Knee pain is a common complaint among young children and adolescents and can be caused by several different reasons. The most common causes of knee pain are related to repeated stress on the knee. However, other reasons such as inflammation or ligament tear can contribute to knee pain.
The child may experience pain in or around the knee. It is common for the pain to arise in connection with physical activity or during sports, and most symptoms go away over time.
Picture of child playing hurting the knee?
Children and adolescents who are still growing and physically active may experience swelling, pain, and stiffness in their knees. Bones grow at the ends near the joint, in an area called the growth plate. While a child is still growing, these areas of growth consist entirely of cartilage, which is weaker and more sensitive than bone. Increased stress on these areas can initiate an inflammation process that causes pain and swelling.
Picture of growth plate in with the knee anatomy
Adjusting activity and avoiding overloading usually suffice for the problems to disappear, but sometimes the knee needs to be examined at a pediatric orthopedic clinic for further assessment.
Below you will find the most common diagnoses and diseases that can lead to knee pain in children and adolescents.
Patellofemoral pain syndrome:
This condition is characterized by pain in the front of the knee, especially when climbing stairs, kneeling, or sitting for long periods of time. It is often caused by overuse or improper alignment of the kneecap. The knee may also lock in a certain position, become swollen, or tender. These symptoms usually disappear over time and do not lead to any other knee problems in the future.
Schlatter's disease (Osgood-Schlatter disease):
Schlatter's disease typically affects active children between the ages of 8 and 15 who are experiencing rapid growth and are simultaneously active in sports. The overuse leads to inflammation in the tendon that connects the kneecap to the shinbone and causes swelling and pain. The child may experience knee pain during physical activity, especially jumping and climbing stairs.
Baker's cysts:
Baker's cysts form due to the bursa at the back of the knee containing more fluid than usual. It is unclear why the cysts form, but they are most common in children under seven years old. The cyst causes swelling in the back of the knee but usually does not cause major discomfort or pain. If the Baker's cyst is large, it may feel tight and make it harder to bend the knee joint.
Sinding-Larsen's disease (jumper’s knee):
Sinding-Larsen's disease, also known as jumper's knee, is common in children who run, play soccer, or participate in high jump. Sinding-Larsen's disease occurs due to small tears in the tendon below the kneecap and can cause long-lasting issues with pain. It is common to feel pain and swelling below the kneecap during physical activity.
Juvenile idiopathic arthritis:
This is a chronic autoimmune disease that can cause inflammation and pain in the joints, including the knees. It can lead to stiffness, swelling, and limited range of motion in the affected joints.
Osteochondritis:
Osteochondritis most commonly affects children between the ages of 12 and 19 and involves a small piece of cartilage and bone detaching in a joint. It is most common to get osteochondritis during puberty. Sometimes osteochondritis leads to swelling, pain, and stiffness in the knee, but sometimes no symptoms occur at all. The cause is unknown, but high stress leading to small injuries in the joint may be a reason. Most people get osteochondritis in the knee joint, but the disease can also occur in other joints in the body such as the elbow or the ankle.
Patella (Kneecap) dislocation:
If a child hits or twists the kneecap forcefully, it can be dislocated from its correct position and end up on the outside of the knee joint. This leads to damage to the joint capsule, which can increase the risk of the kneecap being dislocated again. When the kneecap is dislocated, it is very painful and it may look like the entire knee has dislocated, which it has not. Usually, the kneecap slides back into the correct position on its own, or when the child straightens the leg. Afterwards, the knee may swell and it may be difficult to put weight on the leg for a week.
Ligament and meniscus injuries:
Injuries to the ligaments in the knee, such as the anterior cruciate ligament (ACL) or the medial collateral ligament (MCL), can cause pain and instability in the knee. These injuries are more common in adolescents who participate in high-impact sports.
Meniscus injury can happen as an isolated injury or in a company with other injury like ligament injury or fractures. This injury can cause pain, locking and instability in the knee. These injuries are also more common in adolescents who participate in high-impact sports.
