Anterior knee pain in paediatrics: Key imaging findings

Fatima Ahmad

Abstract


Abstract

 

Anterior knee pain is common in the paediatric population due to the nature of the immature skeleton and the effects of increased physical activity. Particularly in the growing paediatric knee, there are a wide variety of pathologies and normal variants which can make radiological assessment challenging. Thus, the underlying cause of anterior knee pain is important to identify as it impacts on quality of life. Due to the increased reliance on radiology and technological advancements, we discover more pathology contributing to anterior knee pain.  Radiological assessment is the mainstay for investigating causes of knee pain, particularly, plain film, MRI and ultrasound. The purpose of this article is to review the anatomy of the normal knee to demonstrate the structures that are likely to be involved, and to illustrate the causes of anterior knee pain in this population.


Keywords


knee; paediatrics; pathology; pain

Full Text:

PDF

References


References

Akdag, T., Guldogan, E.S., Coskun, H., Turan, A. and Hekimoglu, B. (2019). Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms. Polish Journal of Radiology, [online] 84, pp.e491–e497. doi:https://doi.org/10.5114/pjr.2019.91163.

Berger R, Yen Y. Bipartite Patella - Pediatrics - Orthobullets. Orthobullets.com. https://www.orthobullets.com/pediatrics/4049/bipartite-patella. Published 2021.

Yaniv, M. and Blumberg, N. (2007). The discoid meniscus. Journal of Children’s Orthopaedics, [online] 1(2), pp.89–96. doi:https://doi.org/10.1007/s11832-007-0029-1.

Birchard, Z., Herron, T. and Tuck, J.A. (2022). Discoid Meniscus. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470370/

García-Valtuille R, Abascal F, Cerezal L, et al. Anatomy and MR imaging appearances of synovial plicae of the knee. RadioGraphics 2002;22(4):775–784.

Flores, D.V., Mejía Gómez, C. and Pathria, M.N. (2018). Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain. RadioGraphics, 38(7), pp.2069–2101. doi:10.1148/rg.2018180048.

Warden S, Brukner P. Patellar tendinopathy. Clin Sports Med. 2003;22(4):743-759. doi:10.1016/s0278-5919(03)00068-1

Acute Lateral Patellar Dislocation at MR Imaging: Injury Patterns of Medial Patellar Soft Tissue Restraints and Osteochondral Injuries of the Inferomedial Patella | Radiology (rsna.org)

Zaidi, A., Babyn, P., Astori, I., White, L., Doria, A. and Cole, W. (2006). MRI of traumatic patellar dislocation in children. Pediatric Radiology, [online] 36(11), p.1163. Available at: https://www.academia.edu/25882396/MRI_of_traumatic_patellar_dislocation_in_children [Accessed 5 Mar. 2023].

Dickens, A.J., Morrell, N.T., Doering, A., Tandberg, D. and Treme, G. (2014). Tibial Tubercle-Trochlear Groove Distance: Defining Normal in a Pediatric Population. Journal of Bone and Joint Surgery, 96(4), pp.318–324. doi:https://doi.org/10.2106/jbjs.m.00688.

Ladenhauf H, Seitlinger G, Green D. Osgood–Schlatter disease: a 2020 update of a common knee condition in children. Curr Opin Pediatr. 2020;32(1):107-112. doi:10.1097/mop.0000000000000842

Hirano, Atsushi, et al. “Magnetic Resonance Imaging of Osgood-Schlatter Disease: The Course of the Disease.” Skeletal Radiology, vol. 31, no. 6, 2002, pp. 334–342., doi:10.1007/s00256-002-0486-z.

Cleveland Clinic. Sinding-Larsen-Johansson Syndrome: Diagnosis & Treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22530-sinding-larsen johansson-slj-syndrome. Published 2022. Accessed August 26, 2022.

Alassaf N. Acute presentation of Sinding-Larsen-Johansson disease simulating patella sleeve fracture: A case report. SAGE Open Med Case Rep. 2018 Sep doi: 10.1177/2050313X18799242.

King D, Yakubek G, Chughtai M et al. Quadriceps tendinopathy: a review, part 2— classification, prognosis, and treatment. Ann Transl Med. 2019;7(4):72-72. doi:10.21037/atm.2019.01.63

Arkader A, Warner WC, Jr., Horn BD, Shaw RN, Wells L. Predicting the outcome of physeal fractures of the distal femur. Journal of Pediatric Orthopaedics. 2007;27(6):703– 708.

