The painful knee in childhood: Treatment, symptoms, advice and help

It is imperative when a child presents with a painful knee to exclude any disease or injury at the hip which may present with referred pain at the knee. Cartilage tears and ligament injuries are relatively rare in childhood, this more usually occurs in sporting teenagers and young adults. The commonest afflictions in childhood usually affect the kneecap and the most common of these is chondrom-lacia patellai, this most commonly presents in teenage girls who maybe slightly knock kneed. The patient may present with pain over the back of the kneecap which may be worse by stair climbing or prolonged sitting and may complain of the knee giving way and swelling.

Restricted activity and specific physiotherapy exercises to strengthen the muscles pulling the kneecap over the medial aspect of the knee are recommended. On rare occasions an operation may be indicated to realign the patella tendon.

Osteochondritis Dissecans

This condition generally affects young teenage boys and maybe associated with sporting activity or injury. Usually the patient presents with pain or swelling in the knee which may be associated with giving way or inability to fully straighten the knee. Diagnosis is usually made by either performing plain radiographs of the knee or more detailed scanning including MRI or CT scans. The essential lesion if detachment of a small piece of bone or cartilage from the medial aspect of the femoral joint. If the condition is noted early avoidance of excessive activity and in some cases drilling of the affected fragment can prevent further deterioration. In late cases the fragment may already have detached in which case this is usually removed arthoscopically to prevent further damage within the knee. In severe cases large fragments of bone and cartilage are lost and this may lead to early arthritis.

Osgood-Schlatter's Disease 

This disease occurs in young adolescence and is characterized by the presence of a painful swollen area at the attachment of the patella tendon on the tibia. The cause is usually repetitive stretching of the fibres of the patella tendon tot he bone during repeated activity at a time when the upper tibia is growing. Patients are advised to desist from sporting activity especially those activities which involve repetitive flexion and extension of the knee. Physiotherapy can be helpful and in severe cases the application of a plaster of Paris cylinder may be required. Surgical treatment is extremely rare and his condition does not generally continue after teenage years, although occasionally young adults are affected by the complications of having suffered this problem in their teenage years.