Knee Injuries in the Young Athlete

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Matt Kirchoff, DPT

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With the ever increasing number of children participating in organized sports, the incidence of knee injuries is on the rise. Each year in the United States there are over 1 million emergency room visits and 1.9 million primary care visits for knee injuries. Children make up a large percentage of these visits as their developing musculoskeletal systems are more susceptible to injury. Knee injuries in children often occur as a result to damage of soft tissue structures around the knee which act to stabilize and cushion the joint. Such injuries can not only take a child off of the court or field for the season, but may also result in long term damage to the knee. This is why it is exceedingly important for parents and coaches to understanding why knee injuries occur and how to prevent them.

The knee joint is comprised of the connection between the thigh bone (femur) and the shin bone (tibia). Stability of the knee is derived from 4 major ligaments and two menisci that help cushion the joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are the two primary stabilizers of the knee that help to control rotation through the joint. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) provide stability to the inside and outside of the knee, which help to prevent sideways movement. The crescent shaped medial and lateral menisci are found on top of the tibia and play an integral role in shock absorption and joint stability. The kneecap (patella) sits in a groove in the femur, called the patellofemoral joint, which gives the quadriceps muscle more leverage for straightening the knee. Damage to any of these structures can be quite painful and limit participation in sports. While the incidence of ligament and meniscus tears in on the rise in the pediatric population, dysfunction of the patellofemoral joint is one of the most common causes for referral of children to physical therapy.

Patellofemoral Pain Syndrome (PFPS) is usually attributable to an imbalance of forces that control tracking of the patella. Young athletes experiencing PFPS may report pain behind the patella which is typically exacerbated with running, jumping, squatting and stair-climbing. Additionally, athletes may report clicking or catching when fully bending the knee. Visual swelling of the knee joint is not characteristic of PFPS and may suggest more serious pathology. Onset of PFPS typically occurs when an athlete has begun a new sport or changed the frequency or intensity of an existing sport. Consequently, with mild cases of PFPS relative rest can help to decrease the intensity of symptoms. However, when left untreated PFPS can potentially result in chondromalacia, a condition where roughening of the cartilage on the underside of the patella occurs.

Research indicates the physical therapy is an effective treatment strategy for PFPS. Physical therapy treatment of a young athlete with PFPS emphasizes correction of muscle imbalances across the knee joint in order to promote more optimal patellar tracking. In acute stages of PFPS this may be achieved by taping the knee to prevent excessive lateral tracking of the patella. During early stages of rehabilitation for PFPS manual therapy techniques may be used to improve mobility of the patellofemoral joint or decrease over-activity of adjacent musculature. A strengthening program, with an emphasis on strengthening the medial stabilizers of the knee, is typically initiated within the first 1-2 physical therapy visits. Additionally, progressive stretching of involved muscles around the knee and hip play an important role in the treatment of PFPS. Young athletes are also instructed in a home exercise program of strengthening and stretching exercises to promote a pain-free return to sports. This not only places the responsibility of rehabilitation into the athlete’s hands, but also gives them the tools to independently address potential flare-ups of PFPS in the future.