Knee Pain in Young Athletes
Kevin G. Shea, M.D.PLICA BANDS: Although these structures are seen in adults, there are more common in pediatric and adolescent athletes. A plica is a band of synovial tissues within the knee. In most cases, these are normal structures. In rare cases, these can become enlarged and irritated within the knee. This can occur after trauma to the knee. Plica bands may respond to specific patellar mobilization exercises. In some cases, steroid injections may help. In case that do not respond to therapy, arthroscopic surgery may be necessary.
OSGOOD-SCHLATTER DISEASE: This is a very common problem in the growing athlete. It is characterized by pain around the knee, just below the knee cap. You may notice a small tender lump on the front of the shin bone. This area is known as the tibial tubercle, and it is part of the growth plate about the knee. In most cases, this condition responds to activity modifications, and stretching exercises. Your physical therapist can be very helpful in treating this condition. Stretching should focus upon the quadriceps and hamstrings. Sometimes a cast or knee immobilizer will be used for a short period of time to reduce the pain and swelling.
Most young athletes eventually outgrow this problem. In rare cases, it can be associated with a fracture of the shin bone, which requires surgery. Occasionally, the lump on the shin bone is chronically painful, and may require surgery in older patients.
GROWTH PLATE FRACTURES: Many young athletes sustain injuries to their growth plates, rather than ligament tears. In young athletes, the ligaments can be stronger than the bone growth plate. These injuries can lead to abnormal growth if not treated appropriately. In some cases, the growth plate can be severely affected, leading to a shortened a deformed leg in the future. If your child has had a serious knee injury that produces swelling, a significant limp, or pain, make sure that he or she is evaluated for a growth plate fracture.
OSTEOCHONDRITIS DISSECANS: This is an injury seen in young athletes, in which the articular cartilage and surrounding bone do not develop normally. The exact cause of this injury is unknown, but it may be related to an overuse syndrome. In most cases, surgery is not required, and these lesions will heal with appropriate activity modification and therapy.
In more advanced cases, the cartilage can become detached from the bone, leading to serious problems with arthritis. These cases require surgery to prevent loss of the cartilage. Surgery will be performed to reattach the cartilage to the surrounding bone, and to stimulate the blood supply. This is done to promote healing between the cartilage and the surrounding bone.
KNEECAP DISLOCATION: This is a rare problem, but is seen in young athletes. In most cases, this can be treated with effective physical therapy. Surgery is not usually necessary for patients that have sustained an injury for the first time. In some patients, certain anatomic factors contribute to this problem. On occasion, these patients may require surgery to correct these problems. In patients that have had multiple dislocations, they may require surgical treatment. With each dislocation, the potential for significant damage to the cartilage surface of the joint increases. When the kneecap dislocates to the side of the knee, it can shear off or damage articular cartilage from the kneecap surface, or from the thigh bone cartilage surface. Occasionally, these pieces of damaged cartilage become loose bodies inside the knee joint, and have to be removed surgically.