Czitrom AA, Salter RB, Willis RB. Fractures involving the distal epiphyseal plate of the femur. International Orthopaedics. 1981;4(4):269–277.

Clement, N.D. and Goswami, A. (2009). Salter-Harris II injury of the proximal tibial epiphysis with both vascular compromise and compartment syndrome: a case report. Journal of Orthopaedic Surgery and Research, [online] 4, p.23. doi:10.1186/1749-799X4-23.

Verzin, E.J., Kealey, D., Adair, A., Sloan, S. and Dilworth, G.R. (2001). Salter harris type I fracture of the proximal tibial epiphysis. The Ulster Medical Journal, [online] 70(2), pp.136–138.

Kizaki, K., Yamashita, F. and Funakoshi, N. (2018). Serial Radiographs Showing Progression of a Patellar Stress Fracture and Beneficial Surgical Technique for a Displaced Patellar Stress Fracture. Knee Surgery and Related Research, [online] 30(1), pp.89–92. doi:https://doi.org/10.5792/ksrr.17.044.

Schmidt-Hebbel, A., Eggers, F., Schütte, V., Achtnich, A. and Imhoff, A.B. (2020). Patellar sleeve avulsion fracture in a patient with Sinding-Larsen-Johansson syndrome: a case report. BMC Musculoskeletal Disorders, 21(1). doi:https://doi.org/10.1186/s12891-020-03297-z.

Hunt, D.M. and Somashekar, N. (2005). A review of sleeve fractures of the patella in children. The Knee, 12(1), pp.3–7. doi:https://doi.org/10.1016/j.knee.2004.08.002.

Boushnak, M.O., Moussa, M.K., Abed Ali, A.A., Mohsen, Z.H. and Chamseddine, A.H. (2020). Patellar Sleeve Fracture in an Eight-Year-Old Girl. Cureus. doi:https://doi.org/10.7759/cureus.10345.

Sanchez, R. and Strouse, P.J. (2009). The knee: MR imaging of uniquely pediatric disorders. Magnetic Resonance Imaging Clinics of North America, [online] 17(3), pp.521–537, vii. doi:10.1016/j.mric.2009.03.008. Infrapatellar bursitis

Donahue F, Turkel D, Mnaymneh W, Ghandur-Mnaymneh L. Hemorrhagic prepatellar bursitis. Skeletal Radiol 1996;25(3):298–301.

Steinbach LS, Stevens KJ. Imaging of cysts and bursae about the knee. Radiol Clin North Am 2013;51(3):433–454.

Rammanohar, J., Zhang, C., Thahir, A. and Krkovic, M. (2021). Imaging of Non-ossifying Fibromas: A Case Series. Cureus. doi:https://doi.org/10.7759/cureus.14102.

Fecek, C. and Carter, K.R. (2022). Pigmented Villonodular Synovitis. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK549850/.

Fałek, A., Niemunis-Sawicka, J., Wrona, K., Szczypiór, G., Rzepecka-Wejs, L., Cięszczyk, K., Burdan, M., Puderecki, M., Burzec, P., Marzec-Kotarska, B., Szumiło, J. and Burdan, F. (2018). Pigmented villonodular synovitis. FOLIA MEDICA CRACOVIENSIA, [online] LVIII, pp.93–104. doi:https://doi.org/10.24425/fmc.2018.125707.

Tritschler, P., Baudrez, V. and Mutijima, E. (n.d.). Diffuse Pigmented Villonodular Synovitis of the Subtalar Joint. Journal of the Belgian Society of Radiology, [online] 102(1), p.11. doi:https://doi.org/10.5334/jbsr.1477.

Cheng, X.G., You, Y.H., Liu, W., Zhao, T. and Qu, H. (2004). MRI features of pigmented villonodular synovitis (PVNS). Clinical Rheumatology, 23(1), pp.31–34. doi:https://doi.org/10.1007/s10067-003-0827-x.

Garcia, R.A., Inwards, C.Y. and Unni, K.K. (2011). Benign bone tumors--recent developments. Seminars in Diagnostic Pathology, [online] 28(1), pp.73–85. doi:https://doi.org/10.1053/j.semdp.2011.02.013.

Motamedi, K. and Seeger, L.L. (2011). Benign Bone Tumors. Radiologic Clinics of North America, 49(6), pp.1115–1134. doi:https://doi.org/10.1016/j.rcl.2011.07.002.

