The Pediatric and Adolescent Knee PDF
Preview The Pediatric and Adolescent Knee
1600 John F. Kennedy Boulevard, Suite 1800 Philadelphia, PA 19103-2899 THE PEDIATRIC AND ADOLESCENT KNEE ISBN-13: 978-0-7216-0331-5 ISBN-10: 0-7216-0331-9 Copyright © 2006, Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail: [email protected] may also complete your request online via the Elsevier homepage (http://www.elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions.” NOTICE Knowledge and best practice in this field are constantly changing.As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on his own experience and knowledge of the patient, to make diagnoses, to determine dosages andthe best treatment for each individual patient, and to take all appropriate safety precautions.To the fullest extent of the law, neither the Publisher nor the Editors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher First Edition Library of Congress Cataloging-in-Publication Data The pediatric and adolescent knee / Lyle J. Micheli, Mininder S. Kocher [editors].–1st ed. p. cm. ISBN 0-7216-0331-9 1. Knee. 2. Knee–Diseases. 3. Knee–Care and hygiene. 4. Pediatric orthopedics. I. Micheli, Lyle J., 1940- II. Kocher, Mininder S. RD 723.3.C43P42 2006 617.5182–dc22 2006040515 Acquisitions Editor: Elyse O’Grady Developmental Editor: Boris Ginsburgs Project Manager: David Saltzberg Printed in the United States of America. Last digit is the print number: 9 8 7 6 5 4 3 2 1 Preface Lyle J. Micheli, MD and Mininder S. Kocher, MD In the preface to his 1979 textbook, The Injured Adolescent medicine, exercise physiology, nutrition, rehabilitation, Knee,Dr. Jack Kennedy stated that “the adolescent knee is radiology, and anesthesia. General issues are presented, unlike the adult knee” and that he was “staggered” by the such as epidemiology of injuries, physical examination, incidence of knee injuries in adolescent athletes.* anatomy, growth, and anesthesia. Issues of special interest A lot has changed for the pediatric and adolescent in the pediatric and adolescent athlete, such as strength knee since 1979. Advances in technology such as arthro- training, sports psychology, primary care issues, perform- scopic surgery, magnetic resonance imaging, and minimally ance enhancing drugs, and the adolescent female athlete, invasive repair techniques have allowed for greater recogni- are also highlighted. Specific injuries are thoroughly dis- tion and improved management of knee injuries. Increased cussed, including patellofemoral dysfunction, extensor awareness that pediatric and adolescent athletes can sustain mechanism disorders, fractures, meniscal disorders, chon- major knee injuries has resulted in earlier diagnosis and bet- dral injuries, osteochondritis dissecans, anterior cruciate ter management of these injuries. Old adages like “children ligament (ACL) and other ligament injuries, and tibial don’t get serious knee injuries” and “just put it in a cast and spine fracture. In addition, knee disorders, such as congen- it will heal in kids” have been dispelled. Increased partici- ital knee deformities, angular deformities, infection, arthri- pation in organized sports at younger ages and at higher tis, and complex regional pain syndrome, are overviewed. competitive levels have resulted in dramatic increases in Both surgical approaches and nonoperative approaches to the incidence and severity of knee injuries in pediatric ath- management are emphasized. Technical notes are provided letes. These injuries and their treatments will have impor- to pull out and emphasize how to do a specific technique. tant long-term ramifications in terms of risk of degenerative We would like to thank the authors for their excellent arthritis and disability later in life. chapters and for providing their insight and pearls. We would Youth sports have also changed. Youth sports have like to thank our