Diagnostic arthroscopy of the knee in children

Abstract

Seventy-two symptomatic knees were studied in 68 patients between 2 and 17 years of age. A firm clinical diagnosis was made in all knees before arthroscopy. The clinical diagnosis and the arthroscopic findings were compared to establish the accuracy of the clinical diagnosis. This was 42% in children under 13 years old (Group 1) and 55% in children between 14 and 17 (Group 2). Possible unnecessary arthrotomy was avoided in 58% of the knees in Group 1, and 31% of the knees in Group 2. The most common "incorrect" clinical diagnosis in Group 1 was that of a discoid lateral meniscus followed by a torn medial or torn lateral meniscus in that order. The most common "incorrect" diagnosis in Group 2 was a torn medial meniscus followed by a discoid lateral meniscus. It is considered that children presenting with knee symptoms should be managed by orthopaedic surgeons who are experienced in arthroscopic diagnosis.

Arthroscopy of the knee in children

“…Albeit uncertain, clinical diagnosis is better in adults ( et al , Suman et al 1984. The diagnostic accuracy improved more in our youngest age group, confirming Morrisy et al (1982) and the tendency illustrated by Suman et al (1984).…”

“…Albeit uncertain, clinical diagnosis is better in adults ( et al , Suman et al 1984. The diagnostic accuracy improved more in our youngest age group, confirming Morrisy et al (1982) and the tendency illustrated by Suman et al (1984). The communication barrier between child and doctor certainly increases with decreasing age of the child, and this might explain the abovementioned difference between the two agegroups.…”

“…The value of arthroscopy in the diagnosis of knee disorders in children is less well established than in adults, and there are few reports of its value (Eilert 1976, Ziv & Carrol 1982, Bergstrom et al 1984, Suman et al 1984. The difficulty of making a correct clinical diagnosis of knee problems in children is partly due to the communication barrier between the doctor and the child, and partly due to less specific physical signs.…”

Acute Hemarthrosis of the Knee in Children

“…Morrissy et al 14 reported that arthroscopic examination confirmed the clinical diagnosis in 13 (62%) of 21 patients between 13 and 18 years, but in only 3 (27%) of 11 patients younger than 13 years. Suman et al 23 reported that arthroscopic examination avoided unnecessary arthrotomy in 31% of children between 14 and 17 years and in 58% of those younger than 13 years. We agree with these authors, and we repaired osteochondral defects and removed intraarticular loose bodies without having to perform an arthrotomy in any patient.…”

“…Few reports have attempted to evaluate the cause of an acute traumatic hemarthrosis of the knee in a child.2, 6, ~, 9, 22 When a child sustains a severe injury to the knee, unlike an adult, he or she will often not remember the exact mechanism of injury, making the evaluation more difficult. Suman et al 23 compared the findings at arthroscopic evaluation with their preoperative clinical diagnosis in 68 patients in whom 72 knees were examined. They reported that the clinical diagnosis was accurate in only 8 (42%) of 19 knees in children under 13 years and in 27 (56%) of 48 knees in adolescents between 14 and 17 years.…”