Evaluation and management of knee pain in young athletes: overuse injuries of the knee

Abstract

Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idiopathic anterior knee pain. Although, numerous anatomical and biomechanical factors have been postulated to contribute the knee pain in young athletes, the most common underlying reason is overuse injury. In this paper, we have reviewed selected conditions that case knee pain in athletes, including anterior knee pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johanssen syndrome, juvenile osteochondritis dissecans (JOCD), bipartite patella, plica syndrome, and tendonitis around the knee.

Keywords: Anterior knee pain syndrome; Osgood-Schlatter disease; Sinding-Larsen-Johanssen syndrome; bipartite patella; juvenile osteochondritis dissecans (JOCD); plica syndrome.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Patello-femoral compression or inhibition sign: with athlete supine and knee in extension, have the athlete contract the quadriceps. At the same time place the hand just proximal to patella to inhibit patellar gliding upwards. This will elicit pain in case of patellofemoral pain syndrome.

Figure 2

Plain X-ray showing osteochondritis dissecans lesion of the medial femoral condyle, as a radiolucent area.

Figure 3

Ober test: with the athlete on her side on the examination table, with affected side up, flex and circumduct the hip bringing it into full abduction and extension. In case of decreased ITB flexibility the knee fails to fall past neural.

Figure 4

Noble test: with the athlete supine on the examination table, flex the knee to 90 degrees and the hip to 45 degrees. Apply direct pressure over the lateral femoral condyle and passively extend the knee. In case of ITB friction syndrome, pain is elicited at 30 degrees of knee flexion.

Figure 5

Palpation of the popliteus over the lateral aspect of the knee.