Children's Knee Conditions

Sources

Reference list

All sources cited on this site, grouped by condition. Links open the publisher's page in a new tab.

151 references across 5 conditions.

ACL injury

For trainees: Paediatric ACL Injury: Trainee Guide

  1. Written by: [author name, role]
  2. Reviewed by: [clinical reviewer, role]
  3. Next review due: Oct 4, 2027 ### Core sources
  4. Ardern CL et al. 2018 IOC consensus statement on prevention, diagnosis and management of paediatric ACL injuries. Br J Sports Med 2018
  5. Al-Hadithy N et al. Current concepts of the management of ACL injuries in children. Bone Joint J 2013;95-B
  6. Liao Y et al. Does earlier ACL reconstruction reduce the risk of meniscal and articular cartilage injury in children and adolescents? The Knee 2025;57:414-424
  7. Accadbled F et al. Paediatric ACL tears: management and growth disturbances. A survey of EPOS and POSNA membership. J Child Orthop 2019;13:522-528
  8. De Petrillo G et al. Limited evidence for graft selection in pediatric ACL reconstruction: a narrative review. J Exp Orthop 2022;9:9
  9. Feroe AG, Hassan MM, Kocher MS. Physeal-sparing ACL reconstruction with iliotibial band autograft in the skeletally immature knee. Arthrosc Tech 2022;11:e1597-e1603
  10. Dunn KL et al. Early operative versus delayed or nonoperative treatment of ACL injuries in pediatric patients. J Athl Train 2016;51:425-427
  11. Getgood AMJ et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft ACL reconstruction: 2-year outcomes from the STABILITY study. Am J Sports Med 2020;48:285-297 ### Cited within the core sources
  12. Alomar AZ et al. Knee Surg Sports Traumatol Arthrosc 2021 (hamstring graft diameter)
  13. Cruz AI Jr et al. JBJS Open Access 2020;5:e20.00106 (allograft vs autograft failure)
  14. Dodwell ER et al. Am J Sports Med 2014;42:675-680 (reconstruction trends)
  15. Dumont GD et al. Am J Sports Med 2012;40:2128-2133 (timing and meniscal injury)
  16. Frosch KH et al. Arthroscopy 2010;26:1539-1550 (outcomes and growth disturbance)
  17. Kay J et al. Knee Surg Sports Traumatol Arthrosc 2018;26:1019-1036 (return to sport)
  18. Kercher J et al. J Pediatr Orthop 2009;29:124-129 (physeal volume)
  19. Kocher MS et al. Am J Sports Med 2001;29:292-296 (diagnostic accuracy)
  20. Kocher MS et al. J Bone Joint Surg Am 2018;100:1087-1094 (ITB reconstruction outcomes)
  21. Lawrence JT et al. Am J Sports Med 2011;39:2582-2587 (delay and joint degeneration)
  22. Moksnes H et al. J Bone Joint Surg Am 2012;94:1112-1119 (quality of evidence)
  23. Moksnes H et al. Am J Sports Med 2013;41:1771-1779 (non-operative cohort)
  24. Partan MJ et al. Am J Sports Med 2021;49:1482-1491 (MRI graft prediction)
  25. Perkins CA, Willimon SC. Orthop Clin North Am 2020;51:55-63 (bone age framework)
  26. Pierce TP et al. Am J Sports Med 2017;45:488-494 (transphyseal vs physeal-sparing)
  27. Ramski DE et al. Am J Sports Med 2014;42:2769-2776 (operative vs non-operative)
  28. Salem HS et al. Am J Sports Med 2019;47:2086-2092 (BPTB vs hamstring in young females)
  29. Wiggins AJ et al. Am J Sports Med 2016;44:1861-1876 (second ACL injury) ### To verify before publication
  30. Monaco E et al. 2022 and Perelli S et al. 2022 (paediatric LET cohorts, Am J Sports Med). Confirm full citations.
  31. The Sports Healing Academy LET review (May 2026) was not used as a source. It is not peer reviewed.

