Knee Pain – Adolescent


A. Kaufman, G. Rozea, K. Vanic, J. Hauth, East Stroudsburg University, PA.

email: grozea@esu.edu (Sponsor: K. N. Waninger, FACSM)

HISTORY: A 9-year-old male elementary school student with no past medical history of lower extremity injury. During school recess, patient was playing soccer when his foot “fell into a hole” with a classmate tackling thereafter. Patient described a fixed hyperextension and rotational knee mechanism.

PHYSICAL EXAMINATION: Patient reports with chief complaint of knee pain. Initial management included emergency room referral where x-rays were obtained and ice was provided. The patient presents with pain and swelling. During the initial evaluation, patient reported with an antalgic gait and the feeling that his knee would “give way” when he walks. Visual inspection revealed gross swelling of the tibiofemoral joint with 2+ effusion. Palpation revealed left hamstring guarding. The patient was apprehensive towards fully straightening his left knee with a 30o extension lag was observed. Strength was 4/5 due to pain and guarding. Lachman’s test was positive for 1+ laxity, Anterior Drawer test was positive with a 2cm step off deformity. Valgus and varus stress tests were negative.

DIFFERENTIAL DIAGNOSIS: tibial plateau fracture, avulsion fracture, Salter-Harris fracture, posterior cruciate ligament rupture, lateral collateral ligament rupture, medial collateral ligament rupture, meniscal tear, and an anterior cruciate ligament rupture.

TEST AND RESULTS: Plain radiographs revealed open epiphyseal plates and was negative for fracture. The patient was referred from ER to orthopedic specialty. MRI revealed a partial tear of the anterior cruciate ligament of the left knee.


TREATMENT AND OUTCOMES: The patient was referred to a pediatric orthopedic surgeon. Patient is undergoing knee rehabilitation and will undergo arthroscopic surgical intervention. Special considerations with surgical reconstruction, the possibility of injury to the physes should be given special consideration. The proximal tibial physis is the structure at risk during ACL reconstruction in pediatric patients. The literature offers a variety of operative techniques. Physeal-sparing techniques may result in non-anatomic graft placement and the long-term function of these grafts is unknown.

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