What are the causes of knee pain in an adolescent?
- associated with systemic sx
septic arthritis
cancer
idiopathic/ juvenile arthritis - associated with an abnormal hip examination
irritable hip
perthe’s disease
slipped capital femoral epiphysis - associated with trauma
e. g. ACL/meniscal tear
4. associated with nil systemic sx and nil acute injury Anterior knee pain patellofemoral pain syndrome Osgood-Schlatter's disease Osteochondritis Dissecans
What is severe’s disease?
Apophysitis of the calcaneus
- What is Osteochondritis Dissecans,
- Where is it most common in the knee?
- What causes it?
- When should it be suspected?
- Defect in the subchondral bone → avascular necrosis → subchondral bone cannot support the articular cartilage anymore → damage to the articular cartilage (more common in the medial condyle) → bony fragments
- In the knee occurs most commonly in the medial condyle
- Cause is idiopathic, thought to be secondary to repetitive overloading .
- Should be suspected in a young person with an knee effusion it should be xray’d (ref. MSK for GP’s)
What is chondromalacia?
It overlaps with patellofemoral pain –>
refers to softening and degeneration of the articular hyaline cartilage of the patella and is a frequent cause of anterior knee pain - patella rubs against the femur (Radiopedia)
ACL rupture
Management:
1/ Conservative mx:
Do not all have to be repaired if patient doesn’t complain of being unstable or unable to do what they want to do
2/ Surgical Treatment:
Ideally should be able to straighten nee and waiting to heal for about 4-6/52 before surgery
(Ref: MSK for GP’s 2017)
What is the most useful clinical test for mensical injury?
Thessaly Test (90% sensitivity and 95% specificity in detecting mensical injury)
RACGP 2012 - mensical tear
