The pathology of the knee joints is varied. An orthopedic traumatologist must answer four questions first:
Is there damage to the structures of the knee joint?
Is there acute or chronic knee inflammation?
Are there any congenital features or abnormalities in the area of the knee joints?
Are there any neoplasms in the knee joint area (benign and malignant tumors, paraneoplastic processes)?
An accurate diagnosis allows you to determine the treatment tactics and prognosis of the course of the disease. Today, all relevant methods of diagnostics of the knee joints are used to identify pathologies in children.
The most important information is provided by a thorough collection of anamnesis and high detail of the patient’s complaints. Let us emphasize that it is the patient. Parents often try to tell everything for their child. In this case, the information is greatly distorted, and the child simply agrees with the parent’s version of the presentation of the situation.
It is very important to let your child talk to the doctor on their own, without twitching, interrupting and remarks, after which you will be given time to tell everything that you see fit. The informative value of the patient’s qualitative story is very high and in some cases allows one to form very accurate assumptions about the diagnosis.
Clinical examination and examination reveal:
limiting the range of motion,
limb axis disorders,
pathological symptoms indicating the presence of joint inflammation,
damage to menisci and ligaments and other data.
The relationships in the knee joints, the condition of the bone tissue, the shape of the articular surfaces can be judged by the radiographs made in the frontal, lateral and axial projections. The pictures show the relationship between the femur and the tibia, the articulation between the patella and the thigh. In the vast majority of cases, x-rays can detect fractures of the bones that form the knee joints.
When bone pathology is detected on radiographs, in a number of cases, computed tomography is shown, which makes it possible to detail the state of the altered areas of bone tissue.
If neoplasms and inflammatory diseases of the bones are suspected, bone scintigraphy is used. To determine the level of blood flow in the altered area of the bone, a radiopharmaceutical is injected intravenously, which selectively accumulates in the areas of increased bone formation and bone destruction. About the degree of accumulation, a conclusion is made about the cause of the pathological process in the bone.
Ultrasound and MRI are widely used to study the soft tissue structures of the knee joints:
Ultrasound diagnostics is relevant in the visualization of synovial cysts in the popliteal region, acute and chronic inflammatory diseases.
Magnetic resonance imaging allows visualization of all structures of the knee joints. By MRI, we can judge the condition of the articular cartilage of the femoral condyles, tibia and patella, lateral and medial menisci, anterior and posterior cruciate ligaments, synovial membrane of the knee joint, vessels and nerves.
A comprehensive non-invasive examination makes it possible to make a final diagnosis in more than 95% of patients.
In some cases, to clarify the diagnosis and perform therapeutic manipulations, it is indicated to perform medical and diagnostic arthroscopy of the knee joint.
Diagnostic arthroscopy (“arthro” – joint, “scopy” – look) allows you to examine the cavity of the knee joint and assess the condition of the intra-articular structures with 100% accuracy. Examination is always accompanied by palpation with a diagnostic hook of the menisci, ligaments, articular cartilage and synovium. If necessary, a biopsy of the altered areas can be performed for subsequent pathomorphological examination.
Indications for performing medical and diagnostic arthroscopy of the knee joint in children are absolute and relative.
The indications are:
Multiple Knee Blocks
Injuries to the menisci and cruciate ligaments
Dislocations of the patella, articular hyaline cartilage
Chronic inflammatory diseases
Free bodies in the knee joint cavity
Osteochondritis dissecans (Koenig’s disease)
Synovial fold syndrome.
In most cases, the necessary therapeutic procedures can be performed arthroscopically.
Methods for diagnosing diseases and injuries of the knee joint in children is a rather difficult area that requires a thorough history taking, detailed clarification of complaints, adequate clinical research and the use of a complex of modern examination methods.
In turn, medical and diagnostic arthroscopy of the knee joint serves to establish the final diagnosis and carry out the necessary intra-articular therapeutic manipulations.