Patellofemoral pain syndrome:
When seeking care for anterior knee pain, the doctor usually starts by examining the knee joint. Sometimes, the knee joints may need to be X-rayed to rule out other causes of discomfort. Once the child has stopped growing, the symptoms of anterior knee pain usually go away on their own, but they may still recur during physical activity. Therefore, the treatment of anterior knee pain typically involves the child avoiding activities and movements that cause the symptoms. It is also beneficial to strengthen the muscles around the knee joint through various exercises and to use a support band around the knee to reduce discomfort. Over-the-counter pain relievers can help if the pain is severe.
Picture of child doing exercises
Osgood-Schlatter disease:
The diagnosis of Osgood-Schlatter disease is made by a doctor who examines the knee. In most cases, there is no need for knee X-rays, and most individuals diagnosed with the condition do not require any treatment. For certain chronic and uncomfortable situations, physiotherapy involving stretching and strengthening exercises, in addition to knee strapping, can assist in easing the symptoms.
Picture with knee strapping
Baker's cyst:
To determine if the child has Baker's cyst, a doctor usually examines and feels the child's leg. Sometimes an ultrasound examination may be necessary. In most cases, no treatment is needed if your child has a Baker's cyst because the swelling usually decreases or disappears on its own within one to four years.
Sinding-Larsen's disease (jumper’s knee):
If your child is affected by Sinding-Larsen's disease, physiotherapy can help alleviate the symptoms. It is also beneficial for the child to adjust activities that cause pain. Symptoms usually resolve on their own within a year.
Juvenile idiopathic arthritis:
Proper management of juvenile idiopathic arthritis demands meticulous attention and careful supervision to address the unique needs and challenges of each individual case.
Osteochondritis
Treatment for osteochondritis usually involves avoiding strenuous knee exercises, such as football training, jumping, and running. Different exercises that strengthen the muscles around the knees can also help, but they may not necessarily speed up the healing process.
The risk of complications may increase if the disease occurs after the age of 15. This is because the disease can lead to the formation of a loose piece of bone or cartilage inside the joint, which can get stuck and cause the knee to lock in a certain position for a short period. This can be prevented by surgery where the doctor removes the loose piece of bone or secures it with a pin.
Patella (kneecap) dislocation:
If a child's kneecap dislocates, the treatment usually involves wearing a knee brace for a few weeks. The child can still put weight on the knee, but crutches are often needed during the initial period. A physiotherapist can assist with various mobility and strength exercises to restore knee function and reduce the risk of dislocation recurring. The child may also use a stabilizing knee brace.
If the kneecap has dislocated multiple times or if a doctor assesses a high risk of recurrence, surgery may be necessary. For children who are still growing, an operation to reinforce the joint capsule can stabilize the kneecap. In children who have finished growing, a different operation is usually performed where the patellar tendon is moved to pull the kneecap in a different direction to prevent dislocation. Regardless of the surgery, the child typically needs a period of immobilization afterward, six weeks after joint capsule reinforcement and two to six weeks after tendon repositioning. After the procedure, the child can put weight on the leg as usual, but it is advisable to use crutches for four to six weeks for safety. It is also important to have contact with a physiotherapist immediately after the operation to receive assistance with rehabilitation.
Ligament and meniscus injuries:
The management of ligament and meniscal injuries in adolescents involves a comprehensive approach that takes into consideration the unique growth patterns and activity levels of this age group. Treatment options may include a combination of rest, physical therapy, bracing, and in some cases, surgical intervention.
It is crucial to customize the treatment plan to the individual needs of the adolescent patient, considering factors such as their level of physical activity, puberty level, and remaining growth. Additionally, close monitoring and follow-up care are essential to ensure optimal outcomes and prevent long-term complications.
Treatment for knee pain in children and adolescents often is non-operative (conservative). However, in some cases, surgery is needed. It is important for parents and caregivers to seek medical advice if the knee is unstable with or without locking, or if the pain is severe, persistent, or accompanied by other symptoms such as fever, redness, or warmth in the knee. Prompt diagnosis and treatment can help prevent long-term complications and ensure a speedy recovery for the child or adolescent.
Consultant Pediatric Orthopedic Surgeon
Patient Experience
Chief Arthur Mbanefo, 91 years old, former ambassador to the UN and Representative of Nigeria, thanks the American Hospital Dubai for the excellent medical treatment and personalized care he received.
