgus angular deformities, of which 20 were bilateral and 5 were unilateral. All patients were symptomatic and were followed for regular intervals of 6 months to observe the change of the deformity. Results: The mean preoperative genu valgum deformity was 19.79 degrees (ranging from 13-35 degrees) and genu varum deformity was 17.29 degrees (9-25 degrees). 91.1% of the deformed knees were corrected fully at the mean final follow up period of 27 months, neutralizing the mechanical axis and correction of the deformity. Conclusions: 8-plate is technically simple and potent tool to correct genu valgum and varus deformities around knee in children without need for osteotomies in many children. Based on the low complication rate, patient acceptance, and the rapidity of improvement, this technique should be used as treatment of choice.

Septic Arthritis of the Knee in Children.

Septic arthritis of the knee is the most common form of septic arthritis in children and can lead to irreversible damage to the joint. Staphylococcus aureus is the primary pathogen associated with septic arthritis, although other causative pathogens may be isolate in children with specific risk factors. The diagnosis of knee septic arthritis is based on comprehensive evaluation, including the patient's medical history, physical examination, blood tests, and arthrocentesis. Empirical treatment typically involves anti-staphylococcal penicillin or a first-generation cephalosporin, although modifications may be made based on local resistance patterns and clinical culture data. Surgical debridement, either through open surgery or arthroscopy, involving extensive debridement of the joint, is effective in eliminating the infection. In most cases, additional surgical intervention is not necessary.

The Perils of Sleeper Plates in Multiple Hereditary Exostosis: Tibial Deformity Overcorrection Due to Tether at Empty Metaphyseal Hole.

Hemi-epiphysiodesis is the mainstay of treatment for angular deformities at the knee in children with multiple hereditary exostosis (MHE). Upon deformity correction, the metaphyseal screw may be removed from the hemi-epiphysiodesis plate, the sleeper plate technique, with anticipated reimplantation of the metaphyseal screw should the original deformity recur. The aim of the present study is to compare the incidence of complications with the sleeper plate technique with complete plate removal in an MHE cohort. Patients under the age of 18 with MHE who underwent hemi-epiphysiodesis of the proximal tibia and/or distal femur between February 1, 2016, and February 6, 2022 with a minimum 2-year follow-up or follow-up to skeletal maturity were identified via ICD-10 codes. Patient charts and radiographic images were reviewed to assess for the bone(s) treated, the use of sleeper plates, and whether any complication occurred, including overcorrection from bony ingrowth at the empty holes or deformity recurrence. In 13 patients, 19 knees underwent hemi-epiphysiodesis at 30 sites; 13 distal femoral and 17 proximal tibial. Of 30 plates, 18 (60%) were removed completely upon deformity correction and 3 (10%) did not require removal due to skeletal maturity. Four of 13 (30.8%) femoral plates and 5 of 17 (29.4%) tibial plates were left as sleeper plates. All 5 tibial sleeper plates developed bony ingrowth into the empty metaphyseal screw hole, which led to unintended progressive deformity overcorrection. In the majority of cases, the deformity was addressed by the removal of the plate and exophytic bone and hemi-epiphysiodesis on the other side of the affected proximal tibia with subsequent resolution of the deformity. All tibial sleeper plates developed bony ingrowth into the screwless metaphyseal hole. The bony ingrowth functioned as a tether, resulting in progressive deformity overcorrection. Sleeper plates should be avoided at the proximal tibia in patients with MHE, and extreme caution should be exercised when considering this technique at the distal femur or other sites. Level III-retrospective comparative study.

Comparison between conservative and prophylactically concurrent meniscoplasty on the asymptomatic knee in children with bilateral DLM.

