The adolescent athlete can get injured mostly in these four areas:

• knee,
• elbow,
• spine and
• lumbar disc

THE ADOLESCENT ATHLETE’S KNEE:

Patellofemoral pain and instability

PATHOPHYSIOLOGY:

The exact source of pain is often unknown. Pain occurs due to multiple factors, like musculoskeletal, biomechanical and psychological.

The six structural sources of patellofemoral symptoms are:

1. Subchondral bone,
2. Synovium,
3. Retinaculum,
4. Nerve,
5. Muscle and
6. Skin

One of the rarest sources of patellofemoral symptoms is articular damage.

The most common causes of patellofemoral symptoms are:

• Overuse, patellofemoral malalignment, muscle weakness, imbalance, and trauma.
• Knee and patellofemoral malalignment/abnormality of extensor mechanism lead to a traumatic instability.
• Injury to the knee can result in traumatic instability.

EVALUATION:

HISTORY:

• Determine whether the injury was a specific one.
• Determine location and characterization of pain.
• Determine if they have a prior injury in the lower limb.
• Determine the presence of systemic signs and symptoms.
• Establish whether there is instability associated with the symptoms.
• Consider psychological factors.

PHYSICAL EXAMINATION:

• Examine the hip for strength, flexibility and ROM (Range Of Motion )
• Examine knee to include patellar tracking and stability.
• Evaluate for biomechanical and musculoskeletal alterations.

IMAGING:

• Four view X-ray.
• Weight-bearing AP and tunnel
• Lateral with the knee in extension
• Axial patellar view at 30⁰ – 45⁰ of knee flexion
• CT
• MRI
• Radio nuclide scan.

TREATMENT:

• Rehab is the primary treatment of non-traumatic patellofemoral symptoms.
• Vastus medialis strengthening
• Stretching of lateral retinaculum ad quads
• Kinetic chain balancing
• Use Orthotic devices, taping, and bracing.
• Surgery is not performed unless specific lesions are identified and have to be addressed.

PREVENTION:

• Conditioning program with periodization.
• Emphasize proven intervention of quads, strengthening and increasing hamstring flexibility.

ESSENTIAL:

• To conduct history and physical examination for the injured athlete.
• To differentiate between traumatic and atraumatic causes for patellofemoral pain/instability.
• Understanding rehab is the primary focus.

DESIRABLE:

• To understand musculoskeletal and biomechanical factors.
• To understand patellofemoral anatomy and biomechanics.
• To understand psychological factors in the development and management of pain.
• To educate athletes, parents and coaches.

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