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Arthroscopy in Children and Teenagers (Ages 8 to 18)
Edited By: Gregory A. Schmale, M.D.
Last updated Friday, July 22, 2005
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Review of the conditionCharacteristics of meniscal tears in the knee of adolescents and children Meniscal tears usually occur following a twisting injury. The tears
produce knee swelling and stiffness, and may result in locking (when
the knee gets stuck in one position) or catching (when the knee does
not move smoothly went bent and straightened), and are often
accompanied by pain with standing, walking, running, and especially
squatting.
During a physician examination, patients with a
meniscal tear may experience discomfort with full flexion (bending) or
full extension (straightening) of the knee. The knee is also often
tender along the joint line between the thigh and leg or shin bones. In
addition, patients may experience discomfort when their knee is flexed
and gently twisted.
Types Meniscal tears may occur along the outer edge of the meniscus, allowing
a strip of meniscus (attached at either end to the tibia.) to flip
upward into the knee joint like the handle of a bucket. The tears may
occur in the front or the back of the knee (anterior or posterior
tears). The tears may be a flap shape or a simple vertical or
horizontal split, or the be result of an abnormal formation of the
meniscus, which is called a “discoid meniscus” (Figures D and E).
Normally,
the meniscus should look like a C-shaped ring, broad on the outside
edge and thin on the inside. A discoid meniscus is a piece of cartilage
shaped like a pancake or disc where a ring ought to be. This pancake
shape tends to lead to frequent meniscal tears. They are found in the
lateral side of the knee in approximately 5 percent of people of
western European heritage and 10 to 15 percent of those of Asian
heritage.
Similar conditions
Anterior knee pain may have many similar symptoms as meniscal tears,
but the knee rarely swells with anterior knee pain. The discomfort in a
patient with anterior knee pain often lies under the knee cap and is
frequently the result of tight quadriceps and hamstring (thigh) muscles.
Incidence and risk factors
As young athletes play more sports at greater intensity, meniscal tears
are now being seen more than ever before. Those playing cutting or
rapid direction-changing sports (such as soccer, basketball, tennis,
skiing, and gymnastics) are at greater risk for meniscal tears.
Diagnosis
Examination by a physician of the patient’s knee swelling,
tenderness between the thigh bone and leg bone, pain during knee movements, as
well as the level and location of pain when squatting will help a physician
diagnose meniscal tears. An MRI (magnetic resonance image) study of the knee is
often used to help diagnose meniscal tears.
In some cases, when the patient’s history and exam suggest a
tear but an MRI does not reveal it, the surgeon may suggest a diagnostic
arthroscopy for patients whose condition doesn’t improve through physical
therapy. Medications
Medications may relieve the discomfort temporarily associated with
meniscal tears, but they would not be expected to lead to healing of
the tear. Meniscal tears may heal on their own, if they are small
enough and are located in the outer edge of the meniscus.
Exercises
Exercise can be helpful in some cases of meniscal tears. Some tears
(i.e. small tears near the edge of the meniscus) may heal on their own
and may become asymptomatic over time. Studies suggest that knee
arthritis may occur later in a knee with a torn meniscus that is left
untreated than a knee with a trimmed or repaired meniscus. Thus, if a
patient can perform his or her sports of choice without undue
discomfort with a torn meniscus, that may be preferable to surgery.
Quadriceps and especially hamstring strengthening may help a patient
return to their activities sooner. However, a torn meniscus is at risk
for further tearing, potentially causing greater disability to a knee.
This should be considered when deciding whether to pursue treatment.
Possible benefits of minimally-invasive surgery for a torn meniscus in athletic children
Repairing a torn meniscus when possible and trimming a torn meniscus
when necessary, may improve the range of motion of a knee, the comfort
of the patient and the overall function of the limb. However, these
treatments may also increase the risk of early arthritis.
Surgery for Meniscal tears in the knee of adolescents and children at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-987-3700 to make an appointment. Our clinical center is located in Seattle Washington, USA
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