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Approach to chronic knee pain or injury in children or skeletally immature adolescents

Albert C Hergenroeder, MD
Section Editors
Joseph Chorley, MD
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


The approach to children and skeletally immature adolescents with chronic knee pain will be reviewed here. The approach to acute knee pain in these patients and the evaluation of children with joint pain or swelling are discussed separately. (See "Approach to acute knee pain and injury in children and skeletally immature adolescents" and "Evaluation of the child with joint pain or swelling".)


Chronic injury — In children and skeletally immature adolescents, chronic injury can arise from any of the following situations:

An acute injury that does not heal properly (eg, an anterior cruciate ligament tear that is not fully rehabilitated or in which surgical repair fails)

Insidious onset of pain without specific injury related to excessive activity that is beyond the body's ability to accommodate (eg, iliotibial band syndrome in a soccer player or runner)

Chronic pain — Pain lasting longer than six weeks is typically characterized as chronic. While the six-week threshold is arbitrary, it can be useful since many self-limited acute injuries (contusions) heal by the end of six weeks with appropriate rest. Among active children and skeletally immature adolescents, chronic pain often has a progressive pattern. For example, a child with Osgood-Schlatter disease may initially only have pain over the tibial tuberosity at the end of a basketball practice but may progress over weeks to the point where pain develops after five minutes of playing, or is even present at rest. Chronic pain should also alert the clinician to the possibility of a systemic disease (eg, reactive arthritis, toxic synovitis, osteomyelitis, septic arthritis, arthritis as part of a rheumatologic disease, or malignancy) that is presenting as bone or joint pain (table 1).


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Literature review current through: Sep 2015. | This topic last updated: Jul 29, 2015.
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