This retrospective study aimed to compare the effectiveness between concurrent meniscoplasty and conservative management on the asymptomatic side in children with unilaterally symptomatic bilateral discoid lateral meniscus operated on the symptomatic side in a tertiary level of clinical care. Patients aged under 14 with unilaterally symptomatic bilateral discoid lateral meniscus underwent arthroscopic meniscoplasty were eligible. Patients were either underwent meniscoplasty on the symptomatic side, with the asymptomatic side conservatively treated (group 1) or underwent meniscoplasty on both sides concurrently (group 2). Functional outcomes were evaluated using the Lysholm score and Ikeuchi score. Relative cost collected through the hospital data was applied by the Kruskal-Wallis test. The occurrence of symptoms was applied by the Kaplan-Meier model. A total of 50 patients (39 female and 11 male) were eligible. For the average Lysholm scores, groups 1 and 2 of the previously asymptomatic side were 90.86 ± 8.25 and 92.62 ± 8.68. For the symptomatic side, the Lysholm scores were 91.38 ± 8.90 and 95.71 ± 7.45. For the average cost of treatment, a significant difference was discovered between group 1 and 2 (P < .0001). The Kaplan-Meier survival analysis of the occurrence of symptoms showed no statistical difference between the 2 groups (P = .162), and the terminal survival rates in the 2 groups were 86.2% and 81.0%, respectively. Conservative treatment reached the same clinical outcomes as the concurrent meniscectomy, with a potential of longer mean survival time and lower demand of cost in treatment.

Non-Specific Synovitis of the Knee in Children: Arthroscopic Management

Non-Specific Synovitis of the Knee in Children: Arthroscopic Management

Why paediatric knee surgery is not just knee surgery on small knees

Paediatric knee surgery is a developing subspecialty in the UK. The rise in early participation of children in organized competitive sports has led to an increase in knee injury presentations, and brings unique challenges. Children's knee surgery encompasses varied and complex pathologies, and combines expertise in soft tissue and arthroscopic techniques with an understanding of the unique characteristics of children, their skeleton and growth potential. Children are inherently high-risk surgical candidates due to ligamentous laxity, growth potential, difficulties in rehabilitating post-surgery and risks of re-injury. Goals of treatment include management of instability and pain, restoration of function and rehabilitation, in order to preserve the knee for the child's future. This review will focus on the commonly presenting problems of cruciate, meniscal and patellofemoral pathology.

Follow-up of biological reconstruction of epiphysis preserving osteosarcoma around the knee in children: A retrospective cohort study.

Limb salvage treatment for malignant bone tumors in children includes prosthetic and biological reconstruction. Early function following prosthesis reconstruction is satisfactory; however, there are several complications. Biological reconstruction is another way to treat bone defects. We evaluated the effectiveness of reconstruction of bone defects by liquid nitrogen inactivation of autologous bone with preserving epiphysis in 5 cases of periarticular osteosarcoma of the knee. We retrospectively selected 5 patients with articular osteosarcoma of the knee who underwent epiphyseal-preserving biological reconstruction in our department between January 2019 and January 2020. Femur involvement occurred in 2 cases and tibia involvement occurred in 3 cases, with an average defect of 18 cm (12-30 cm). The 2 patients with femur involvement were treated with inactivated autologous bone by liquid nitrogen with vascularized fibula transplantation. Among the patients with tibia involvement, 2 were treated with inactivated autologous bone with ipsilateral vascularized fibula transplantation and 1 was treated with autologous inactivated bone with contralateral vascularized fibula transplantation. Bone healing was evaluated by regular X-ray examination. At the end of the follow-up, lower limb length, knee flexion, and extension function were evaluated. Patients were followed up for 24 to 36 months. Average bone-healing time was 5.2 months (3-8 months). All patients achieved bone healing with no tumor recurrence and no distant metastasis and all patients survived. The lengths of both lower limbs were equal in 2 cases, with shortening by ≤1 cm in 1 case and shortening by 2 cm in 1 case. Knee flexion was >90° in 4 cases and between 50 and 60° in 1 case. The Muscle and Skeletal Tumor Society score was 24.2 (range 20-26). Inactivation of autogenous bone with the epiphysis preserved by liquid nitrogen combined with vascularized fibula reconstruction for periarticular osteosarcoma of the knee in children is safe and effective. This technique supports bone healing. Postoperative limb length and function, and short-term effects were satisfactory.

Factors associated with subsequent surgery after septic arthritis of the knee in children.

