Pediatric Patellar Injuries

Pediatric patellar injuries are common causes of anterior knee pain in children and adolescents and are frequently encountered in emergency and acute care settings. These conditions range from load-related overuse syndromes to acute traumatic injuries requiring timely recognition and referral. Unique features of the skeletally immature knee, including evolving ossification centers, open physes, and cartilaginous structures, may complicate diagnosis and contribute to missed or delayed recognition.

This review provides an evidence-informed, emergency medicine-oriented approach to the evaluation and management of pediatric patellar injuries, with emphasis on key history and examination findings, imaging selection, initial treatment, and indications for orthopedic referral.

Pediatric patellar conditions include patellofemoral pain syndrome, patellar subluxation and dislocation, prepatellar bursitis, patellar tendinopathy, Sinding-Larsen-Johansson syndrome, chondromalacia patellae, and patellar fractures. Most load-related conditions are diagnosed clinically and managed nonoperatively with symptom control, activity modification, and rehabilitation. In contrast, acute patellar dislocation and fractures require careful assessment for osteochondral injury, loose bodies, and extensor mechanism disruption. Radiographs are the first-line imaging study for traumatic presentations; magnetic resonance imaging or ultrasonography may be necessary when clinically important cartilaginous, osteochondral, or extensor mechanism injury is suspected despite nondiagnostic radiographs. Computed tomography (CT) has a selective role when detailed characterization of an osseous or osteochondral fragment would alter management.

A systematic approach to pediatric anterior knee pain can help emergency clinicians distinguish low-risk load-related syndromes from injuries requiring immobilization, advanced imaging, or urgent orthopedic consultation. Attention to mechanism of injury, effusion, focal tenderness, patellar instability, and active knee extension is central to appropriate diagnosis and disposition.