colleagues in the Division of Sports become a big business with scouts at middle school games and Medicine and the Department of Orthopaedic Surgery at adolescent athletes becoming professionals after high school. Children’s Hospital. Most importantly, we would like to thank Pediatric and adolescent athletes can face an enormous our pediatric and adolescent patients and their families, who amount of pressure to succeed from themselves, their peers, have given us their trust in the management of their injuries. their coaches, and their parents. The negative effects of youth Dr. Kocher would like to specifically thank his guru, sports can be seen in psychological burnout, eating disorders, Dr.John Feagin, for inspiring and encouraging him to take and the increasing use of ergogenic aids. However, the bene- on this project. He would like to thank his mentors, Drs. ficial effects of youth sports are overwhelming. Physically, David Sabiston, Jr., John Hall, James Kasser, Richard children have improved health with lower rates of obesity, Steadman, and Lyle Micheli, for their continued support heart disease, osteoporosis, and diabetes. Psychosocially, ado- and for being exemplary role models. Most importantly, he lescent athletes have improved self-esteem, lower rates of would like to thank his wife, Mich, and children, Sophia, recreational drug use, and lower rates of teen pregnancy. Izzy, Calvin, and Ava, for their understanding and patience In this textbook, we have striven to give a compre- during this project. hensive and useful overview of injuries and disorders of the Dr. Micheli would like to thank his many mentors, pediatric and adolescent knee. The authors are experts in teachers, colleagues, and fellows, each of whom has helped diverse fields, including pediatrics, orthopaedics, sports him to better grasp the special challenges of the child ath- lete. In addition, special thanks are due to all of the patients and parents who have patiently participated in *Kennedy, JC (ed): The Injured Adolescent Knee. Baltimore: The Williams this process. As always, his wife Anne has loyally supported and Wilkins Company, 1979. vi Preface the often excessive demands of combining an active clini- ent in terms of growth, laxity, physiology, and anatomy. We cal practice with academic and publishing efforts. hope that this book provides a comprehensive and useful We agree with Dr. Kennedy that the pediatric and ado- framework for treating knee injuries in your young athletes lescent knee is not a little adult knee. They are very differ- and patients. Foreword John A. Feagin, MD Many years ago, The Injured Adolescent Knee was by edited They have entrusted you with the young person’s knee; this by Dr. J.C. Kennedy* with contributions by Drs. Fowler, knee needs to function for many years. Your skill and James, Larson, Roberts, and Salter—all giants of their gen- knowledge are critical. They need to know and believe that eration and doctors who cared for adolescent patients and you are their advocate—not just the surgeon. had visions for the betterment of the care of the adolescent The concepts presented in the book are appropriate knee. They chose a meaningful niche for making contribu- and useful. The body of knowledge is specialized. The con- tions to orthopedic literature. tributors to The Pediatric and Adolescent Kneehave brought The Injured Adolescent Knee became a mainstay of my the pediatric and adolescent knee into focus. You will use library and influenced my thought processes. The treat- this knowledge and focus daily. The contributors to the ment of the adolescent knee is a discipline within the dis- book are outstanding in their fields. Their contributions cipline of knee care. The adolescent and his or her knee will enrich your knowledge and expertise as you absorb the deserve a special page in history and a special place in daily wisdom emanating