eric small, md, faap

ERIC SMALL, MD, ERIC SMALL, MD, FAAPFAAPERIC SMALL, MD, ERIC SMALL, MD, FAAPFAAP

Assistant Clinical Professor of Assistant Clinical Professor of Pediatrics, Orthopedics, and Pediatrics, Orthopedics, and

Rehabilitation MedicineRehabilitation Medicine

Mount Sinai School of MedicineMount Sinai School of Medicine

New York, New YorkNew York, New York

Director Sports Medicine Center for Young Director Sports Medicine Center for Young AthletesAthletes

Blythedale Children’s HospitalBlythedale Children’s Hospital

Common Knee Injuries in theCommon Knee Injuries in thePediatric PatientPediatric Patient

Common Knee Injuries in theCommon Knee Injuries in thePediatric PatientPediatric Patient

Differential DiagosisDifferential DiagosisDifferential DiagosisDifferential Diagosis

•Orthopedic/Musculoskeletal ConditionOrthopedic/Musculoskeletal Condition•Medical ConditionMedical Condition

Lyme DiseaseLyme Disease JRAJRA SLESLE RSD/FibromyalgiaRSD/Fibromyalgia

HistoryHistoryHistoryHistory

•Traumatic vs. NontraumaticTraumatic vs. Nontraumatic•Type of Treatment GivenType of Treatment Given•Past Medical History Past Medical History •Family HistoryFamily History


•Traumatic vs. NontraumaticTraumatic vs. Nontraumatic•Type of Treatment GivenType of Treatment Given•Past Medical HistoryPast Medical History •Family HistoryFamily History


•Traumatic vs. NontraumaticTraumatic vs. Nontraumatic•Type of Treatment GivenType of Treatment Given•Past Medical History Past Medical History •Family HistoryFamily History

Key QuestionsKey QuestionsKey QuestionsKey Questions

• Immediate Swelling?Immediate Swelling?•Able to continue to play?Able to continue to play?•Full or Partial Weightbearing?Full or Partial Weightbearing?

SwellingSwellingSwellingSwelling

• Immediate SwellingImmediate Swelling•Swelling Several hours laterSwelling Several hours later•Swelling Next DaySwelling Next Day

Pain Pain Pain Pain

•Pain with activityPain with activity•Pain after activityPain after activity•Pain the next dayPain the next day

SymptomsSymptomsSymptomsSymptoms

•LockingLocking•Clicking Clicking •Giving WayGiving Way

Physical ExamPhysical ExamPhysical ExamPhysical Exam

•SwellingSwelling•Point TendernessPoint Tenderness•Comparison with other kneeComparison with other knee

Special TestsSpecial TestsSpecial TestsSpecial Tests

•Anterior Drawer TestAnterior Drawer Test•Lachman TestLachman Test•McMurray TestMcMurray Test•Apley TestApley Test

COMMON DIAGNOSESCOMMON DIAGNOSESCOMMON DIAGNOSESCOMMON DIAGNOSES• Patellafemoral Pain SyndromePatellafemoral Pain Syndrome• Osgood Schlatter DiseaseOsgood Schlatter Disease• Patella TendonitisPatella Tendonitis• Sinding Larsen Johannson SyndromeSinding Larsen Johannson Syndrome• Patella Subluxation/DislocationPatella Subluxation/Dislocation• ACL TearACL Tear

PATELLAFEMORAL PAIN PATELLAFEMORAL PAIN SYNDROMESYNDROMEPATELLAFEMORAL PAIN PATELLAFEMORAL PAIN SYNDROMESYNDROME

•Chondromalacia PatellaeChondromalacia Patellae•Anterior Knee PainAnterior Knee Pain•Runner’s KneeRunner’s Knee

PRESENTING SYMPTOMSPRESENTING SYMPTOMSPRESENTING SYMPTOMSPRESENTING SYMPTOMS

•Pain in and around patellaPain in and around patella•Swelling only in severe casesSwelling only in severe cases•Pain walking up and down stairsPain walking up and down stairs•Positive theatre signPositive theatre sign

