Under «knee trauma» very different worlds coexist: bone, cartilage, ligaments, menisci. Surgery comes into play when the picture cannot be solved with bracing, rehabilitation and time.
A child's and adolescent's knee is not a smaller adult knee. The presence of growth plates (distal femur and proximal tibia) changes X-ray reading, technique choice and long-term follow-up.
A typical paediatric/adolescent lesion: the ACL insertion detaches with a bony fragment. Treated arthroscopically with dedicated wires or screws.
Displaced fragments preventing full extension or destabilising the knee.
It is different from the classic adult ACL tear, even if the mechanisms are similar.
When a cartilage and underlying bone fragment detaches or risks detaching. Depending on stage: fragment fixation, microfractures, cartilage regeneration procedures.
Unstable, symptomatic fragments not responding to conservative treatment.
Fractures involving the distal femoral growth plate. Depending on type, reduction and fixation with screws or wires, often with minimally invasive technique.
Displaced or intra-articular forms; care is taken not to damage the physis further.
Long-term follow-up is required to catch any growth disturbance.
Including metaphyseal and proximal physeal fractures. Screw or wire fixation, axis control.
Displaced or unstable forms, especially when the physis or joint is involved.
After a first patellar dislocation a fragment may detach from the patella or femoral condyle. MRI assessment; if significant, arthroscopic or open refixation.
Loose intra-articular fragment, joint locking, recurrent patellar instability.
Many knee traumas in children and adolescents resolve with bracing, rehabilitation and time. MRI should be prescribed with judgement: it is useful when it can change the decision, not to «see everything».
Can ligaments be operated on in a growing child?
Yes, but with techniques designed not to damage the growth plates. The decision considers age, sport, instability and associated picture.
Will my child return to the same sport?
In many cases yes, with a serious rehabilitation pathway and timing that depends on the lesion and surgery. Skipping stages is the main cause of recurrence.
Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.
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