from each chapter. To you, I recommend practice. this book, The Pediatric and Adolescent Knee. Adolescents’ knees are different from those of adults. The editors, Dr. Lyle J. Micheli and Dr. Mininder S. Also, adolescents’ parents, families, and coaches are Kocher, are to be commended for recognizing the hiatus involved and concerned. The future for the adolescent is that had developed in our knowledge and filling it so forthcoming. The responsibility of all involved is ever pres- admirably. ent. Adolescents need all the expertise and advocacy that Were Dr. J.C. Kennedy still with us, he would applaud can be marshaled. We need this new book,ThePediatricand the efforts of Drs. Kocher and Micheli and the addition that Adolescent Knee. This book prepares the physician for the the contents of this book bring to our armamentarium. responsibility of caring for the pediatric patient, the adoles- Iknow Dr. Larson will be proud of this extension of his orig- cent patient, and those concerned individuals who sur- inal work. round the patient. Thank you for your interest in The Pediatric and I recommend that you embrace the concepts contained Adolescent Knee at this point in your career. The book, the in this book. Respect the pediatric and adolescent knee as a rest of your practice—the rest of your journey—will benefit unique entity. Respect the child and the adolescent, the from your interest in the pediatric and adolescent knee. parents, the coaches and trainers, and the patient’s peers. Godspeed. *Kennedy, JC (ed): The Injured Adolescent Knee. Baltimore: The Williams and Wilkins Company, 1979. Contributors John A. Abraham, MD Luke H. Balsamo, MD Resident Bone and Joint Sports Medicine Institute Department of Orthopaedic Surgery Portsmouth Naval Hospital Harvard Combined Orthopedic Residency Program; Portsmouth, Virginia Department of Orthopaedic Surgery Children’s Hospital Boston David B. Bendor, PsyD (candidate) Boston, Massachusetts Postdoctoral Fellow Human Relations Service Wellesley, Massachusetts Paolo Aglietti, MD Professor Charles B. Berde, MD, PhD First Orthopaedic Clinic Professor University of Florence Department of Anaesthesia and Pediatrics Florence, Italy Harvard Medical School; Chief Jay C. Albright, MD Division of Pain Medicine Director of Pediatric Sports Medicine Department of Anesthesiology, Perioperative and Medical Education Faculty Pain Medicine Arnold Palmer Children’s Hospital; Children’s Hospital Boston Pediatric Orthopaedic Surgery Boston, Massachusetts Orlando Regional Health Systems Orlando, Florida Treg D. Brown, MD Assistant Clinical Professor Allen F. Anderson, MD Department of Orthopaedic Surgery Tennessee Orthopaedic Alliance; Tulane University Director New Orleans, Louisiana; Lipscomb Foundation for Education and Research Orthopaedic Surgeon Nashville, Tennessee Southern Illinois Orthopaedic Center Southern Orthopaedic Associates Peter J.Apel, BA Herrin, Illinois Stritch School of Medicine Bernard Cahill, MD Loyola University, Chicago Past President (retired) Maywood, Illinois American Orthopaedic Society of Sports Medicine Peoria, Illinois Nigel M. Azer, MD Surgeon-in-Chief W. Dilworth Cannon, MD Washington Orthopaedic Center Professor Washington, DC Department of Orthopedic Surgery University of California, San Francisco San Francisco, California xiv Contributors Michelina Cassella, PT John M. Flynn, MD Lecturer on Orthopaedic Surgery Associate Professor Harvard Medical School Department of Orthopaedic Surgery Harvard University University of Pennsylvania; Cambridge, Massachusetts; Surgeon Director Department of Orthopaedic Surgery Department of Physical Therapy and Occupational The Children’s Hospital of Philadelphia Therapy Services Philadelphia, Pennsylvania Children’s Hospital Boston Boston, Massachusetts Peter J. Fowler, MD, FRCS Professor Henry G. Chambers, MD Department of Surgery Associate Clinical