Knee trauma covers very different injuries involving bone, cartilage, ligaments and menisci. The indication for surgery depends on the lesion: instability, osteochondral fragments or repairable injuries may warrant surgery from the outset, while in other cases surgery is considered after an appropriate conservative pathway.
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. The fragment is reduced and stabilised arthroscopically with different systems — wires, screws or, in selected cases, resorbable implants — chosen according to fragment size and patient age.
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 or detached fragments may require surgery without first attempting conservative treatment. For stable lesions, persistent symptoms or failure to heal after appropriate care may change the indication.
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 injuries in children and adolescents can be treated without surgery, but the pathway depends on the injured structure. MRI should be prescribed selectively, particularly when examination suggests a meniscal, ligament, cartilage or osteochondral injury and the result could change management.
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 rehabilitation and timing tailored to the lesion and procedure. Return to sport should be based on healing, symptoms, strength, control and sport-specific function rather than a fixed date; recurrence or reinjury risk is multifactorial.
Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.
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