PFSS-Other findingsPFSS-Other findingsPFSS-Other findingsPFSS-Other findings•More common in FemalesMore common in Females•Q AngleQ Angle•Patella HypermobilityPatella Hypermobility•Shallow trochlear GrooveShallow trochlear Groove•Patella SubluxationPatella Subluxation

PHYSICAL EXAMPHYSICAL EXAMPHYSICAL EXAMPHYSICAL EXAM

•Patella Facet PainPatella Facet Pain•Positive Patella Compression TestPositive Patella Compression Test•May have associated PlicaMay have associated Plica•May have pain with hyperflexionMay have pain with hyperflexion

MANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENT•Decrease running by 30 - 50%Decrease running by 30 - 50%•Straight leg raising to 10 pounds Straight leg raising to 10 pounds

(VMO)(VMO)•McConnell TapingMcConnell Taping• If fail conservative management If fail conservative management

lateral release and plica resectionlateral release and plica resection

OSD BACKGROUNDOSD BACKGROUNDOSD BACKGROUNDOSD BACKGROUND•First described in 1903First described in 1903•Osgood (Boston)Osgood (Boston)•Schlatter (Switzerland)Schlatter (Switzerland)• ImmobilizatonImmobilizaton•5:1 in boys than in girls5:1 in boys than in girls

OSD HISTORYOSD HISTORYOSD HISTORYOSD HISTORY

• In peak growth spurtIn peak growth spurt

•Pain with running and Pain with running and squattingsquatting

OSD PHYSICALOSD PHYSICALOSD PHYSICALOSD PHYSICAL

•Pain at tibial tuberclePain at tibial tubercle

•Extremely tight Extremely tight hamstrings (SLR hamstrings (SLR 30 degrees)30 degrees)

OSD MANAGEMENTOSD MANAGEMENTOSD MANAGEMENTOSD MANAGEMENT• Hamstring Stretches 3 - 4 times per dayHamstring Stretches 3 - 4 times per day• Cho-pat Osgood Schlatter BandCho-pat Osgood Schlatter Band• Neoprene Knee sleeve with patella cut-Neoprene Knee sleeve with patella cut-

outout• Do not immobilizeDo not immobilize• Biking and swimming encouragedBiking and swimming encouraged

Patella TendonitisPatella TendonitisPatella TendonitisPatella Tendonitis

•More common in adolescence in More common in adolescence in association with Osgood Schlatter association with Osgood Schlatter or SLJor SLJ

Patella Tendonitis TreatmentPatella Tendonitis TreatmentPatella Tendonitis TreatmentPatella Tendonitis Treatment• Ice MassageIce Massage•Hamstring/Quad StrengtheningHamstring/Quad Strengthening•Biking/SwimmingBiking/Swimming•Decrease Impact activities by 30-Decrease Impact activities by 30-

50%50%

SINDING LARSEN JOHANNSON SINDING LARSEN JOHANNSON SYNDROMESYNDROME

SINDING LARSEN JOHANNSON SINDING LARSEN JOHANNSON SYNDROMESYNDROME

•Pain at inferior pole of patellaPain at inferior pole of patella• juvenile osteochondrosisjuvenile osteochondrosis• jumper’s kneejumper’s knee

SLJ TreatmentSLJ TreatmentSLJ TreatmentSLJ Treatment

•Decrease Training by 30-50%Decrease Training by 30-50%•Hamstring/Quad StretchingHamstring/Quad Stretching•Biking/SwimmingBiking/Swimming

COMMON DIAGNOSESCOMMON DIAGNOSESCOMMON DIAGNOSESCOMMON DIAGNOSES• Patellafemoral Pain SyndromePatellafemoral Pain Syndrome• Osgood Schlatter DiseaseOsgood Schlatter Disease• Patella TendonitisPatella Tendonitis• Sinding Larsen Johannson SyndromeSinding Larsen Johannson Syndrome• Patella Subluxation/DislocationPatella Subluxation/Dislocation• ACL TearACL Tear

ACL TearACL TearACL TearACL Tear

•Noncontact InjuryNoncontact Injury•More common in femalesMore common in females•Rise in skeletally immature populationRise in skeletally immature population•Surgery is dependent on individual Surgery is dependent on individual

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eric small, md, faap

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