Adolescent (12-18)
Orthopaedic Conditions

Slipped Capital Femoral Epiphysis (SCFE)

The femur (thigh bone) is made up of a head attached by a thin neck of bone to the main shaft. In children there is a growth plate between the head and the neck. In a SCFE the head of the femur slips off the neck causing a lack of blood supply and the eventual death of bone tissue.

The condition occurs in 10-15-year-olds who are often obese. Symptoms include a limp, an irritable hip, and knee pain. In 20% cases both hips are involved.

I will advise and discuss with you the best treatment for your child. This will include being on crutches for six weeks to ease the weight on the hips as well as surgery to realign and pin the head of the femur in place.

The sooner treatment, the better the outcome will be.

ACL, PCL, Collateral
ligament injuries

The four main ligaments in the knee hold the joint steady. Twisting can cause these ligaments to stretch and even rupture. Quite frequently a ligament injury is associated with the tearing of the meniscus, the rubbery knee cartilage that cushions the shinbone from the thighbone.

In severe injuries the knee will be swollen and very tender. It may lock, get stuck and be unable to straighten. Ligaments that have been completely ruptured generally need surgical repair to help them heal. If it is not repaired, the knee may be unstable, prone to further injury and osteoarthritis in later years.

Milder injuries do well with physical therapy and a carefully managed rehabilitation programme.

I will help diagnose the injury and discuss with you and your child the most effective treatment.

Meniscal injuries

The meniscus is the rubbery, cartilage cushion between the thigh and the shin bone. It can be torn through sudden twisting, especially when playing sport. This can cause pain, the knee joint to lock and to swell.

Surgery may be needed to stabilize the meniscus and wherever possible I aim to repair the tears to help maintain the knee’s important cartilage cushion.

Knee cap/thigh bone joint (patella-femoral) problems

The patella-femoral joint is the joint between the knee cap (patella) and thigh bone (femur).

Patello-femoral joint pain is the most common cause of knee pain. Usually nothing specific has caused the pain to start. It is often felt behind the knee cap or deep in the knee and is aggravated by activities such as climbing stairs, walking down hills, squatting and prolonged sitting. This pain may be associated with unusual body movement and poor tracking of the knee cap.

I will assess your child’s knee pain and develop a physical therapy plan to make sure the knee cap runs more smoothly on the thigh bone. The pain generally responds well to exercises that are aimed at improving muscle strength and control.

In-toeing. Out-toeing.
Bow legs. Knock knees.
(Rotational abnormalities)

As children grow into adolescence and adulthood, their legs are continually changing shape and the bones in the leg gradually rotate. At some stage nearly all children show signs of In-toeing, Out-toeing, Bow legs and Knock knees. Most children outgrow these conditions naturally. Sometimes these conditions can cause muscles and joints to overcompensate. This can lead to leg pain and make it difficult for your child to walk and run. If the condition is not treated it may lead to excessive wear and tear on the joints and subsequent osteoarthritis.

When you come to see me I will examine your child’s legs; talk to you about the causes of your child’s condition; and how my aim will be to position the bones, joints and muscles to make it easier for your child to be fully active.