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The anatomical structures of the knee relevant to the present discussion are shown in Figures 26-1 and 26-2.
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Acute injuries of the knee can cause sprains, dislocations, or fractures (Table 26-1). The anterior cruciate ligament (ACL) itself is injured most often in youth sports such as football and soccer, although this injury can happen in any sport, which involves running, cutting, or jumping. ACL injuries are more common in older adolescent athletes nearing skeletal maturity. There are also gender differences in ACL injury in adolescent athletes. One Norwegian study demonstrated a 5.4 fold increased risk of ACL injury in female athletes in matched soccer cohorts aged 15 to 18 years. In addition, the female athletes had a much lower rate of return to play following treatment than males.1 Isolated posterior cruciate ligament injuries are uncommon in skeletally immature athletes, and may occur in sports such as football. The medial collateral ligament is one of the most commonly injured structures in the knee. Meniscal tears are not common in children and adolescents. Meniscal tears are more common in sports such as soccer, football, and wrestling, but have been reported in may other sports. There is greater variability in the types of meniscus tears in the young athlete, but horizontal tears are relatively uncommon.2–4
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The mechanisms of injuries are reviewed below under discussion of specific injuries.
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The athlete may be seen by the pediatrician on the field or the sideline or later in the office. On the field, the athlete may present with a history of an injury to the knee or the leg following a fall, sudden twisting of the leg, or collision with another player. Rapid onset swelling, radiation of the pain, numbness, paresthesias, and sensation of cold, distal to knee may suggest neurovascular involvement, typically associated with displaced fractures or dislocations, that need urgent appropriate surgical consultation and treatment.
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Most cases are seen by pediatricians in the office setting when the athlete is seen either for a follow-up after seen on the field or the emergency department, or for initial visit following the injury. Key elements of the history are listed in ...