My Aching Knee

In youth sports, the incidence and prevalence of knee injuries continues to rise. In fact, in parallel to adults, knee pain may soon become the #1 reason young patients visit my office. The knee is composed of four bones, several muscles, cartilage and ligaments. All are susceptible to injury. 
Anatomy of the knee

Most knee injuries are resultant to “overuse.” Soreness is the most common complaint of kids and rarely is swelling an issue, for overuse. Categorically, these types of injuries are strains. The muscle is injured and healing will occur in two to three weeks. Return to sports is recommended when the child can run and play without pain. One of the increasingly more common entities afflicting the knee is Patellofemoral syndrome. In brief, when one has patellofemoral syndrome she will complain that “my kneecap hurts.” It is very common, more so in young girls, and is noted when one sits for prolonged periods of time, climbs stairs, and runs. An associated ailment, Osgood-Schlatter Disease occurs in young teens. Pain presents with a bump on the leg (tibia) bone, just below the kneecap. It may even appear swollen. And likely it is. This bump, called the tibial tubercle, is an area of growing bone. In some, the growth of this particular bone does not keep pace with the growth of the rest of the bones and a bump appears. In actuality, we all have this bump but in the growing child, due to the pain associated, we have a name it. For Patellofemoral Syndrome and Osgood- Schlatter Disease, treatment is geared toward reducing stress across the knee and improving strength of the Quadriceps muscle. A good suggestion, for those kids who always seem to find their way to the pavement, kneepads may help decrease the incidence of both patellofemoral Syndrome and Osgood-Schlatter disease. Other injuries of the knee involve the cartilage (menisci) and ligaments. Injuries of the cartilage, usually meniscal tears, are increasing in incidence. Usually traumatic in origin, possibly a twisting injury is the culprit. The knee feels sore and may have limited motion. It may even feel “stuck” when trying to bend and/or straighten it. After the injury, swelling is likely to occur. Injuries of the ligaments, in particular the Anterior Cruciate Ligament, have been discussed a lot recently. These injuries, almost always activity related, arise in many running athletes. Either a direct blow or a sudden twisting injury, and the knee feels immediate pain and noted instability ensues. Swelling is likely and the child may describe a sensation of a sudden “slipping forward and backward” of the knee. The incidence of these injuries is much greater in females than males due to several proposed theories. Some tout anatomic differences as the main culprit. Others speak of hormonal differences, but the most common agreement is that of differing physiology between males and females. The female knee is simply more vulnerable due to its muscles function when attempting to complete a task. For all of the above, a visit to the physician is prudent. For those with pain and swelling, a visit to the physician is recommended. The treatments for almost all of the above include a course of exercise therapy and improved stretching techniques. For a tear of the Anterior Cruciate Ligament, surgery is a possibility.