Adolescents

Adolescents are full of energy. Sports are a great way for them to disperse some that energy while also helping to develop confidence, strength and fitness. Injuries are most frequent in late childhood and early teens as they head into puberty. The number of injuries rise in September, when adolescents return to school and sports programmes. Overload/over-training injuries can just make it too painful to participate and certainly cause concern. Falls, tackles and twisting injuries are common but frequently don't cause significant problems but occasionally they can lead to serious knee injuries.

Several knee conditions can affect your child’s knees and make it challenging for them to participate in sports. Some common knee conditions and injuries that affect adolescents include:

1. Patella femoral pain: pain that is usually at the front of the knee, typically worse on stairs. It may be associated with fat pad impingement where the Hoff’s fat pad gets pinched by the kneecap.
2. Osgood-Schlatter disease: an overload condition that causes pain and swelling at the bony prominence located just below the kneecap.
3. Sinding Larsen Johanssen disease: an inflammation of the patellar tendon often with a slight separation of the bone where it joins the patella.
4. ACL injuries: tears or sprains of the anterior cruciate ligament, which connects the thighbone to the shinbone.
5. Meniscus tears: tears in the cartilage that cushions the knee joint. These can cause the knee to jam or lock.
6. Patella dislocation: a condition where the kneecap comes out of its track to end up off to the side of the knee. It fortunately relocates on straightening the knee.
7. Osteochondritis dissecans: a condition that affects the bone and cartilage of the knee joint. Occasionally a loose fragment breaks free to cause locking.
8. Rarely hip pain can be perceived to be in the knee.

If your child is experiencing knee pain or discomfort that doesn't easily settle you might consider seeing a physiotherapist who is experienced in treatment children and teens. If there has been a significant injury, fall or twisting accompanied by a lot of swelling, you should seek advice as soon as is practical. Similarly, if the knee is locking or jamming see a specialist who is experienced in treating children and teens.

It can help to splint the limb. Applying ice can reduce swelling and pain. It's also important to make sure your child takes the time to rest and recover fully from their injury or condition before returning to sports. Returning too quickly can increase the risk of further injury or complications. If you are unsure or physiotherapy isn't working please ask for advice.

Children and teenagers frequently suffer minor sports injuries. If the problem starts to recover quickly or with the help of physiotherapy, you may be best to wait and see as most minor problems are self-limiting. Any condition that recurs or fails to settle should have a formal diagnosis made. Any mechanical problems such as instability, locking and being unable to weight bear warrant prompt attention. Similarly, you should seek advice if the knee locks or there is any abnormal appearance such as lumps, swelling or unusual alignment.

Treatment options for the different adolescent knee conditions

The appropriate treatment for an adolescent knee problem will depend on the specific condition or injury. Treatment options may include rest, physiotherapy, bracing, medication or surgery. I will work with you to develop an individualised treatment plan that meets your child's unique needs.

Typically the following apply in most cases:

1. Patella femoral pain: Physiotherapy.
2. Osgood-Schlatter disease: Physiotherapy. Rarely brace or plaster.
3. Sinding Larsen Johanssen disease: Physiotherapy. Rarely brace or plaster.
4. ACL injuries: Some will manage with physiotherapy alone others will require surgery.
5. Meniscus tears: Likely surgery, especially if knee is clunking or locking intermittently.
6. Patella dislocation: Physiotherapy. May require surgery to stabilise the patella, if a loose body jams the knee or the dislocation happens a second time.
7. Osteochondritis dissecans: If caught early prolonged time off sports may be required but that may avoid the need for surgery. If the knee is locking or swelling, surgery may be required to fix the loose piece back.

As a knee surgeon, I am well-versed in treating knee conditions and injuries in adolescents. I did some of my early orthopaedic training at Great Ormond Street and have ever since enjoyed treating children and teenagers. I typically see children from around 10/11 years old. I have treated a lot of children with many of the conditions listed above and have reconstructed many children’s knees after dislocation of patella, ACL rupture, osteochondral problems and meniscal problems.