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

Assessment

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

Red Flags

Be alert to red flags suggestive of

Referral

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 CCG-15N

Referral Forms

DRSS Referral Proforma

Supporting Information

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: May 2017

 

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