*Department of Orthopaedic Surgery, University of Cincinnati ‡Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH †Baylor College of Medicine, Houston, TX §Children's Orthopaedics of Louisville, Louisville, KY.
: Physical examination may be inconclusive in adolescents presenting with an acute traumatic knee effusion because of pain and guarding. The purpose of this study was to describe the magnetic resonance imaging (MRI) findings in adolescents with traumatic knee effusions and to compare injuries based on age, sex, and physeal maturity.
: All MRIs using a knee trauma protocol performed at our institution over a 2-year period were evaluated. One hundred thirty-one patients between the ages of 10 to 18 years of age with a clinical history of acute knee trauma and an effusion confirmed on MRI met our study inclusion criteria. They were divided into 2 age groups: 10 to 14 and 15 to 18 years old. Pathology was confirmed using clinical history, MRI, and any available surgical reports.
: Of the 131 patients with an acute knee effusion, there were 59 patients in the younger group (10 to 14 y old) and 72 patients in the older group (15 to 18 y old). In the younger group, patellar dislocations (36%), anterior cruciate ligament (ACL) tears (22%), and isolated meniscus tears (15%) were the most common injuries. In the older group, ACL tears (40%), patellar dislocations (28%), and isolated meniscus tears (13%) were the most common injuries. ACL injuries represented 28% of injuries in males and 38% of injuries in females, whereas patellar dislocations represented 28% of injuries in males and 37% of injuries in females. There was a trend toward adolescents with active growth plates sustaining more patellar dislocations and adolescents with closed growth plates sustaining more ACL injuries. Forty-one percent of patients in this study underwent surgery.
: Patellar dislocation is a common injury in children who present with a traumatic knee effusion, especially in young adolescents and females. Adolescents presenting with a traumatic knee effusion should undergo MRI because of the high rate of positive findings missed by physical examination and plain radiographs that may warrant surgical repair or reconstruction.
: Level III.
[Show abstract][Hide abstract] ABSTRACT: As more children and adolescents are involved in sporting activities, the number of injuries to immature knees rises. We will focus on three entities: ruptures of the anterior cruciate ligament, patellar dislocation, and meniscal injuries. There is a trend in recent literature toward early reconstruction of the anterior cruciate ligament in children and adolescents. In this article, we will try to highlight the anatomic specialities and the diagnostic steps toward the correct diagnosis, review technical considerations and risks of the different surgical techniques, and present outcomes and offer a treatment recommendation. The treatment of patellar dislocation has changed considerably since we gained a better understanding of the unique anatomy of the patellofemoral joint. We will show diagnostic steps and risk factors for recurrent patellar dislocation, discuss conservative and different operative therapy options, and present a modified technique to achieve a dynamic reconstruction of the medial patellofemoral ligament without damage to the growth plates. Meniscal tears and discoid menisci are rare in comparison to the other injuries. We will herein explain what specialities in the anatomy should be considered in children and adolescents concerning the menisci, and present the diagnostic steps and treatment options available.
European Journal of Trauma and Emergency Surgery 09/2013; 2014(40):23-36. DOI:10.1007/s00068-013-0339-6 · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND:Hemarthrosis after acute knee trauma is a sign of a potentially serious knee injury. Few studies have described the epidemiology and detailed injury spectrum of acute knee injuries in a general pediatric population. PURPOSE:To document the current injury spectrum of acute knee injuries with hemarthrosis in children aged 9 to 14 years and to describe the distribution of sex, age at injury, type of activity, and activity frequency in this population. STUDY DESIGN:Descriptive epidemiology study. METHODS:All patients in the Stockholm County area aged 9 to 14 years who suffered acute knee trauma with hemarthrosis were referred to Astrid Lindgren Children's Hospital, Karolinska University Hospital, from September 2011 to April 2012. The patients underwent clinical examination, radiography, and magnetic resonance imaging (MRI). The type of activity when injured, regular sports activity/frequency, and patient sex and age were registered. The diagnoses were classified into minor and serious injuries. RESULTS:The study included 117 patients (47 girls and 70 boys; mean age, 13.2 years). Seventy percent had a serious knee injury. Lateral patellar dislocations, anterior cruciate ligament ruptures, and anterior tibial spine fractures were the most common injuries, with an incidence of 0.6, 0.2, and 0.1 per 1000 children, respectively. The sex distribution was equal up to age 13 years; twice as many boys were seen at the age of 14 years. The majority of injuries occurred during sports. Forty-six patients (39%) had radiographs without a bony injury but with a serious injury confirmed on MRI. CONCLUSION:Seventy percent of the patients aged 9 to 14 years with traumatic knee hemarthrosis had a serious intra-articular injury that needed specific medical attention. Fifty-six percent of these patients had no visible injury on plain radiographs. Physicians who treat this group of patients should consider MRI to establish the diagnosis when there is no or minimal radiographic findings. The most common serious knee injury was a lateral patellar dislocation. This should be taken into consideration to improve prevention strategies and treatment algorithms in pediatric knee injuries.
The American Journal of Sports Medicine 04/2014; 42(7). DOI:10.1177/0363546514529639 · 4.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute knee pain is a common complaint among patients presenting to outpatient clinics. Although most injuries are minor and resolve without surgical intervention, some injuries, such as extensor mechanism injuries, tibial plateau fractures, and multi-ligament knee injuries, require prompt evaluation by an orthopedic surgeon. A thorough history and physical examination combined with radiographs are usually sufficient to diagnose these more urgent injuries. If the diagnosis remains uncertain, magnetic resonance imaging is the imaging modality of choice in diagnosing ligamentous, tendinous, meniscal, and chondral injuries.
Medical Clinics of North America 07/2014; 98(4). DOI:10.1016/j.mcna.2014.03.002 · 2.61 Impact Factor
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