Knee Pain in Kids


Key messages:

  • With softer, growing bones, children and adolescents generally present with a different set of knee problems to adults
  • While they are relatively rare, some cases of knee pain in children and adolescents are caused by serious health issues – for this reason ‘wait and see’ is a poor option, and kids need to have their complaints professionally and promptly assessed by a physio or GP.

When we look at knee pain in adults, a case is usually either related to trauma (for example, an anterior cruciate ligament injury), repeated wear and tear, or overuse (for example, osteoarthritis or patella pain). When it comes to kids we add a third category – disorders of development or growth.

Traumatic knee injuries in children

Fractures

Trampolines, jumping castles, skateboards, monkey bars, tree climbing, and other daredevil behaviours are kids’ natural environments. It’s no wonder they hurt themselves, and lower limb fractures are relatively common. The good news – kids are fast and effective healers, and are typically less likely to need surgery, require less time in plaster, and achieve a quicker return to full function than adults suffering the same injury.

Patella Dislocation

Remember how much more flexible you were as a child? Combined with high force from a fall or direct blow, those loose ligaments can make a child more prone to patella (kneecap) dislocation. The problem is more common in girls and may affect both knees.

If your child’s patella has slid back into place, see your GP or physio as soon as possible. If it remains dislocated, go to the Emergency Department where with the aid of medication it will be gently relocated.

Physiotherapy is the first line of treatment for patella dislocations. Depending on your child’s presentation and the time post-injury, we might provide:

  • An x-ray referral to exclude any bony damage
  • A brace to stabilise injured structures within the knee and relieve pain
  • Crutches
  • Specific exercises to restore movement and strengthen the muscles that hold the patella in place

In some cases where repeated dislocations occur despite bracing and physiotherapy, surgery may be recommended. The type of surgery will depend on the cause of the unstable patella.

Overuse knee injuries in children

Patella Pain

Patella pain is a complaint that can occur in both adults and children. It’s a common problem and we have a resource dedicated to identifying and treating the condition.

Osgood-Schlatters Disease and Sinding Larsen Johansson Syndrome

In the tradition of medical people naming problems after themselves, these are both common knee issues in children that sound much scarier than they actually are! They are often very painful and activity-limiting, but typically respond well to treatment.

Both Osgood-Schlatters Disease and Sinding Larsen Johansson Syndrome are characterised by pain and inflammation caused by the pull of a strong patellar tendon on its attachment to the softer, growing bones of a child or adolescent.

The patellar tendon joins the patella (kneecap) to the front of the tibia (shin bone).

  • If the inflammation is occurring at the patella attachment, it’s referred to as Sinding Larsen Johansson Syndrome
  • If the inflammation is occurring at the shin bone attachment, often with a noticeable lump at the top of the front of the child’s shin, your child might have Osgood Schlatters Disease. This is far more common than SLJ Syndrome.
Knee pain in children

Both problems tend to occur in active children during growth spurts – as the bones grow, the muscles and tendons are relatively less flexible for a time until they catch up. See a physiotherapist for assessment and treatment – in the majority of cases simple measures like partial rest, stretching, and strengthening exercises will resolve the issue.

Disorders of development or growth

Referred pain from the hip

Compared to the issues described above, hip problems in children are rare. However hip pain can often present with referred pain to the knee, and there are a number of hip syndromes affecting children and adolescents with potentially serious health outcomes.

Children aged from 4 to 18 may develop these issues. Symptoms of childhood hip disorders include:

  • Pain in the groin, front of the thigh or knee, especially with activity
  • Inability to walk or bear weight on the affected leg
  • A painless limp
  • Appearance of a leg length difference
  • Limited hip movement

It is important to remember that many other conditions, including some of the knee pain syndromes summarised above, can cause similar symptoms. For this reason it is important to have your child’s complaint professionally assessed.

Bone growths or tumours

These problems occur when cells within the bones grow in an uncontrolled or abnormal way, and are more common in bones that are growing quickly (i.e. children and adolescents).

Bone tumours are a rare but serious cause of knee pain (and pain elsewhere) in children. Symptoms include:

  • Pain unrelated to trauma, especially at night
  • A lump that might feel soft and warm
  • Fever, tiredness, and weight loss

Many conditions – including common childhood infections – can cause these symptoms, not just bone tumours. If your child has any of these symptoms and you are concerned, talk to your child’s doctor.


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