12yr old boy knee pain

i have just recently seen a 12yr old boy with knee pain. i have sent him for an mri scan did i do the right thing?

he has been suffering from knee pain in the inferior poles in both legs for 1 year but he recently had a fall on his right knee 1 month ago and is in alot of pain. he has had an x-ray done and was clear. observation showed puffiness of the knee around the patella, and swelling was present girth was 1.5 cm more on his right. on movements ext is painful end range, his flex is limited to 70 degrees, pain does occur earlier but gets severe at 70. on passive more can be acheived but pain increases. internal rotation is fine but on passive ext rotation he gets pain. the pain is always around the inferior patella. on palpation he has pain 7/10 VAS along the joint line medial and lateral, on the medial side he has pain along the length of mcl. i cannot do any ligament test meniscus, acl or pcl as he is in pain with flexion, mcl and lcl cause pain with the hand pressure not the stress on the ligament, i can not do any prone tests as he can not put weight on the patella at all. he can not stand on his right leg to bear all his weight. to clear his hip i did rotation but pain again was at his knee. isometric quad and hamstring cause pain in inferior patella. what can i do to help? i thought about sinding larsen johanoson disease but his right knee seems alot worse due to the fall and i was thinking menisus, is the mri scan going to help. all i have been able to do is contrast ice and heat treatment to reduce the swelling as it has been 1 month since the fall. any info welcome

[Physiobase]

Although this is not classic Osgood Schlatter's the presentation appears similar albeit at a different location.

It would be key to understand the play habits/sporting/weight issues of this 12 year old. It might just well be growing pains with a bit of increased loading as a result, perhaps aggravating the patella tendon insertion to the patella.

MRI is an OK thing to do to rule out other pathology and it is non-invasive. Does the boy have any other issues that could indicate he is seeking attention from the family members at this time?

I would do what you are doing for now. Rest, ice, reassurance that this is part of growing and if you like unload the tendon with some taping technique of your choice. See the effect of this and a review over one week and if symptoms are resolving then do nothing more. If they are not then let us know and we can think about other issues at that time.

thanks for your info

the young lad plays cricket and golf so theres not much loading on the joints, after the fall onme month ago he has reduced even stopped his sport due to the pain.

as far as i could see there was no attention seeking, as he was very specific to his symptoms, which also matched the tests i could do.

i shall let you what happens in a week

[Physiobase]

OK, but there is a lot of knee loading in cricket. Is he bowling?

[arunja]

I think you should think laterally than confined to the joint alone. Is there any injury to Qceps , may be a contusion may precipitate the same symptoms. We cannot also neglect the possibility of sup and inf bursae. MRI is good , so you can easily rule out the structure at fault.

[andyakers]

Have you considered Sindig-Larrson-johansson disease ?

This is similar to Osgood-Schlatters but occurs at the inferior pole of the patella. treatment is very similar.

MRI would be useful to confirm the presence of the condition.

[wutti]

hi, concerning to the fall on the knee, it might be infrapatellar bursitis and also hoffers fad pad might be inflamed. if tibial tuberosity is painfull, osgood schlatter might be the reason.
if you want to check lig (ACL) use lachmann test, you only need about 30 to 40 degrees od knee flex. Pcl gravity sign might be useful.

cheers