Children’s Knee Injuries
Knee pain in childhood and adolescence is common and can range from simple sprains, seen in young athletes, to more significant injuries requiring specialist care. Whether due to sports, falls, or growth-related conditions, early assessment and treatment are key to ensuring proper healing and preventing long-term issues.
While children and young people are susceptible to many of the same knee injuries as adults, some conditions only occur during growth and development. Further information on specific childhood conditions is outlined below.
Prevention of injury is a fundamental component of training young athletes. Please also see Injury Prevention and Return to Play sections for further information.
Osteochondritis Dissecans
Osteochondritis Dissecans (OCD) is an uncommon condition that affects the cartilage surface of the thigh bone (femur) within the knee.
The Cause is not fully understood but believed to be due to a temporary problem with the blood supply to part of the bone after recurrent microtrauma. This leads to separation of a portion of bone and cartilage.
Often these heal by themselves without complication, but occasionally they can become loose or in some cases completely separate and break off within the knee.
OCD causes pain and swelling but both can settle, which can make diagnosis difficult. It can be identified on X-ray but typically an MRI scan is required to grade its severity.
While the Childs growth plates are still open the OCD has an excellent chance of healing with just rest and activity modification. If symptoms fail to settle or the OCD looks more severe on MRI keyhole surgery maybe recommended.
Osgood-Schlatter Disease
This common condition typically affects very sporty children during the ‘growth spurt’ years. It occurs over the bony prominence at the front of the knee. Patients complain of pain which is worse with activities and better with rest. Symptoms peak in boys at about 12–15 years of age, and girls at about 8–12 years of age
Avoiding activities (particularly jumping / landing sports) does help settle the symptoms. It can take up to 2 years to fully settle or until the child has completed their growth. Continuing with sports during this period does not appear to have any longterm detrimental impact on the knee.
A similar condition (Sinding-Larsen-Johansson disease) exists when the pain is coming from the bottom edge of the knee cap. It is caused by a similar issue of traction of the muscle and tendon on the growing bone, and follows a similar recovery pattern.
Discoid Lateral Meniscus
This condition typically affects females more than males. It is commonly identify it in both knees however one knee tends to be more symptomatic than the other. Patients usually present at about 8–12 years of age complaining of pain or a ‘clunk’ from the knee.
This is a congenital condition where the lateral meniscus fails to develop from a complete circle to crescent shape. It is therefore larger and more likely to get entrapped within the knee during flexion & extension.
Not infrequently these discoid pattern menisci are identified incidentally on an MRI scan being done for another issue. The presence of a discoid shape to the meniscus is only important surgically if it is associated with locking or catching of the knee, instability or pain.
Key hole (arthroscopic) surgery can be utilised in symptomatic patients to repair the meniscus (if torn) and reshape the meniscus into the more typical crescent shape.
Meniscal Tears
Meniscal tears in children and adolescents are increasingly common, often resulting from sports injuries or twisting movements of the knee. Unlike adults, children’s menisci are thicker and more vascular, meaning they have a better potential for healing if treated appropriately. Typical symptoms include knee pain, swelling, locking, or difficulty fully straightening the knee.
Preserving the meniscus is critical to long-term knee health. Unlike in adults, where partial meniscal resection may sometimes be necessary, in children, removing meniscal tissue significantly increases the risk of later arthritis. Whenever possible, repair rather than removal is the priority to maintain knee stability and function.
Most paediatric meniscal tears require keyhole (arthroscopic) surgery to repair the damaged tissue. Post-surgical bracing is often needed to protect the repair, and a structured rehabilitation programme is essential. Return to sport typically takes several months, depending on healing and rehabilitation progress.
Despite careful management, there remains a risk of re-tear, particularly in high-impact sports. A gradual and well-supervised return to activity, combined with strengthening and neuromuscular training, helps reduce this risk and promotes long-term knee preservation.
ACL Tears
Anterior cruciate ligament (ACL) injuries can occur in children and adolescents, particularly those involved in sports like football, rugby, and gymnastics. These injuries can be serious, leading to instability and an increased risk of further knee damage if not properly managed.
Treating ACL injuries in growing children presents unique challenges. Standard surgical techniques risk damaging the growth plates, which can lead to leg length discrepancies or angular deformities. Alternative techniques that avoid the growth plates may reduce this risk but can result in the graft being in a non-anatomical position by adulthood, potentially affecting long-term knee function.
Re-tear rates in young athletes are high, making rehabilitation and careful return-to-sport decisions crucial. In very young children, delaying surgery for as long as symptoms allow can reduce the risks associated with operating on an immature skeleton. A structured rehabilitation programme can help maintain knee stability and function in the meantime.
Scandinavian studies have shown excellent success rates with non-surgical rehabilitation alone in selected cases. This approach prioritises muscle strengthening, neuromuscular training, and activity modification to manage symptoms and maintain knee function while reducing the risks of early surgery.