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Meniscal Injuries and Disorders in the Youthful Knee
October 02, 2003 |
By Jennifer Solar for Knee1
While injuries and disorders to the meniscus in children may resemble those of adults, young age can be a factor in the diagnosis and treatment of such conditions.
Comprised primarily of collagen fibers arranged in a c-shape, the meniscus serves to absorb shock where the bones of the shin and thigh meet. In the case of injury and/or abnormal development, the meniscus’ supportive function becomes hindered.
Although the incidence of meniscal tears in children and adolescents is deemed uncommon, these injuries can occur, particularly in the young athlete.
"As kids play a higher level of sports, we are seeing a greater incidence of meniscal disorders," states Dr. Kevin Klingele of Columbus Children’s Hospital in Columbus, Ohio. Meniscal tears are often caused by twisting motions of the knee, which are common in sports such as football, soccer and basketball.
The diagnosis of a meniscal tear is usually made by clinical observation when a child or adolescent presents with symptoms such as pain or swelling in the knee. When MRI is used to accompany clinical examination in diagnosing pediatric injuries to the meniscus, it should be interpreted with caution, according to Dr. Joseph Bosco of the New York University Department of Orthopedic Surgery.
"The developing knee is highly vascularized," Dr. Bosco said, and added that this increased blood flow could show up as a false positive on a MRI image. Dr. Bosco suggested that MRI is best used in the context of symptoms.
While some meniscal injuries in children and adolescents are small and can heal on their own, most will require surgery, according to a recent article in the journal, Orthopedic Clinics of North America. The authors of the article suggest that because of the healing potential of children and their young age, repairing the meniscus should be prioritized over removing the portion of the tear.
Another condition inhibiting proper function of the child or adolescent meniscus is the discoid lateral meniscus. It is an abnormality that sometimes can be recognized after birth by a snapping sound or sensation. Dr. Bosco explained that in the case of the discoid lateral meniscus, "the meniscus hasn’t formed properly; rather, it is formed as a flat disc instead of being c-shaped."
If symptoms of the discoid lateral meniscus are present, they can include pain, popping and swelling. Tears are commonly associated with the discoid meniscus because of the increased stress in the knee caused by the abnormality.
MRI readings may have limitations in detecting a discoid lateral meniscus. According to Dr. Klingele, the younger the child the less exact is the MRI reading and could yield a false-negative result.
As with tears, repairing a discoid lateral meniscus in children and adolescents is preferred over removal a portion of or the entire meniscus. "Anytime you can save the meniscus, it is better – regardless of the condition," said Dr. Klingele. "Studies will tell you that the more you lose, the greater chance of trouble later on, such as early arthritis."
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