All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Referral
Knee Pain in Children
Knee pain is common at all ages
In young active adolescents, overuse with sports or exercise is an important cause of anterior knee pain
Children who are overweight are more prone to knee pain
Signs and Symptoms
Be alert to red flags suggestive of malignancy, sepsis, non accidental injury
- Be alert to any features that suggest inflammatory arthritis
- Be alert to referred pain from the hip
- Remember - normal variants should not cause pain
Anterior knee pain is common and encompasses a range of conditions that result in pain worse on exercise and likely relate to biomechanical factors such as patella tracking on flexion, leg alignment and foot posture
The figure attached shows common sites of tenderness with anterior knee pain
Be alert to red flags suggestive of
- Malignancy (see link appendix ) – refer as 2WW to orthopaedics
- Sepsis (see link appendix) - immediate referral to the emergency department
- Non accidental injury (see link appendix) – refer to ED
Referral Criteria
The Table below summarises the causes of several conditions that can cause knee pain
| Condition | Symptoms | Signs | Management | Refer To |
| Patellofemoral pain / chondromalacia patellae | Pain Worse with activity Pain or crepitus on patellar tracking | Genu valgum Hypermobility Tibial torsion Pronated forefeet | Physiotherapy Activity modification | Physiotherapy |
| Patella Dislocation | Pain | Dislocated patella | Reduction of patella Mobilisation | Physiotherapy – refer to orthopaedics if recurrent dislocation |
| Osgood Schlatter's disease | Pain on activity | Pain on resisted extension Tender (+/- swollen tibial tuberosity) | Ice Activity modification | Physiotherapy |
| Sinding-Larsen Johannson disease | Pain lower pole patella | Tender lower pole patella Worse on extension | Ice Physiotherapy Activity modification | Physiotherapy |
| Plica syndrome | Pain on flexion | May be tenderness | NSAID Activity modification | Physiotherapy |
| Osteochrondritis dissecans | Pain Locking Weakness | NSAIDs Intermittent locking, resolves without swelling, could be managed with period of analgesia | Orthopaedics | |
| Loose body | Pain Locking Giving way Swelling | Tenderness, effusion, joint restriction | May need arthroscopic removal of loose body | Orthopaedics |
| Haemarthrosis | Pain Swelling (soon after injury) | Large, tense effusion Hamstring spasm | May need MRI / Aspiration | Orthopaedics - detail injury mechanism to allow decision re (+/-) MRI prior to review |
Referral Instructions
e-Referral Service Selection
- Specialty: Children's and Adolescent Services
- Clinic Type: Orthopaedics
- Service: DRSS-Western-Orthopaedics- Devon ICB-15N
Referral Form
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: May 2017