Arndt, C.A.S., Rose, P.S., Folpe, A.L. and Laack, N.N. (2012). Common Musculoskeletal Tumors of Childhood and Adolescence. Mayo Clinic Proceedings, 87(5), pp.475–487. doi:https://doi.org/10.1016/j.mayocp.2012.01.015.

Pan, K.L., Chan, W.H. and Chia, Y.Y. (2010). Initial Symptoms and Delayed Diagnosis of Osteosarcoma around the Knee Joint. Journal of Orthopaedic Surgery, 18(1), pp.55– 57. doi:https://doi.org/10.1177/230949901001800112.

Kundu, Z. (2014). Classification, imaging, biopsy and staging of osteosarcoma. Indian Journal of Orthopaedics, 48(3), p.238. doi:https://doi.org/10.4103/0019-5413.132491.

Durer, S. and Shaikh, H. (2020). Cancer, Ewing Sarcoma. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559183/.

Laor, T. (2004). MR imaging of soft tissue tumors and tumor-like lesions. Pediatric Radiology, 34(1), pp.24–37. doi:https://doi.org/10.1007/s00247-003-1086-3.

Schoot, R.A., McHugh, K., van Rijn, R.R., Kremer, L.C.M., Chisholm, J.C., Caron, H.N. and Merks, J.H.M. (2013). Response Assessment in Pediatric Rhabdomyosarcoma: Can Response Evaluation Criteria in Solid Tumors Replace Three-dimensional Volume Assessments? Radiology, 269(3), pp.870–878. doi:https://doi.org/10.1148/radiol.13122607.

van der Have, N., Nath, S.V., Story, C., Tapp, H., Nicola, C., Moore, S., Sutton, R. and Revesz, T. (2012). Differential diagnosis of paediatric bone pain: Acute lymphoblastic leukemia. Leukemia Research, [online] 36(4), pp.521–523. doi:https://doi.org/10.1016/j.leukres.2012.01.001.

Onciu, M. (2009). Acute Lymphoblastic Leukemia. Hematology/Oncology Clinics of North America, 23(4), pp.655–674. doi:https://doi.org/10.1016/j.hoc.2009.04.009.

Tannenbaum, M.F., Noda, S., Cohen, S., Rissmiller, J.G., Golja, A.M. and Schwartz, D.M. (2020). Imaging Musculoskeletal Manifestations of Pediatric Hematologic Malignancies. American Journal of Roentgenology, 214(2), pp.455–464. doi:https://doi.org/10.2214/ajr.19.21833.

Marshall, R.A., Mandell, J.C., Weaver, M.J., Ferrone, M., Sodickson, A. and Khurana, B. (2018). Imaging Features and Management of Stress, Atypical, and Pathologic Fractures. RadioGraphics, 38(7), pp.2173–2192. doi:https://doi.org/10.1148/rg.2018180073.

Chotel, F., Unnithan, A., Chandrasekar, C.R., Parot, R., Jeys, L. and Grimer, R.J. (2008). Variability in the presentation of synovial sarcoma in children. The Journal of Bone and Joint Surgery. British volume, 90-B(8), pp.1090–1096. doi:https://doi.org/10.1302/0301-620x.90b8.19815.

Eilber, F.C. and Dry, S.M. (2008). Diagnosis and management of synovial sarcoma. Journal of Surgical Oncology, 97(4), pp.314–320. doi:https://doi.org/10.1002/jso.20974.

Osteonecrosis of the Hip: A Primer. (2019). The Permanente Journal. [online] doi:https://doi.org/10.7812/tpp/18-100.

Tang, Y.M., Jeavons, S., Stuckey, S., Middleton, H. and Gill, D. (2007). MRI features of bone marrow necrosis. AJR. American journal of roentgenology, [online] 188(2), pp.509– 514. doi:https://doi.org/10.2214/AJR.05.0656.

Shea, K.G., Jacobs, J.C., Carey, J.L., Anderson, A.F. and Oxford, J.T. (2013). Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology. Clinical Orthopaedics & Related Research, 471(4), pp.1127–1136. doi:https://doi.org/10.1007/s11999-012-2619-6.

Kijowski, R., Blankenbaker, D.G., Shinki, K., Fine, J.P., Graf, B.K. and De Smet, A.A. (2008). Juvenile versus Adult Osteochondritis Dissecans of the Knee: Appropriate MR Imaging Criteria for Instability. Radiology, 248(2), pp.571–578. doi:https://doi.org/10.1148/radiol.2482071234




DOI: http://dx.doi.org/10.36162/hjr.v9i1.620

Refbacks

  • There are currently no refbacks.