Latest / MSKMag OutLoud / Children Are Not Mini Adults: Rethinking Sudden Anterior Knee Pain in the Skeletally Immature Athlete

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Children Are Not Mini Adults: Rethinking Sudden Anterior Knee Pain in the Skeletally Immature Athlete · MSKMag OutLoud

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  SPEAKER_00: Children are not mini adults.
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  SPEAKER_00: Rethinking sudden anterior knee pain in the skeletally immature athlete.
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  SPEAKER_00: A developmental approach to diagnosis and rehab for clinical physiotherapists.
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  SPEAKER_00: Written by Angie Jackson.
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  SPEAKER_00: Sponsored by Virillo.
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  SPEAKER_00: And if you click the link surrounding this audio or article,
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  SPEAKER_00: you can get a free guide to selling your MSK practice.
• 0:23
  SPEAKER_00: And you get expert insights from 100 or more transactions to help maximize the value
• 0:28
  SPEAKER_00: of your exit.
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  SPEAKER_00: A 12-year-old soccer player lands in knee flexion from a jump
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  SPEAKER_00: and develops sudden left-sided anterior knee pain.
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  SPEAKER_00: He cannot continue playing,
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  SPEAKER_00: is reluctant to flex the knee and describes giving way on weight-bearing.
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  SPEAKER_00: He cannot perform a straight leg raise or adequately contract quadriceps because
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  SPEAKER_00: of pain and has an effusion.
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  SPEAKER_00: Plane radiographs in the emergency department are reported normal
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  SPEAKER_00: and he is discharged without walking aids or follow-up.
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  SPEAKER_00: He presented for physiotherapy assessment.
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  SPEAKER_00: A story like this in a growing child should set alarm bells ringing.
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  SPEAKER_00: A normal x-ray does not mean nothing to worry about.
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  SPEAKER_00: Unless you know your paediatric anatomy and pathology,
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  SPEAKER_00: you may not appreciate that the tissue that fails under load depends entirely
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  SPEAKER_00: on skeletal maturity.
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  SPEAKER_00: Why adult reasoning isn't enough here.
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  SPEAKER_00: Adult MSK expertise remains highly relevant to paediatric practice.
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  SPEAKER_00: Clinical reasoning,
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  SPEAKER_00: exercise prescription and progressive loading principles still apply,
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  SPEAKER_00: but applying adult diagnoses and management
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  SPEAKER_00: without considering paediatric skeletal anatomy,
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  SPEAKER_00: growth and pathology can lead to incorrect diagnosis and inappropriate loading.
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  SPEAKER_00: Same location,
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  SPEAKER_00: same mechanism,
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  SPEAKER_00: same sporting load,
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  SPEAKER_00: but a growing skeleton can fail completely differently to a mature one.
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  SPEAKER_00: The growing knee isn't just a scaled-down adult knee.
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  SPEAKER_00: It's tempting to think of paediatric anatomy as adult anatomy scaled down.
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  SPEAKER_00: It isn't.
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  SPEAKER_00: A growing knee has structural features not present in the adult,
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  SPEAKER_00: and each changes how load, injury and imaging must be interpreted.
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  SPEAKER_00: Every bone has its own ossification timeline,
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  SPEAKER_00: opening a window for paediatric-specific pathologies that vary by site,
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  SPEAKER_00: sex and individual.
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  SPEAKER_00: Depending on his maturation status,
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  SPEAKER_00: our athlete likely has a partially cartilaginous,
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  SPEAKER_00: still ossifying patella with an active distal patella apophysis.
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  SPEAKER_00: In an adult, the patella tendon attaches directly to cortical bone.
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  SPEAKER_00: In a child,
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  SPEAKER_00: it attaches to the apophysis,
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  SPEAKER_00: which is structurally weaker than the mature bone and most vulnerable
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  SPEAKER_00: during rapid growth.
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  SPEAKER_00: The patella and its distal apophysis don't fully fuse until late adolescence.
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  SPEAKER_00: Once the physis closes, the injury patterns revert to adult ones.
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  SPEAKER_00: Knowing where a child sits on this timeline is central to getting the diagnosis right.