Paediatrics – Knee

There are several conditions that can affect knees during childhood and adolescence, most commonly it is nothing to worry about but occasionally it can be the result of a condition that requires immediate Orthopaedic intervention.

If you are concerned about knee pain, you should make an appointment with your GP in the first instance and they will be able to ensure you are appropriately screened.

If you would like a more in depth understanding of the anatomy of the spine, check out – AnatomyZone – Your Guide to Human Anatomy and search ‘knee’.

Adolescent Anterior Knee Pain

What is it?

Anterior knee pain (AKP) is an umbrella term used to describe pain felt at the front of the knee or around the kneecap (patella). It can occur for a number of reasons but in under 18’s is most often related to growth and growth spurts. It is believed to occur in approximately 30% of all adolescents.

Would an X-ray help?

X-rays are often not required to diagnose anterior knee pain and are rarely done for this condition.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation x-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the x-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an x-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about x-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

  1. Advice sheet – normally following referral for knee pain you will be sent an advice sheet, if appropriate, with the option to contact physiotherapy for an appointment if the exercises do not work.
  2. Physiotherapy – Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation.
  3. Advanced Practitioner – If your knee pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  4. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  5. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.

Osgood Schlatters Disease

What is it?

Osgood Schlatters disease is a specific type of adolescent anterior knee pain. It is a result of the growth and growth spurts. The pain will be felt specifically over a small lump on the shin known as the tibial tubercle.

Would an x-ray help?

In the case of Osgood Schlatters an X-ray is often not required as the lump is often palpable.

X-rays work by passing a low level radiation through the body to produce an image. Due to the radiation x-rays will only be used if there is no other way to accurately diagnose the problem or if there is a concern that there may be a more serious problem. Radiologists (people who complete the x-rays) will only do one if they feel the referring clinician (such as a doctor, specialist physio or nurse practitioner) has given a valid reason for the risk of radiation. This means that you may have been referred for an x-ray but it has not been completed because the radiologists feel that other methods should be used to determine the problem first.

For more information about x-rays please see the NHS website below:

What are the pathways at East Sussex Healthcare Trust (ESHT)?

  1. Advice sheet – normally following referral for knee pain you will be sent an advice sheet, if appropriate, with the option to contact physiotherapy for an appointment if the exercises do not work.
  2. Physiotherapy – Options include advice, exercises, hands on therapy, acupuncture, hydrotherapy or gym-based rehabilitation.
  3. Advanced Practitioner – If your knee pain has not improved with Physiotherapy, a referral to the AP may be your next option. Here you can discuss current management options, including the merits of medical imagining.
  4. Orthopaedics – If the AP is concerned or imagining is completed and shows something abnormal an appointment with an orthopaedic consultant maybe advised. Further management and treatments can be discussed here; including surgical intervention if indicated (although this is rare in children and would need to be completed at a specialised centre).
  5. Pain Management Programme – Although not provided by ESHT. A referral into the Evelina Hospital in London’s Pain management programme may help for pain that is not resolving or does not have a specific medical cause.