Abstract
Purpose
To investigate the knee arthroscopic findings of pediatric patients with knee pain.
Subjects
Ninety-five knees of 94 patients (46 males and 48 females) aged 15 years or younger who underwent knee arthroscopy during a 4-year period from January 2007 were studied. The mean age at surgery was 13.5 (7–15) years. The mean interval from symptom onset to arthroscopic examination was 6.8 months (5 days to 2 years 10 months).
Results
The most common cause of knee pain was sports-related activities (64 knees). Other causes included falling from a moving bicycle (5 knees), while knee pain appeared with no defined reason in 14 knees. The most frequent final diagnosis based on knee arthroscopic findings was anterior cruciate ligament (ACL) injury (35 knees), followed by discoid lateral meniscus (16 knees), lateral meniscal tear (11 knees), and medial plica syndrome (9 knees), while no arthroscopic abnormality was observed in 8 of 95 knees. Among the 95 knees, the diagnosis based on preoperative physical tests and imaging findings was different from the arthroscopic diagnosis in 16 knees, 8 of which were diagnosed preoperatively as medial meniscal tear.
Conclusion
ACL injury and discoid lateral meniscus were the predominant conditions in pediatric patients who underwent knee arthroscopic surgery for knee pain. Knee arthroscopy is useful to provide a definitive diagnosis for knee pain in pediatric patients. Preoperative evaluations had a diagnostic accuracy of only 83.2 % and failed to diagnose conditions such as medial plica syndrome and chondral injury. Therefore, diagnosis before knee arthroscopy has to be interpreted with caution.
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References
Accadbled F (2010) Arthroscopic surgery in children. Orthop Traumatol Surg Res 96(4):447–455
Accadbled F, Cassard X, Sales de Gauzy J, Cahuzac JP (2007) Meniscal tears in children and adolescents: results of operative treatment. J Pediatr Orthop B 16(1):56–60
Ahn JH, Shim JS, Hwang CH, Oh WH (2001) Discoid lateral meniscus in children: clinical manifestations and morphology. J Pediatr Orthop 21(6):812–816
Binfield PM, Maffulli N, Good CJ, King JB (2000) Arthroscopy in sporting and sedentary children and adolescents. Bull Hosp Jt Dis 59(3):125–130
Bouju Y, Carpentier E, Bergerault F, De Courtivron B, Bonnard C, Garaud P (2011) The concordance of MRI and arthroscopy in traumatic meniscal lesions in children. Orthop Traumatol Surg Res 97(7):712–718
Deblock N, Mazeau P, Ceroni D, Scotto Di Luzio A, Meyer Zu, Reckendorf G, Dimeglio A (2001) Knee arthroscopy in children. Rev Chir Orthop Reparatrice Appar Mot 87(4):355–360
Faraj AA, Schilders E, Martens M (2000) Arthroscopic findings in the knees of preadolescent children: report of 23 cases. Arthroscopy 16(8):793–795
Fehnel DJ, Johnson R (2000) Anterior cruciate injuries in the skeletally immature athlete: a review of treatment outcomes. Sports Med 29(1):51–63
Flynn JM, Kocher MS, Ganley TJ (2004) Osteochondritis dissecans of the knee. J Pediatr Orthop 24(4):434–443
Fuchs R, Wheatley W, Uribe JW, Hechtman KS, Zvijac JE, Schurhoff MR (2002) Intra-articular anterior cruciate ligament reconstruction using patellar tendon allograft in the skeletally immature patient. Arthroscopy 18(8):824–828
Good CR, Green DW, Griffith MH, Valen AW, Widmann RF, Rodeo SA (2007) Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy 23(2):157–163
Kocher MS, DiCanzio J, Zurakowski D, Micheli LJ (2001) Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents. Am J Sports Med 29(3):292–296
Kocher MS, Tucker R, Ganley TJ, Flynn JM (2006) Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 34(7):1181–1191
Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL (2008) Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Am J Sports Med 36(7):1283–1289
Ochiai S, Hagino T, Watanabe Y, Senga S, Haro H (2011) One strategy for arthroscopic suture fixation of tibial intercondylar eminence fractures using the meniscal viper repair system. Sports Med Arthrosc Rehabil Ther Technol 3:17
Reynders P, Reynders K, Broos P (2002) Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation. J Trauma 53(1):49–54
Sarpel Y, Ozkan C, Togrul E, Tan I, Gulsen M (2007) Arthroscopy of the knee in pre-adolescent children. Arch Orthop Trauma Surg 127(4):229–234
Siparsky PN, Kocher MS (2009) Current concepts in pediatric and adolescent arthroscopy. Arthroscopy 25(12):1453–1469
Stanitski CL (1998) Correlation of arthroscopic and clinical examinations with magnetic resonance imaging findings of injured knees in children and adolescents. Am J Sports Med 26(1):2–6
Suenaga E, Fukushima K, Ono M (2004) Arthroscopic findings for the knee of children aged 15 years or less. J Jpn Ped Orthop Assoc (Japanese) 13(2):141–146
Takeda Y, Ikata T, Yoshida S, Takai H, Kashiwaguchi S (1998) MRI high-signal intensity in the menisci of asymptomatic children. J Bone Joint Surg Br 80(3):463–467
Tallón-López J, Barón-Pérez Y, Flores-Ruiz MA (2007) Arthroscopic findings in children’s and adolescents’ Knees. Rev Ortop Traumatol (Madr.) 51:237–244
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Hagino, T., Ochiai, S., Watanabe, Y. et al. Usefulness of knee arthroscopy for diagnosis of knee pain in pediatric patients: comparison with preoperative clinical diagnosis. Arch Orthop Trauma Surg 133, 669–673 (2013). https://doi.org/10.1007/s00402-013-1725-6
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DOI: https://doi.org/10.1007/s00402-013-1725-6