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Date of last update: 9/9/2017.

Forum Name: Pediatric Topics

Question: Pediatric Knee Problem

 JustDionne - Wed Jun 29, 2005 2:52 pm

My daughter who is now 9 years old has been able to "pop" the bone in her shin where it attaches to the knee in and out at will since she was 3 years old. Our family doctor insisted that the knee didn't require any intervention. He said that children often have "soft" bones and ligament connections don't always tighten until they are much older. As the ability to do this knee thing didn't seem to be causing her pain, he insisted we leave it alone and evaluate it later if it began to bother her. Granted, it didn't seem to bother her so we did leave it alone, but I've insisted that she quit popping it in and out just for the fun of it. Now, she seems to be having lots of problems with her knee. She complains of pain in it constantly - sometimes worse than others. When she is on it for a prolonged period, she actually retains quite a bit of fluid on it. And now I notice that occassionally the knee just seems to give out on her making her fall. I've taken her back to the family doctor for the problem, but he says that it is Austen-Schlatters (sp?) and there really isn't anything to do but exercise it regularly and take motrin for the pain. That just doesn't seem right. She is quite active already and given being on it for a long period makes it retain fluid and really hurt, I just don't think this is the best advice. I am afraid that we've waited too long to treat this correctly. I am afraid to take her to a regular orthopedic doctor, but can't get an appointment with a pediatric orthopedic doctor for many months. Any suggestions what this might be? And should I give in a take her to a regular orthopedic doctor instead of waiting for the pediatric ortho at Children's Hospital? Thanks.
 Dr. Heba Ismail - Fri Jul 01, 2005 3:31 am

Dear JustDionne,
Osgood-Schlatter disease occurs in children and adolescent athletes where repetitive extension of the knee causes inflammation and injury of the tibial tubercle (of the bone itself).
The tibial tubercle is the protuberant knob on the front of the tibia, a couple of inches below the knee, where the patellar tendon attaches. This pain is typically worse when extending the leg. The tibial tubercle is painful and tender to touch and over time begins to protrude more because the chronic inflammation stimulates the bone to grow.
This is a self-limited condition that usually resolves as the bone stops growing with the end of adolescence (at about age 17 years in males and age 15 years in females). Treatment includes PRICE therapy, which stands for:
PROTECT the knee from further trauma which can be done with knee padding.
REST the knee.
ICE the knee. Use an icebag placed on the knee 2-3 times a day for 20-30 minutes each time.
COMPRESS the knee with a knee brace or wrap.
ELEVATE the knee.
Over-the-counter pain control medications such as naproxen (Aleve or Naprosyn) and ibuprofen (Advil or Motrin) also play a role in treatment.
In severe cases, splinting the knee for a few weeks may help reduce the pain and halt the inflammation cycle.
My advice is: give the PRICE therapy together with medication one week, and if no improvemnt, go see an orthopedic doctor, as this usually points to some other underlying condition.
 JustDionne - Fri Jul 01, 2005 11:41 am

Dr. Ismail

Thank you for the information and your advice regarding my daughter's knee problem. Your advice sounds very reasonable. We will proceed as you suggest, and hopefully bypass the need to see an orthopedist. Thank you for your time.

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