Knee Injuries In The Youth Athlete

As community-based, organized youth sports have increased in popularity over the last several years, so has the rise of pediatric orthopaedic sports medicine as a subsubspecialty. Although nonsurgical fractures and overuse injuries are seen most commonly, the incidence of surgical injuries, particularly about the knee, is on the rise. This article will review and synthesize recent advances in the treatment of knee disorders resulting from youth sports participation. Surgically treated tibial spine fractures result in low rates of residual instability, but postoperative arthrofibrosis continues to be a problem. Further meniscal injury with nonsurgical treatment of anterior cruciate ligament rupture is likely, and repair of meniscal tears during anterior cruciate ligament reconstruction may be more successful than in adults, even with "marginally reparable'' tears. Evidence suggests that transepiphyseal, extraphyseal, and transphyseal reconstruction with soft-tissue graft and extraphyseal fixation all can be performed safely, even in prepubescent patients, although mild residual clinical laxity often results. Symptomatic discoid meniscal tears are increasingly treated with repair of peripheral rim instability while preserving maximal meniscal tissue. Stable juvenile (compared with adult) osteochondritis dissecans lesions have increased healing potential with nonsurgical treatment, although assessing stability with MRI is more difficult than in adults. Finally, although medial patellofemoral ligament reconstruction for patellar instability is increasingly performed in the skeletally mature, there are physeal anatomical considerations in the immature, and outcome studies of physeal sparing techniques are better documented in the literature. Newer surgical techniques for treatment of knee injuries in youth athletes may offer more successful return to play with decreased incidence of complications such as stiffness and growth arrest.