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Updated: Oct 16, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Treatment of knee sprains in children
Elie Choufani1, Sébastien Pesenti1, Franck Launay1
1AP-HM, Service d'orthopédie pédiatrique, hôpital Timone-Enfants, 264, rue St-Pierre, 13005 Marseille, France; Aix-Marseille université, faculté de médecine, 27, boulevard Jean-Moulin, 13005 Marseille, France.
Insights
Pediatric knee sprains are rising, often involving bone avulsions due to skeletal immaturity. Treatment focuses on preserving the anterior cruciate ligament (ACL) and growth plates in children.
Area of Science:
- Pediatric Orthopedics
- Sports Medicine
- Pediatric Traumatology
Background:
- Pediatric knee sprains are increasingly common.
- Children's unique skeletal and ligamentous anatomy predisposes them to bone avulsions.
- While peripheral injuries are frequent, associated cruciate or patellofemoral ligament injuries require careful diagnosis.
Purpose of the Study:
- To review current understanding and management of pediatric knee sprains.
- To highlight diagnostic considerations based on age.
- To discuss evolving treatment strategies for anterior cruciate ligament (ACL) injuries in children.
Main Methods:
- Review of current literature on pediatric knee sprains and ligamentous injuries.
- Analysis of age-related diagnostic challenges and treatment outcomes.
- Discussion of surgical techniques for ACL injuries adapted for pediatric patients.
Main Results:
- Bone avulsions are common in younger children due to skeletal immaturity.
- Tibial spine fractures (TSFs) are prevalent in young children, with potential for residual laxity.
- Reparation techniques for interstitial ACL ruptures are regaining favor to preserve native ACL function and proprioception.
Conclusions:
- Age is a critical factor in diagnosing and managing pediatric knee sprains.
- ACL reconstruction techniques are advancing, with adaptations from adult procedures.
- Preserving physeal integrity during treatment is crucial to prevent growth disturbances, emphasizing the role of pediatric orthopaedic surgeons.
Abstract:
The incidence of knee sprains in children is steadily increasing. Skeletal immaturity and anatomical features of the child's ligamentous structures explain the frequency of bone avulsions in young children. Peripheral ligament injuries are the most common and often benign. Nevertheless, associated injuries of the cruciate or patellofemoral ligament(s) are not rare and must not be missed. Age is a determining factor in diagnostic guidance. Anterior intercondylar tibial eminence fractures, otherwise known as tibial spine fractures (TSF), usually occur in young children. Ligamentous distension at the time of the accident would explain the residual laxity that can affect the prognosis of these fractures. The treatment of interstitial ruptures of the ACL follows recommendations that are becoming clearer through multicentric studies. Reparation techniques, historically rejected as ineffective, have again become topical under specific conditions with the aim of preserving the native ACL and its proprioceptive receptors, which are essential in children. ACL reconstruction techniques have made progress in children, especially with techniques adapted from adults. Preservation of growth plates remains pertinent, especially at the femur to avoid growth disorders, thus highlighting the important role paediatric orthopaedic surgeons have in the management of these knee sprains.
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