What is it about ?
Children and active teens often develop knee pain. Typically, the pain is in the front of the knee, around or just below the kneecap. Many diagnoses can explain these complaints. Fortunately, most disorders are mild and result from overwork. They disappear on their own, provided that a period of rest is observed.
What sets children and adolescents apart from adults is that they are still growing up. Most knee pain therefore appears before or during a growth spurt. Muscles, tendons and joints are not yet fully developed. Sometimes children walk, jump, and do more activity than their knee can handle. It is also possible that a child or teenager has knee problems due to a disorder in the hip or back.
Here are some of the most common disorders.
Osgood-Schlatter disease
This condition is very common. It is often seen in young athletes during the growth spurt of puberty. In boys, it often occurs around the age of 13-15 (but can also appear earlier). In girls, symptoms develop a little earlier than in boys. It is pain in the front of the knee, just below the kneecap. The pain goes away with rest and gets worse during exercise. The pain is localized to the precise place where the tendon of the patella is attached to the tibia, it is a specific sign of this disease. Osgood-Schlatter disease is seen primarily in young people who play sports in which they often have to run and jump. Usually only one knee is affected, but it is also possible that pain is felt in both knees.
Sinding-Larsen-Johansson disease
Similar to Osgood-Schlatter disease, this disease is distinguished by the fact that it affects children around 10 years old, sometimes younger. Less common than Osgood-Schlatter disease, it is accompanied by pain mainly localized just under the kneecap. The complaints are similar to those of “jumper’s knee” (patellar tendinopathy) seen in adults.
Patellofemoral syndrome
This syndrome combines all the pain in the front of the knee without any damage being demonstrated. The pain occurs when putting weight on the knee, for example when going down the stairs, playing sports or sitting for a long time. This latter phenomenon is known as the “cinema sign”. The person experiences knee pain after sitting for a long time with the knees bent, for example during a car trip or at a movie. Patellofemoral syndrome is very common. Again, the pain can affect both knees at the same time.
Osteochondritis dissecans
This is an important but difficult diagnosis. Indeed, the symptoms depend on the stage of the disease. In the knee joint, fragments of cartilage are formed which can detach from the joint surface. These fragments receive an insufficient blood supply and eventually die. Pain is usually felt in one or both knees. The cause is not well established. Sometimes this disease is associated with serious underlying diseases or requires large doses of corticosteroids. In most cases, however, no underlying disease is present and the condition is seen in healthy, growing children.
Fallback syndrome
The knee joint is delimited on its inside by a thin membrane. This membrane is known as the synovial membrane or plica. It presents folds in almost everyone. In some cases, these folds are so marked that they can cause pain. If an MRI points to this diagnosis and there are clinical signs such as lameness, limitation of movement, or muscle wasting, knee arthroscopy (under general anesthesia) may be considered. During this operation, the surgeon can remove the fold. In some cases, complaints improve, in others not. This is the reason why this intervention is controversial.
Non-specific pain in the knee
No clear cause may be found to explain knee pain. There are no characteristic symptoms and no abnormalities can be seen on an x-ray of the knee. Most often, symptoms appear during a growth spurt and improve on their own over the following weeks or months. Each painful episode lasts no more than a few hours. Symptoms are usually not related to physical activity.
What is their frequency?
The general practitioner regularly sees young patients suffering from knee pain in his office. The exact figures are not known.
How to recognize them?
It is in all cases a pain felt in the knees. Usually the pain is localized in front of or above the knee joint, or above, around and below the kneecap. The knee may ‘crack’. Pain usually occurs during or right after exercise. Sometimes there is a big difference between the left knee and the right knee. The knee may be swollen. It is also possible that the thigh muscle, above the knee, is more developed on one side than the other. Sometimes touch or pressure on a single point can trigger the pain. It is also often the case that the symptoms vary from day to day. Symptoms sometimes appear when playing certain sports or doing certain movements (eg running and jumping) and go away during another activity (eg swimming).
How is the diagnosis made?
The doctor will start by asking you a few specific questions and then perform a full physical examination. He will also examine the hip and the back. Normally, he can already get a good idea of the situation on the basis of this information. Sometimes rest is enough. This rest period can also be used to better observe the evolution of symptoms.
In some cases, the doctor orders an imaging test. It can be an x-ray, ultrasound, or CT scan. In some specific cases, the general practitioner can also refer you directly to a sports doctor, an orthopedist or a specialist in physical medicine. In rare cases, exploratory surgery (arthroscopy) will be done to detect certain diseases.
What can you do ?
Patience and rest are often the key elements of a favorable development. So follow the advice on rest. Before seeing a doctor, try to identify for yourself when and how exactly the symptoms appear.
There are also many types of supportive knee braces on the market, which you can buy freely. However, we advise you to consult your doctor first.
Painkillers relieve symptoms, but do not cure them. Overuse of the knee may be made worse by taking medicines (because they mask the pain). Therefore, do not take them before consulting a doctor.
Many treatments require effort on the part of you as a patient. You may need to do exercises, usually under the supervision of a physical therapist.
What can your doctor do?
The doctor will work with you to find the most suitable treatment. The type of pain and the diagnosis, the intensity of the pain and its influence on your daily activities, are very important elements in choosing the treatment. Not everyone has the same level of sport activity and the treatment can be adapted to the sport practiced.
Want to know more?
- My child is going to have an X-ray – Plaster
- My child is going to have an ultrasound – Plaster
- My child will have a CT scan – Plaster
- My child is going to have an MRI – Plaster
- My child is going to be operated on under general anesthesia – Plaster
- The radiography, here, Where to find on this page of Cliniques St Luc UCL
- Ultrasound here Where to find on this page of Cliniques St Luc UCL
- The scanner, here, Where to find on this page of Cliniques St Luc UCL
- MRI, here, Where to find on this page of Cliniques St Luc UCL
- Arthroscopy for knee surgery – CHU Montreal
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