Knee conditions

摘要

Knee pain is a common condition addressed in the primary care setting. Strong evidence suggests that pediatric knee injuries differ from those seen in adults because of factors such as the comparative strength of the ligaments, the degree of skeletal immaturity, risk of damage to open growth plates, and the effect on potential future growth. ? On the basis of strong evidence, a thorough history and physical examination are necessary to better classify these as acute traumatic or chronic overuse injuries. Evaluation should take into account the type and intensity of sports played, the training environment and equipment, mechanics of an injury or trauma, and predisposing anatomical risk factors. ? On the basis of some research evidence and consensus, radiographic evaluation is more likely to be necessary for acute injuries, especially those with significant knee effusions. Plain radiographs should be obtained first to rule out a fracture. Magnetic resonance imaging of the knee may be necessary to evaluate soft tissue and ligamentous damage when radiographs are inconclusive. (5) ? Chronic overuse injuries are the result of microtrauma and repetitive stress on muscles, tendons, and bone without sufficient time for repair and recovery. On the basis of some research evidence and consensus, conservative management that consists of rest, ice, nonsteroidal anti-inflammatory drugs, and appropriate rehabilitation and physical therapy is usually sufficient and results in a good prognosis. (1) ? On the basis of strong research evidence, referral to an orthopedic surgeon should be considered in cases of acute knee injury and in chronic overuse conditions in which initial conservative therapy failed. ? Finally, on the basis of strong research evidence, the management plan for overuse injuries in athletes should always include adoption of preventive measures, such as identifying possible risk factors, ensuring appropriate training conditions and equipment, modifying training activities to avoid repetitive use, and allowing adequate time for rest during training and between seasons.