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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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SummaryOverview Active children and teenagers sometimes can have structural injuries to
their knees. The meniscus, which is a shock-absorbing cartilage in the
knee, can tear; often these painful injuries are treated surgically,
using a minimally-invasive procedure called arthroscopy. Using
arthroscopy, surgeons can repair or trim torn meniscus cartilages,
which can relieve pain and often return the child or teen to a high
level of athletic function.
The knee is made up of the femur
(thigh bone), the tibia (leg or shin bone), and the patella (knee cap),
which are held together by ligaments. Between the femur and the tibia
are two rings that are like bumpers, one on the medial (inner) side of
the knee called the medial meniscus (Figure 1), and one on the lateral
(outer) side of the knee called the lateral meniscus (Figure 2). The
meniscus functions to improve the fit between the femur and the tibia,
to absorb shock and distribute weight in the knee, and to help move
lubricating fluid around the knee. The meniscus is made of a type of
cartilage which gives it a rubbery texture. However, within the
meniscus there are also fibers of collagen that help maintain the shape
of the meniscus. The meniscus has blood supply only at its outer
attachments. In adolescents and adults, about 4/5 of a meniscus has no
blood supply and so tears in this inner 4/5 of meniscus will usually
not heal. In younger children, more of the meniscus has a blood supply,
so tears have a greater potential to heal. Tears larger than about one
centimeter in length also have a low chance of healing on their own, so
repair of the torn tissue is an excellent and often necessary way to
help nature’s healing along. Trimming of a torn meniscus that has a low
capacity to heal, even with the help of sutures or other repair
devices, is the next best treatment to repair when repair is unlikely
to be successful.
Tears are usually caused by sudden twists of
the knee, though sudden bending forces from the side of the knee may
also cause injury to the meniscus. A torn meniscus can cause pain with
standing, walking, or bending of the knee. In the long term, a knee
with a large meniscal tear and a knee missing some meniscus because of
surgical removal both have a greater chance of developing arthritis.
Meniscal tears usually cause swelling of the knee, and they may cause
the knee to be locked in one position or merely decrease the total
flexion and extension of the knee (Figures 3 and 4).
Meniscal
tears larger than about one centimeter or located in the inner or more
central portion of the meniscus often do not heal on their own, so
surgery is likely the quickest way to return an athlete to their sport
or a person to their normal daily activities.
Meniscal repair,
whenever possible, is always recommended for patients as it may
decrease the risk of future arthritis. Meniscal repair in children may
also have a greater likelihood of success because of the better blood
supply to the meniscus, and blood brings healing factors to the tear.
The result of a meniscal repair is typically pain-free function of the
knee.
A patient with a knee locked from a piece of torn meniscus
in the joint should experience a return to more normal function after
repair. If a repair is not possible, because of the location of the
tear or the condition of the piece of torn meniscus, trimming or
removal of the torn piece of meniscus is the next-best treatment,
allowing an earlier return to sports — but at the risk of earlier
wear-and-tear arthritis in the knee.
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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