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Knee problems in children

X-ray of ACL Avulsion

X-ray of the knee showing a fragment of bone in the middle of the knee. This represents a pull-off (avulsion) of the ACL from its insertion in the middle of the knee.

Ligament avulsions

When an adult damages their anterior cruciate ligament following trauma, the tear tends to occur in the middle of the ligament. In children and adolescents the attachment of ligament to bone is a point of weakness. A ligament injury in a child tends to lead to the ligament being pulled off from its attachment with a fragment of bone. This can occur in both ACL and PCL injuries. This pattern of injury has a significant impact on treatment as it may be possible to re-attach the bone fragment with its attached ligament. Depending on the type and site of injury this may be carried out with key-hole surgery.


Ligament re-attachment can only be carried out in the first week or two after the injury. Any later than this, and the ACL/PCL will need to be reconstructed in the same fashion as in adults.

 

Osteochondroses

This is a group of conditions affecting the growing skeleton and lining of joints (articular cartilage) It commonly affects the knee. Multiple causes may be to blame such as genetics, poor blood supply and excessive stress on the cartilage.

 

In the knee, a number of conditions have been described which occur as a result of excessive pulling on tendons near their attachment to bone. This most commonly area affected is where the patella tendon inserts on to the shin bone and is called Osgood-Schlatter syndrome. The symptoms include a bony prominence where the tendon inserts on to the shin which is tender. The other commonly effected area is where the patella tendon takes its origin from the lower part of the patella. The pull on the patella tendon at this point causes localised pain. This condition is called Sinding-Larsen-Johansson syndrome. Both conditions have a good prognosis and settle down with avoidance of aggravating activities, muscle strengthening and flexibility exercises. In less than 5% of patients surgery may be required.

 

Patients with Osgood-Schlatter syndrome are left with bony prominence on the front of thier shin bone for the rest of their lives.



Orthopaedic consultation

Orthopaedic consultation

Key-hole  knee surgery

Key-hole knee surgery

Mr Wilson carrying out knee arthroscopy surgery

Mr Wilson carrying out knee arthroscopy surgery

Anaesthetist - Dr Nick J looking over the drapes

Anaesthetist - Dr Nick J looking over the drapes

Scrub team before ACL surgery

Scrub team before ACL surgery