Septic arthritis of the knee in children is a challenging problem. Surgical debridement is an established treatment, but there is a paucity of literature on long-term prognosis. To determine the rates and factors associated with return to surgery (RTS) and readmission after index surgical debridement for septic arthritis of the knee in children. This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project (HCUP). We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017. Demographic data included age, gender, race, hospital type and insurance type. Clinical data including index admission length of stay (LOS) and Charlson Comorbidity Index (CCI) were available from the HCUP database. Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed. Nine-hundred thirty-two cases of pediatric septic knee were included. This cohort was 62.3% male, with mean age of 9.0 (± 6.1) years. Approximately 46% of patients were white and approximately half had Medicaid insurance. Thirty-six patients (3.6%) required RTS at a minimum of 2 year after index surgery, and 172 patients (18.5%) were readmitted at any point. The mean readmission LOS was 11.6(± 11.3) d. Higher CCI was associated with RTS (P = 0.041). There were no significant associations in age, gender, race, insurance type, or type of hospital to which patients presented. Multivariate analysis showed that both increased CCI (P = 0.008) and shorter LOS (P = 0.019) were predictive of RTS. Septic arthritis of the knee is an important condition in children. The CCI was associated with RTS at a minimum of 2 years after index procedure. No association was found with age, gender, race, insurance type, or hospital type. Shorter LOS and CCI were associated with RTS in multivariate analysis. Overall, risk of subsequent surgery and readmission after pediatric septic knee arthritis is low, and CCI and shorter LOS are predictive of RTS.

Non Standard Deviation – Managing angular deformities around the knee in young age

Angular deformities around the knee in children are common presentations in day to day practice. While some of the deformities are physiological that need careful observation, the others are pathological and need timely medical or surgical intervention. Systematic evaluation of the deformity is the first step in making the correct decision about the management. The right choice of treatment, the correct timing and perfect execution of the technique are necessary for optimum outcome. This article describes the aetiology, clinicoradiological evaluation and management of angular deformities around the knee in children. Keywords: Knee, Angular deformity, Children.

THE KNEE JOINT IS THE ACHILLES' HEEL OF A CHILD'S BODY

The study objective was to draw practicing physicians’ attention to the risk of knee joint disorders in children during intensive growth to ensure timely detection and treatment. Materials and Methods. We analyzed the results of studies on the diseases of the knee joint carried out by modern scientists over the past ten years. We also took into account the clinical observations of children receiving inpatient treatment at the regional children's hospital. The examination methods were radiography, computer tomography, magnetic resonance imaging, and ultrasound. Results and Discussion. During growth, a child's knee joint is subjected to enormous loads and is sensitive to external and internal factors. The knee joint plays a dominant role in the limb’s longitudinal growth; the growth zones grow so intensively that they can be compared to the work of a "bone nuclear reactor." The bones of the skeleton grow unevenly and intermittently. The peak height velocity is observed at 10–14 years in girls and at 13–18 years in boys; then, height velocity slows down, and after 19 years, height growth almost stops. During the period of intensive growth, bones are very sensitive to internal and external factors of shape formation (growth hormones, physiological loads, radiation, vibration, injuries, hypothermia, metabolic disorders, etc. Therefore, this part is most sensitive to various endogenous and exogenous factors, which is manifested by various dysplastic changes and diseases. Conclusions. During the intensive growth of the child, the knee joint is most vulnerable to various endogenous and exogenous negative factors, which is manifested by various diseases. Osteogenic sarcoma, fibrous cortical defect, and juvenile osteocartilaginous exostoses most often affect the weakest place of the knee joint – the metaphyses of the femur and tibia (Achilles’ heel).

Age-related Sonoanatomical Change of the Knee in Children

Age-related Sonoanatomical Change of the Knee in Children

Radiological and pathological characteristics of synovial hemangioma of the knee.

Synovial hemangioma, a rare benign tumor that occurs most frequently in the knee in children and young adults, has four histological subtypes: Venous, arteriovenous, cavernous and capillary hemangiomas. Since the clinical presentation and radiological findings of synovial hemangioma are non-specific, there is frequently a long period between the onset and the diagnosis. The cases of nine patients, pathologically diagnosed with synovial hemangioma and surgically treated, were retrospectively analyzed. All nine patients had persistent knee pain. In addition, three patients also had a swollen knee with intra-articular hemorrhage. Plain radiography revealed intra-articular phleboliths in two patients. In seven patients, T1-weighted magnetic resonance imaging showed low signal intensity with small signal voids. On T2-weighted imaging, all patients showed high signal intensity containing small signal voids. All patients underwent surgical excision; there was no postoperative recurrence after the final operation, and the knee pain had disappeared at the final follow-up. From the pathological findings, the diagnoses were venous hemangioma, cavernous hemangioma and capillary hemangioma (three patients each).

Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma around the Knee in Children.

Survival and reconstruction in osteosarcoma is quite challenging. The study aimed to investigate the prognosis in patients treated with neoadjuvant chemotherapy and determine the clinical outcomes of expandable endoprosthesis reconstruction in children. From January 2009 to December 2014, we retrospectively analyzed 29 skeletally immature children (mean age, 10.5 years; range, 6-15 years) with osteosarcoma around the knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, an expandable prosthesis was implanted for reconstruction. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, and lengthening procedures. The survivorship and recurrence were assessed by GraphPad Software, and the function was evaluated by the Musculoskeletal Tumor Society (MSTS) scoring system. A mean follow-up time was 8.9 years (range, 6-12 years), and the overall 5-year survival was 89.1% based on Kaplan-Meier analysis. Three patients suffered a relapse and one underwent amputation. Lung metastasis developed in one patient. At 6 months after the operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery, one for implant infection and one for aseptic loosening. Prognosis is correlated with alkaline phosphatase change after treatment. Chemotherapy scheme and limb salvage can achieve high survival rates. This expandable prosthesis was associated with good function and low complication rates. The character of expandability could be a method to overcome discrepancies in the growth period.

Intravoxel incoherent motion (IVIM) MRI in pediatric patients with synovitis of the knee joint: a prospective pilot study

BackgroundDiagnosing synovial inflammation by administration of gadolinium-based contrast agents is limited by invasiveness and possible side effects, especially in children and adolescents.PurposeWe investigated diagnostic accuracy of diffusion-weighted (DWI) MRI with intravoxel incoherent motion (IVIM) imaging compared to contrast-enhanced MRI for detecting synovitis of the knee in a population of pediatrics and young adults. In addition we compared quantitative measures of synovial diffusion and perfusion to a group of healthy volunteers.MethodsIn this prospective study, 8 pediatric patients with 10 symptomatic knees (6 girls and 2 boys, mean age 13 years) with known or suspected synovitis underwent pre- and post-contrast 3.0 T MRI of the knee joint and additional DWI sequences between October 2016 and July 2019. For comparison we enrolled 5 healthy young adults (2 women and 3 men, median age 27 years) with contrast-free MRI of both knees. Post-contrast T1w images and DWI images at b = 1000s/mm2 with apparent diffusion coefficient (ADC) maps of patients were separately rated by two independent and blinded readers with different levels of experience for the presence or absence and degree of synovitis along with the level of confidence. We measured signal intensity on DWI of synovium, joint effusion and muscle with regions of interests and calculated the IVIM-parameters tissue diffusion coefficient (D) and perfusion fraction (f) for patients and volunteers.ResultsAll patients showed at least some synovial contrast enhancement, 8 (80%) children knees were diagnosed with synovitis on contrast-enhanced (= ce)-T1w, the diagnostic standard. Ratings by the first and second reader on ce-T1w and DWI showed full agreement (kappa = 1) in diagnosing synovitis and substantial agreement (k = 0,655) for the degree of synovial enhancement. Interobserver agreement on DWI showed fair agreement (k = 0,220) between both readers. Diagnostic confidence was lower on DWI. Mean D- and f-values of muscle was comparable between patients and volunteers. Effusion mean D was higher, mean f was lower, synovial mean D was lower, mean f higher in patients than in volunteers. All differences were statistically significant (p < 0.001).ConclusionsDiffusion-weighted MRI with IVIM imaging remains a promising, though reader-dependent alternative to i.v. contrast-enhanced imaging in pediatric patients to reliably diagnose, or rule out, synovitis of the knee joint. We detected significantly restricted synovial diffusion and increased perfusion in patients compared to healthy volunteers.Trial registrationEthical Comitee University Hospital Ulm, Nr. 320/16.