Professor University of Western Ontario Department of Orthopaedic Surgery London, Ontario, Canada University of California, San Diego; Chief of Staff John Franco, MD Children’s Hospital and Health Center Fellow San Diego, California Santa Monica Sports and Orthopaedic Group Santa Monica, California Antonio Ciardullo, MD First Orthopaedic Clinic Theodore J. Ganley, MD University of Florence Assistant Professor Cto Department of Orthopaedic Surgery Florence, Italy University of Pennsylvania School of Medicine; Orthopaedic Director of Sports Medicine Jennifer L. Cook, MD Department of Pediatric Orthopaedic Surgery Insall Scott Kelly Fellow The Children’s Hospital of Philadelphia Department of Orthopaedic Surgery Philadelphia, Pennsylvania Lenox Hill Hospital New York, New York Mark C. Gebhardt, MD Department of Orthopaedic Surgery Pierluigi Cuomo, MD Harvard Medical School; First Orthopaedic Clinic Chief University of Florence Orthopaedic Surgery Cto Orthopaedic Surgeon-in-Chief Florence, Italy Department of Orthopaedic Surgery Beth Israel Deaconess Medical Center J.T. Davis, MD Boston, Massachusetts Department of Orthopaedics Tulane Institute of Sports Medicine Peter G. Gerbino, II, MD Tulane University Instructor New Orleans, Louisiana Department of Orthopaedic Surgery Harvard Medical School; Harvey N. Dulberg, PhD Assistant in Orthopaedic Surgery Private Practice of Sports Psychology Department of Orthopedic Surgery Brookline, Massachusetts Children’s Hospital Boston, Massachusetts Pierre A. d’Hemecourt, MD Director of Primary Care Sports Medicine Fellowship Carl Gustafson, RPT, ATC, CSCS Children’s Hospital Boston Division of Sports Medicine Boston, Massachusetts Children’s Hospital Boston Avery D. Faigenbaum, EdD Boston, Massachussetts; Associate Professor Sports and Physical Therapy Associates Department of Health and Exercise Science Wellesley, Massachusetts The College of New Jersey Ewing, New Jersey Vincenzo Guzzanti, MD Professore Ordinario di Ortopedia e Traumatologia Universita di Cassino; Primario Ortopedia e Traumatologia Ospedale Bambino Gesu—Roma Italia Contributors xv László Hangody, MD, PhD, DSc Diego Jaramillo, MD, MPH Clinical Professor Professor Orthopaedic Clinic Department of Radiology Debrecen Medical School Hospital of the University of Pennsylvania; Debrecen, Hungary; Radiologist-in-Chief and Chairman Orthopaedic Surgeon Department of Radiology Orthopaedic and Traumatology Department Children’s Hospital of Philadelphia Uzsoki Hospital Philadelphia, Pennsylvania Budapest, Hungary James R. Kasser, MD Christopher D. Harner, MD John E. Hall Professor of Orthopaedic Surgery Professor Harvard Medical School; Department of Surgery Orthopaedic Surgeon-in-Chief University of Pittsburgh; Department of Orthopaedic Surgery Medical Director Children’s Hospital Boston Department of Orthopaedics Boston, Massachusetts University of Pittsburgh Medical Center for Sports Medicine Danielle A. Katz, MD Pittsburgh, Pennsylvania Assistant Professor Department of Orthopedic Surgery Richard Y. Hinton, MD, MPH, Med, PT SUNY Upstate Medical University Staff Orthopaedic Surgeon Syracuse, New York Director of Sports Medicine Department of Orthopaedic Surgery Kevin E. Klingele, MD Union Memorial Hospital Assistant Clinical Professor Baltimore, Maryland Department of Orthopaedic Surgery The Ohio State University; Charles P. Ho, PhD, MD Assistant Director California Advanced Imaging Resident Education and Research Atherton, California; Department of Orthopaedics Vail Imaging Center Columbus Children’s Hospital Vail, Colorado Columbus, Ohio Christopher Iobst, MD Mininder S. Kocher, MD, MPH Attending Physician Assistant Professor Department of Orthopaedic Surgery Department of Orthopaedic Surgery Miami Children’s Hospital Harvard Medical School Miami, Florida Harvard School of Public Health; Associate Director Mary Lloyd Ireland, MD Department of