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.
Common Paediatric Knee Conditions
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.
FAQ: Children & Young People (Knee Injuries & Conditions)
When should my child see a specialist for knee pain?
If your child has knee pain that lasts more than a week, keeps coming back, or affects sport and daily activity, it’s a good idea to seek specialist advice. You should also arrange an assessment if there is swelling, locking, giving way, a limp, or pain after a specific injury.
What are the most common knee problems in children and young people?
Some of the most common knee issues in children and adolescents include:
- Osgood-Schlatter disease
- Meniscal tears
- Discoid lateral meniscus
- Osteochondritis dissecans (OCD)
These conditions often occur during growth spurts or in young athletes who play running and jumping sports.
Is knee pain in young athletes always caused by an injury?
Not always. Knee pain in children and teenagers can be caused by overuse, growth-related conditions, or biomechanical factors as well as acute injuries. A proper assessment helps identify the cause and ensures the right treatment plan is started early. It is also important to exclude problems with the Childs hips as a cause of referred pain to the knee.
What symptoms might suggest a meniscal tear in a child or teenager?
Common symptoms of a meniscal tear include pain along the joint line, swelling after activity, clicking, catching, or the knee “locking.” Some children may also feel their knee is unable to go fully straight compare with the other knee.
What is Osgood-Schlatter disease and how is it treated?
Osgood-Schlatter disease is a common cause of knee pain in active children and teenagers, caused by irritation where the patellar tendon attaches below the knee. Treatment is usually non-surgical and may include activity modification, physiotherapy, stretching, and gradual return to sport as symptoms improve.
What is a discoid meniscus and does it need surgery?
A discoid meniscus is a variation in the shape of the meniscus that some children are born with. It doesn’t always cause symptoms, but if it leads to pain, swelling, clicking, or locking, treatment may be needed. In some cases, arthroscopic surgery is recommended to reshape and preserve the meniscus.
What is osteochondritis dissecans (OCD) of the knee?
Osteochondritis dissecans (OCD) is a condition where a small area of bone and cartilage in the knee becomes irritated and may loosen. It can cause pain, swelling, and sometimes catching or locking. Early diagnosis is important because treatment depends on age, symptoms, and the stability of the affected area.
Will my child need an MRI scan for knee pain?
An MRI scan may be recommended if symptoms suggest a meniscal injury, cartilage problem, or another internal knee issue. MRI is useful because it shows soft tissues like the meniscus, ligaments, and cartilage, helping confirm the diagnosis and guide treatment. MRI involves no radiation but it does require the child to stay as still as possible for about 15-20mins in the machine to get the best quality images.
Can children return to sport after a knee injury or knee surgery?
Yes — most children and young people can return to sport after the right treatment and rehabilitation. The timeline depends on the condition and severity, but a structured recovery plan helps restore strength, movement, and confidence while reducing the risk of re-injury.
Can my child return to school on crutches or wearing a brace?
In most cases, yes. Children can usually attend school safely while using crutches or a brace after a knee injury or surgery. Schools should make reasonable adjustments to support attendance. Temporary changes such as avoiding stairs or allowing extra time between classes, and ensuring adequate access to toileting facilities are often enough to help a child stay in education during their recovery.