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ERIC SMALL, MD, FAAP Assistant Clinical Professor of Pediatrics, Orthopedics, and Rehabilitation Medicine Mount Sinai School of Medicine Mount Sinai School.

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Presentation on theme: "ERIC SMALL, MD, FAAP Assistant Clinical Professor of Pediatrics, Orthopedics, and Rehabilitation Medicine Mount Sinai School of Medicine Mount Sinai School."— Presentation transcript:

1 ERIC SMALL, MD, FAAP Assistant Clinical Professor of Pediatrics, Orthopedics, and Rehabilitation Medicine Mount Sinai School of Medicine Mount Sinai School of Medicine New York, New York New York, New York Director Sports Medicine Center for Young Athletes Blythedale Children’s Hospital

2 Common Knee Injuries in the Pediatric Patient

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4 Differential Diagosis Orthopedic/Musculoskeletal ConditionOrthopedic/Musculoskeletal Condition Medical ConditionMedical Condition u Lyme Disease u JRA u SLE u RSD/Fibromyalgia

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

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

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

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

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

10 Key Questions Immediate Swelling?Immediate Swelling? Able to continue to play?Able to continue to play? Full or Partial Weightbearing?Full or Partial Weightbearing?

11 SwellingSwelling Immediate SwellingImmediate Swelling Swelling Several hours laterSwelling Several hours later Swelling Next DaySwelling Next Day

12 PainPain Pain with activityPain with activity Pain after activityPain after activity Pain the next dayPain the next day

13 SymptomsSymptoms LockingLocking ClickingClicking Giving WayGiving Way

14 Physical Exam SwellingSwelling Point TendernessPoint Tenderness Comparison with other kneeComparison with other knee

15 Physical Exam SwellingSwelling Point TendernessPoint Tenderness Comparison with other kneeComparison with other knee

16 Physical Exam SwellingSwelling Point TendernessPoint Tenderness Comparison with other kneeComparison with other knee

17 Physical Exam SwellingSwelling Point TendernessPoint Tenderness Comparison with other kneeComparison with other knee

18 Special Tests Anterior Drawer TestAnterior Drawer Test Lachman TestLachman Test McMurray TestMcMurray Test Apley TestApley Test

19 COMMON 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

20 PATELLAFEMORAL PAIN SYNDROME Chondromalacia PatellaeChondromalacia Patellae Anterior Knee PainAnterior Knee Pain Runner’s KneeRunner’s Knee

21 PRESENTING 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

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

23 PHYSICAL 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

24 MANAGEMENTMANAGEMENT Decrease running by 30 - 50%Decrease running by 30 - 50% Straight leg raising to 10 pounds (VMO)Straight leg raising to 10 pounds (VMO) McConnell TapingMcConnell Taping If fail conservative management lateral release and plica resectionIf fail conservative management lateral release and plica resection

25 OSD 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

26 OSD HISTORY In peak growth spurtIn peak growth spurt Pain with running and squattingPain with running and squatting

27 OSD PHYSICAL Pain at tibial tuberclePain at tibial tubercle Extremely tight hamstrings (SLR 30 degrees)Extremely tight hamstrings (SLR 30 degrees)

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29 OSD 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- outNeoprene Knee sleeve with patella cut- out Do not immobilizeDo not immobilize Biking and swimming encouragedBiking and swimming encouraged

30 Patella Tendonitis More common in adolescence in association with Osgood Schlatter or SLJMore common in adolescence in association with Osgood Schlatter or SLJ

31 Patella Tendonitis Treatment Ice MassageIce Massage Hamstring/Quad StrengtheningHamstring/Quad Strengthening Biking/SwimmingBiking/Swimming Decrease Impact activities by 30-50%Decrease Impact activities by 30-50%

32 SINDING LARSEN JOHANNSON SYNDROME Pain at inferior pole of patellaPain at inferior pole of patella juvenile osteochondrosisjuvenile osteochondrosis jumper’s kneejumper’s knee

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34 SLJ Treatment Decrease Training by 30-50%Decrease Training by 30-50% Hamstring/Quad StretchingHamstring/Quad Stretching Biking/SwimmingBiking/Swimming

35 COMMON 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

36 COMMON 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

37 ACL 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 caseSurgery is dependent on individual case

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