Knee pain is one of the most common problems we see in our clinic. Generally surgery isn’t required however given the broad range of problems we see it’s important to get to the bottom of what’s going on. We can usually see your child either the same or the following week and with careful assessment and appropriate imaging, get the right diagnosis quickly. If appropriate, we can then quickly refer on to our network of dedicated paediatric physiotherapists to start treatment.
Common knee conditions
- Patellofemoral instability (unstable knee caps).
One of the most common causes of anterior (front of) knee pain, especially in teenage girls. This can develop after an acute patella dislocation or be present due to anatomical problems with the shape of the kneecap or thigh bone and/or under development of the muscles and ligaments around the knee.
- Osgood schlatters and Jumpers knee.
Another common condition we see and treat are these two conditions that affect the growing knee. In active teenagers the patella tendon can overload its bony insertion causing a cycle of micro-fracture and repair than leads to chronic swelling and activity related pain. This rarely need surgery but can be quite debilitating. Thankfully it improves when you stop growing and treatment with physio and activity modification is recommended.
- Chondromalacia and osteochondral lesions
These are 2 distinct disease processes which affect the cartilage lining of the joints, commonly the knee and sometimes the ankle. Chonrdomalacia is likened to softening of the cartilage, which when severe can lift off from the bone. This can usually be managed with physio and activity modification but sometimes we recommend an arthroscopy (key hole surgery).
Osteochondral defects (OCDs) can be more acute when a piece of bone and cartilage separate away from the main body of the bone. They may heal by themselves if not widely separated but often we would recommend an arthroscopy (key hole surgery) to repair or excise them.
- Discoid meniscus and synovial plica
These are fairly uncommon problems that we see specifically in children. The meniscus cartilage is a specialised form of fibrocartilage and in the knee acts as a cushion or shock absorber and is a crescent moon shape. In a discoid meniscus, if not formed properly and is disc shaped rather than crescent shaped. This can cause pain and mechanical clicking and clunking symptoms.
- Miserable malalignment syndrome
As the name suggests this condition isn’t much fun! Rotational malalignment of both the femur (thigh bone) and the tibia (shinbone) leave the patella (kneecap) in the middle and prone to instability and pain. Physio can improve symptoms but surgery to realign or ‘derotate’ the bones may be necessary. We call this surgery ‘derotation osteotomies’ in which we cute the bones (osteotomy) get the rotational alignment back where it should be then fix it with a plate or nail.