Question 1

How does ACL injury in children occur?

Accepted Answer

An ACL injury is most likely to occur when children are taking part in sports involving twisting, pivoting and jumping, such as football, netball, tennis and rugby, which are all played regularly in UK schools. Skiing, due to the pressure on the knee whilst the ankle is kept in a fixed position, is also one of the sports with a higher than average occurrence of ACL tears.

It can also occur with certain movements, such as a child jumping and landing hard on their feet. If the quadriceps muscles aren’t strong enough, a movement can suddenly put too much pressure on the knee joint, causing the ACL, a rope-like band of tissue, to tear or rupture.

The increasing number of ACL injuries in children may be due to a number of factors: many children are heavier; they are competing at a higher level from a younger age and more are taking part in extreme sports such as skiing and snowboarding.

The increasing role of strength and conditioning in youth sport; all-year round pitch availability; improvements in footwear technology and increasingly accurate diagnosis also play a part.

A higher average pace of play is now common, increasing the need for the participants to change direction more frequently resulting in higher stresses through the stabilising structure of the knee more often.

Teenage girls are between two and ten times more likely than boys to tear an ACL, due to their body shape, limb alignment, neuromuscular control, and the presence of hormones which might loosen the ligament.

Question 2

What are the symptoms of an ACL injury?

Accepted Answer

Usually with an ACL injury, there will be a popping sound. The child may also use their hands to demonstrate a severe twist of their knee or describe it as feeling wobbly or loose.

They will definitely feel pain when the ACL tear happens, however afterwards, they may or may not have symptoms, depending on the severity of the injury. Often there is pain, which can be intense, and swelling of the knee joint, which can happen within 24 hours of the injury occurring.

Most will have no problems walking. But if they try to go back to sport, they may have some instability, or be unable to bear weight on the affected knee.

Question 3

What should I do if I suspect my child or pupil has torn their ACL?

Accepted Answer

For any knee injury or following a ski fall or collision on the football or netball field, it is important to stop activity straight away. If the knee is swollen, ice should be applied for at least 20 minutes at a time, and the knee should be kept elevated.

A trip to A & E or a local minor injuries clinic is the first port of call, or to your GP, whichever is available soonest. If weight bearing is painful, your child should be kept off their feet until you can get them assessed.

If your child has any of the symptoms of a ligament injury mentioned above, you must insist on getting a referral to a knee specialist, who is an expert in ligament injuries. Your consultant will need an MRI scan to confirm the diagnosis, so request that your child is referred for a scan at the same time.

While an X-ray might be taken at A & E, this will only show bone damage, so will be used to rule out a fracture or break. An MRI scan, which assesses ligaments and muscles can confirm a partial or complete ACL tear so you really need one to confirm diagnosis.

It is extremely important to see a knee specialist early if you suspect ligament damage. The average time from knee ligament injury to fixing the problem is four weeks in Australia, the US and many European countries. Unfortunately, it can take 18 months in the UK by which time there is usually significant secondary damage to the joint surface and meniscus shock absorbers which is bad news. This is why our outcomes are less than ideal and lagging behind the rest of the world.

Question 4

Who is most at risk of osteochondritis?

Accepted Answer

Children and teenagers who take part in sport are more likely to develop the condition and it’s also more common in boys.

Question 5

What are the symptoms of osteochondritis?

Accepted Answer

Symptoms include pain, swelling, stiffness and/or weakness in the joint. There may also be a feeling of the joint ‘popping’ and, in some cases, locking.

Question 6

How is osteochondritis diagnosed?

Accepted Answer

Adrian will discuss your child’s symptoms with you and carry out an examination of the knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, he will arrange for them to have an X-ray to confirm the diagnosis. The final diagnosis is made with an MRI scan.

Question 7

How is it treated?

Accepted Answer

In most cases, resting and taking the weight off the knee for a period of time will settle things. Adrian may also advise that your child has a course of physiotherapy to strengthen the muscles and tendons around the joint. However, in some cases, he may advise that your child has surgery to fix the bone and cartilage fragment that have partially detached.

Types of osteochondritis include:

Osgood-Schlatter disease
Pain and swelling in the bony lump that lies just below the kneecap can be caused by Osgood-Schlatter disease.
What causes Osgood-Schlatter disease?
Osgood-Schlatter disease is caused by a bone at the top of the shin bone becoming affected during a growth spurt. It’s more common if your child takes part in sports that include running and jumping or where there is repeated stress on the knees.
What are the symptoms of Osgood-Schlatter disease?
The most common symptom is the formation of a bony growth where the patella tendon joins the shin bone.
How is Osgood-Schlatter disease diagnosed?
Adrian will discuss your child’s symptoms with you and carry out an examination of the knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, he will arrange for them to have an X-ray to confirm the diagnosis.
How is Osgood-Schlatter disease treated?
In most cases, resting, along with taking painkillers (as prescribed by your doctor) is enough to relieve the symptoms and your child is likely to make a complete recovery by the time he or she stops growing. Surgery is only very rarely necessary. However, children with Osgood-Schlatter syndrome will still have a bony lump on the front of the shin bone, even after surgery.
Sinding-Larsen-Johansson syndrome
This painful condition often affects teenagers during growth spurts.
What causes Sinding-Larsen-Johansson syndrome?
It’s caused by repetitive strain on the patella tendon which causes the growth plate to become inflamed and painful. It’s more common in boys aged 10-15. It’s sometimes described as the childhood equivalent to jumper’s knee.
How is Sinding-Larsen-Johansson syndrome diagnosed?
Adrian will discuss your child’s symptoms with you and carry out an examination of the knee to check for tenderness, stiffness, swelling and any difficulties with movement. In most cases, he will arrange for them to have an X-ray to confirm the diagnosis.
How is Sinding-Larsen-Johansson syndrome treated?
In most cases, resting, along with taking painkillers (as prescribed by your doctor) is enough to relieve the symptoms and your child is likely to make a complete recovery by the time he or she stops growing. Surgery is only recommended in around 5% of cases.

Knee problems in children