Pediatric Knee Sports Injuries

It is a pleasure to introduce this special focus section of the Journal of Knee Surgery presenting topics related to pediatric sports knee injuries. Experts in this field address interesting and timely topics.

Dr. Ganley and colleagues present the concepts that fractures of the tibial spine are estimated to occur in 3 per 100,000 children annually, but account for 2% to 5% of pediatric knee injuries with effusion. Although these fractures were historically associated with bicycle accidents, the surge of organized youth sports in recent decades has brought renewed attention to this injury. While minimally displaced fractures can be treated nonoperatively, several techniques have been described for the fixation of displaced or comminuted fractures. Sequelae of this injury can include arthrofibrosis, knee instability, and nonunion. Future collaborative endeavors will aim to further identify risk factors for these complications to optimize the treatment of tibial spine fractures in children.

Dr. Bauer presents the concepts that osteochondral injuries in pediatric patients may occur as a result of a traumatic injury or secondary to an osteochondritis dissecans lesion (OCD). Lateral patella dislocation is a common traumatic cause of osteochondral injury that typically occurs at the medial facet of the patella or the lateral aspect of the distal femur. Multiple theories have been proposed for the cause of an OCD lesion in the knee, including trauma or repetitive microtrauma, local vascular insufficiency, and family history. The most “classic” location for OCD lesions of the knee is the lateral aspect of the medial femoral condyle of the distal femur. Multiple treatment options are available for both traumatic osteochondral injuries and OCD lesions, with important determining factors of treatment being skeletal maturity of the patient, instability of the fragment, lesion location, and size of the lesion. Nonsurgical management is appropriate in some situations. Surgical options range from simple fragment excision to internal fixation of the fracture fragment to more complex cartilage restoration or replacement procedures. This special focus section will discuss the diagnosis and treatment options for traumatic osteochondral knee injuries, including the subset secondary to juvenile OCD lesions.

Dr. Seeley and colleagues provide insight into the challenging condition of anterior knee pain (AKP). AKP is a common presenting complaint for pediatricians and orthopaedic surgeons and is often seen in young athletes. AKP is multifactorial and has a broad differential diagnosis. The growth changes, biomechanics, and anatomy around the knee add to the complexity of diagnosis and treatment of AKP. Common causes of AKP include Osgood–Schlatter's disease, patellar tendinitis, and patellofemoral instability. In the diagnosis of AKP, it is important to rule out serious and morbid causes of pain, including infection and tumor. It is crucial to complete a detailed history and physical examination and obtain appropriate imaging studies. In general, the majority of patients will respond to nonoperative measures targeted to correct neuromuscular control and kinetic chain dysfunction.

Fanelli and Fanelli present the concept of the multiple ligament injured knee in patients of 18 years of age and younger. The posterior cruciate ligament-based multiple ligament injured, or dislocated, knee is often part of a multisystem injury complex that not only includes the knee ligaments but also may include blood vessels, skin, nerves, fractures, and other organ system trauma. These factors must be considered in the scope of treating this complex knee injury. These complex knee ligament injuries can result in significant functional instability for the affected individual. Their article discusses multiple ligament knee injury evaluation, treatment, and special considerations in the pediatric and adolescent population.

The purpose of this special focus section of the Journal of Knee Surgery is to provide experienced knee surgeons, general orthopaedic surgeons, fellows, residents, medical students, and other health care professionals with an interest in pediatric sports knee injuries, a useful reference for the management of these complex conditions.