Official reprint from UpToDate®
www.uptodate.com ©2015 UpToDate®

Approach to the child or adolescent athlete with chronic knee pain or injury

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


Chronic knee pain in the young athlete may be caused by inadequate rehabilitation of a previous injury or repetitive activity. Chronic knee pain can also be caused by conditions unrelated to sports activity (eg, bone tumors, infection, arthritis, slipped capital femoral epiphysis, Legg-Calvé-Perthes disease) and these conditions must be considered in the differential diagnosis and evaluation [1]. (See appropriate topic reviews).

The approach to chronic knee pain is similar to that for acute pain. The same physical examination techniques are used to evaluate individual structures, although the patient usually is in less pain. Additional techniques and maneuvers are used to detect problems that only occur chronically (eg, the Ober test for iliotibial band syndrome, the Thomas test for quadriceps flexibility).

The approach to the young athlete with chronic knee pain will be reviewed here. The causes and the approach to acute knee pain in the young athlete, are discussed separately. (See "Approach to acute knee pain and injury in children and skeletally immature adolescents".)


In the evaluation of a young athlete with knee pain or injury, it is important to determine [2,3]:

Whether the complaint is acute or chronic. The evaluation of acute complaints is discussed separately. (See "Approach to acute knee pain and injury in children and skeletally immature adolescents".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2015. | This topic last updated: Apr 23, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2015 UpToDate, Inc.
  1. Muscolo DL, Ayerza MA, Makino A, et al. Tumors about the knee misdiagnosed as athletic injuries. J Bone Joint Surg Am 2003; 85-A:1209.
  2. Stanitski CL. Pediatric and adolescent sports injuries. Clin Sports Med 1997; 16:613.
  3. Pasque, CB, McGinnis, DW. Knee. In: Care of the Young Athlete, American Academy of Orthopedic Surgeons and American Academy of Pediatrics, Elk Grove Village, IL 2000. p.377.
  4. Juhn MS. Patellofemoral pain syndrome: a review and guidelines for treatment. Am Fam Physician 1999; 60:2012.
  5. Tachdjian MO. The knee and leg. In: Clinical Pediatric Orthopedics: The Art of Diagnosis and Principles of Management, Appleton and Lange, Stamford 1997. p.87.
  6. Staheli LT. The lower limb. In: Pediatric Orthopaedics, 3rd, Morrissy RT. (Ed), Lippincott, Philadelphia 1990. Vol 2, p.41.
  7. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician 2005; 71:1545.
  8. Messier SP, Edwards DG, Martin DF, et al. Etiology of iliotibial band friction syndrome in distance runners. Med Sci Sports Exerc 1995; 27:951.
  9. Safran MR, Fu FH. Uncommon causes of knee pain in the athlete. Orthop Clin North Am 1995; 26:547.
  10. Miller TT, Staron RB, Koenigsberg T, et al. MR imaging of Baker cysts: association with internal derangement, effusion, and degenerative arthropathy. Radiology 1996; 201:247.
  11. Medlar RC, Lyne ED. Sinding-Larsen-Johansson disease. Its etiology and natural history. J Bone Joint Surg Am 1978; 60:1113.
  12. Lee K, Siegel MJ, Lau DM, et al. Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology 1999; 213:697.
  13. Cotten A, Delfaut E, Demondion X, et al. MR imaging of the knee at 0.2 and 1.5 T: correlation with surgery. AJR Am J Roentgenol 2000; 174:1093.
  14. Feller JA, Webster KE. Clinical value of magnetic resonance imaging of the knee. ANZ J Surg 2001; 71:534.
  15. Rose NE, Gold SM. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy 1996; 12:398.
  16. Stanitski CL. Correlation of arthroscopic and clinical examinations with magnetic resonance imaging findings of injured knees in children and adolescents. Am J Sports Med 1998; 26:2.