Orthopaedic Surgery Team Physician Division of Sports Medicine Eastern Kentucky University Children’s Hospital Boston Richmond, Kentucky; Boston, Massachusetts Consultant in Orthopaedic Surgery Shriner’s Hospital; Roger V. Larson, MD President and Orthopaedic Surgeon Associate Professor Kentucky Sports Medicine Clinic Department of Orthopaedic and Sports Lexington, Kentucky Medicine University of Washington Matthias Jacobi, MD Seattle, Washington Department of Orthopedic Surgery Hôpital cantonal Fribourg Kevin H. Latz, MD Fribourg, Switzerland Professor Department of Orthopaedic Surgery Roland P. Jakob, MD Children’s Mercy Hospital and Clinic; Professor Assistant Professor Medical Faculty University of Missouri, Kansas City University of Berne; Kansas City, Missouri Chief Orthopaedic Department Hôpital cantonal Switzerland xvi Contributors Ronald E. Losee, MD, ScD Paul J. Moroz, MD, MSc, FRCSC Private Practice; Assistant Professor Ennis Academy of Orthopaedic Friends Department of Orthopedic Surgery Ennis, Montana University of Ottawa; Attending Surgeon Anthony C. Luke, MD, MPH, CAQ(SM) Division of Pediatric Orthopaedic Surgery Assistant Professor Children’s Hospital of Eastern Ontario Department of Orthopaedics; Ottawa, Ontario, Canada Director Primary Care Sports Medicine Martha Meaney Murray, MD Family and Community Medicine Instructor University of California, San Francisco Department of Orthopaedic Surgery San Francisco, California Harvard Medical School; Orthopaedic Surgeon Nicola Maffulli, MD, MS, PhD, FRCS(Orth) Department of Orthopedic Surgery Professor Children’s Hospital Boston Department of Trauma and Orthopaedic Surgery Boston, Massachusetts Keele University School of Medicine; Consultant Michael F. Murray, MD Department of Trauma and Orthopaedic Surgery Instructor in Medicine University Hospital of North Staffordshire Harvard Medical School; Stoke on Trent, Staffordshire, England Clinical Chief Division of Genetics Jung Y. Mah, MD, FRCSC Department of Medicine Associate Clinical Professor Brigham and Women’s Hospital Division of Orthopaedic Surgery Boston, Massachusetts Michael G. DeGroote School of Medicine McMaster University Andrés T. Navedo-Rivera, MD Hamilton, Ontario, Canada Instructor Department of Anesthesia Bert R. Mandlebaum, MD Harvard Medicine School; Team Physician Assistant in Anesthesia US Soccer and Pepperdine University; Department of Anesthesia Director Children’s Hospital Boston Santa Monica Orthopaedic Research and Education Boston, Massachusetts Foundation and Fellowship Santa Monica, California Scott C. Nelson, MD Assistant Clinical Professor Lyle J. Micheli, MD Department of Orthopaedic Surgery O’Donnell Family Professor of Orthopaedic Sports Loma Linda University School of Medicine Medicine and Director Loma Linda, California; Division of Sports Medicine Medical Director Harvard Medical School; Cure International Division of Sports Medicine Santo Domingo, Dominican Republic; Children’s Hospital Boston Attending Surgeon Boston, Massachusetts Department of Orthopaedic Surgery Riverside County Regional Medical Center Tom Minas, MD, MS Moreno Valley, California Associate Professor Harvard Medical School Jason H. Nielson, MD Boston, Massachusetts; Sports Medicine Fellow Director Department of Orthopaedics Cartilage Repair Center Division of Sports Medicine Brigham and Women’s Hospital Harvard Medical School; Chestnut Hill, Massachusetts Children’s Hospital Boston Boston, Massachusetts Contributors xvii Michael J. O’Brien, MD William G. Rodkey, DVM Clinical Instructor Diplomate Department of Sports Medicine American College of Veterinary Science; Harvard Medical School; Director Staff Physician Basic Science Research Department of Sports Medicine Steadman Hawkins Research Foundation Children’s Hospital Boston; Vail, Colorado Staff Physician Department of Musculoskeletal Medicine Senthilkumar Sadhasivam, MD Beth Israel Deaconess Medical Center Assistant Professor Boston, Massachusetts Department of Anesthesia University of Cincinnati; Norman Y. Otsuka, MD, FRCSC, FACS Cincinnati Children’s Hospital Medical Center Associate Clinical Professor Cincinnati, Ohio Department of Orthopaedic Surgery David Geffen School of Medicine Frederic Shapiro, MD University of California, Los Angeles; Associate Professor Assistant Chief of Staff Department of Orthopaedic Surgery Shriner’s Hospitals for Children Harvard Medical School; Los Angeles, California Attending Orthopaedic Surgeon Department of Orthopaedic Surgery; Susan M. Ott, MD Research Associate Clinical Instructor and Team Physician Orthopaedic Research Laboratory Department of Athletics Children’s Hospital Boston Florida Southern College Boston, Massachusetts Lakeland, Florida; Orthopedic Surgeon Krishn M. Sharma, MD Department of Surgery Resident South Florida Baptist Hospital Department of Orthopaedic Surgery Plant City, Florida Union Memorial Hospital Baltimore, Maryland George A. Paletta, Jr., MD Associate Professor Kevin G. Shea, MD Chief of Sports Medicine Center for Orthopaedics and Biomechanics Research Department of Orthopaedic Surgery Boise State University; Washington University St. Luke’s Children’s Hospital St. Louis, Missouri Boise, Idaho Ron Pfeiffer, EdD, LAT, ATC Angela D. Smith, MD Professor Department of Orthopaedics Department of Kinesiology; The Children’s Hospital of Philadelphia Codirector Philadelphia, Pennsylvania Center for Orthopaedic and Biomechanics Research (COBR) Carl L. Stanitski, MD Boise State University Professor Boise, Idaho Department of Orthopaedic Surgery Medical University of South Carolina; Gábor Ráthonyi, MD Children’s Hospital Orthopaedic Surgeon Charleston, South Carolina Orthopaedic and Traumatology Department Uzsoki Hospital Deborah Stanitski, MD, FRCS(C) Budapest, Hungary Professor Department of Orthopedic Surgery Kathleen Richard, PT, PCS Medical University of South Carolina; Supervisor Department of Orthopaedic Surgery Outpatient Department Medical University of South Carolina Hospital Department of Physical Therapy Charleston, South Carolina Children’s Hospital Boston Boston, Massachusetts xviii Contributors J. Richard Steadman, MD Brett L. Wasserlauf, MD Clinical Professor Assistant Professor University of Texas Southwestern Medical School Department of Orthopedic Surgery Dallas, Texas; University of Connecticut Orthopaedic Surgeon Farmington, Connecticut; Steadman Hawkins Clinic; Orthopaedic Surgery Chairman of the Board St. Francis Hospital Steadman Hawkins Research Foundation Hartford, Connecticut Vail, Colorado Jason K.F. Wong, MBChB, MRCS (Ed) Andrea Stracciolini, MD Lecturer Lecturer in Sports Medicine Blond McIndoe Plastic and Reconstructive Surgery Harvard Medical School; Laboratories Department of Orthopaedic Surgery The University of Manchester; Division of Sports Medicine Research Registrar Children’s Hospital Boston Department of Burns and Plastic Surgery Boston, Massachusetts Central Manchester and Manchester Children’s University Hospitals NHS Trust Edward C. Sun, MD Manchester, England Staff Physician Spine Care Medical Group Amy L. Woodward, MD, MPH San Francisco Spine Institute Instructor Daly City, California Department of Pediatrics Harvard Medical School; Robert P. Sundel, MD Assistant in Medicine Associate Professor Rheumatology Program Department of Pediatrics Children’s Hospital Boston Harvard Medical School; Boston, Massachusetts Director of Rheumatology Department of Medicine Yi-Meng Yin, MD, PhD Division of Immunology Chief Resident Children’s Hospital Boston Department of Orthopaedics Boston, Massachusetts University of California, Los Angeles Los Angeles, California John M. Tokish, MD Chief Sports Medicine; Head Team Physician US Air Force Academy Colorado Springs, Colorado
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