For families: ACL Injuries in Children: Information for Families

  1. Ardern CL et al. 2018 International Olympic Committee consensus statement on paediatric ACL injuries. Br J Sports Med 2018
  2. Al-Hadithy N et al. Current concepts of the management of ACL injuries in children. Bone Joint J 2013
  3. Liao Y et al. Does earlier ACL reconstruction reduce meniscal and cartilage injury in children and adolescents? The Knee 2025
  4. De Petrillo G et al. Graft selection in paediatric ACL reconstruction. J Exp Orthop 2022
  5. Accadbled F et al. Paediatric ACL tears: a survey of EPOS and POSNA members. J Child Orthop 2019

Osteochondritis dissecans

For trainees: Juvenile Osteochondritis Dissecans of the Knee: Trainee Guide

  1. Written by: [author name, role]
  2. Reviewed by: [clinical reviewer, role]
  3. Next review due: Oct 4, 2027 ### Core sources
  4. Masquijo J, Kothari A. Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review. EFORT Open Rev 2019;4:201-212
  5. American Academy of Orthopaedic Surgeons. Clinical practice guideline on the diagnosis and treatment of osteochondritis dissecans. Rosemont (IL): AAOS; 2010 ### Cited within the core sources
  6. Kessler JI et al. The demographics and epidemiology of osteochondritis dissecans of the knee in children and adolescents. Am J Sports Med 2014;42:320-326
  7. Hefti F et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 1999;8:231-245
  8. Heywood CS et al. Correlation of MRI to arthroscopic findings of stability in juvenile OCD. Arthroscopy 2011;27:194-199
  9. Roßbach BP et al. Discrepancy between morphological findings in juvenile OCD: MRI vs arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016;24:1259-1264
  10. Carey JL et al. Novel arthroscopic classification of osteochondritis dissecans of the knee: a multicenter reliability study. Am J Sports Med 2016;44:1694-1698
  11. Kocher MS et al. Management of osteochondritis dissecans of the knee: current concepts review. Am J Sports Med 2006;34:1181-1191
  12. Wall EJ et al. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am 2008;90:2655-2664
  13. Gunton MJ et al. Drilling juvenile osteochondritis dissecans: retro- or transarticular? Clin Orthop Relat Res 2013;471:1144-1151
  14. Tabaddor RR et al. Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants. J Pediatr Orthop 2010;30:14-20
  15. Adachi N et al. Functional and radiographic outcomes of unstable juvenile OCD treated with lesion fixation using bioabsorbable pins. J Pediatr Orthop 2015;35:82-88
  16. Gudas R et al. Osteochondral autologous transplantation versus microfracture for OCD of the knee in children: a prospective randomized study. J Pediatr Orthop 2009;29:741-748
  17. Mithöfer K et al. Functional outcome of knee articular cartilage repair in adolescent athletes. Am J Sports Med 2005;33:1147-1153
  18. DiBartola AC et al. Clinical outcomes after autologous chondrocyte implantation in adolescents' knees: a systematic review. Arthroscopy 2016;32:1905-1916 ### Newer evidence (2019 to 2026)
  19. American Academy of Orthopaedic Surgeons. The diagnosis and treatment of osteochondritis dissecans: evidence-based clinical practice guideline, rapid update. Adopted 1 December 2023
  20. Heyworth BE, Ganley TJ, Liotta ES et al. Transarticular versus retroarticular drilling of stable osteochondritis dissecans of the knee: a prospective multicenter randomized controlled trial by the ROCK Group. Am J Sports Med 2023;51(6):1392-1402
  21. Nissen CW, Albright JC, Anderson CN et al. Descriptive epidemiology from the Research in Osteochondritis Dissecans of the Knee (ROCK) prospective cohort. Am J Sports Med 2022;50(1):118-127
  22. Fabricant PD, Milewski MD, Kostyun RO et al. Osteochondritis dissecans of the knee: an interrater reliability study of magnetic resonance imaging characteristics. Am J Sports Med 2020;48(9):2221-2229
  23. ROCK Group. Which osteochondritis dissecans lesions will heal nonoperatively? An application of machine learning to the ROCK prospective cohort. Orthop J Sports Med 2024;12(12)
  24. Accadbled F, Turati M, Kocher MS. Osteochondritis dissecans of the knee: imaging, instability concept, and criteria. J Child Orthop 2023;17(1):47-53
  25. Andriolo L, Solaro L, Altamura SA et al. Classification systems for knee osteochondritis dissecans: a systematic review. Cartilage 2022;13(3)
  26. Muchintala R, Coladonato C, Perez A et al. Return to sport after treatment of stable osteochondritis dissecans lesions of the knee in adolescents: a systematic review. Am J Sports Med 2025;53(7):1761-1768
  27. Coladonato C, Perez AR, Sonnier JH et al. Evaluating return to sports after surgical treatment of unstable osteochondritis dissecans of the knee: a systematic review. Orthop J Sports Med 2024;12(8)
  28. Crawford EA, Rosenberg SI, Patel NB. Management and outcomes of osteochondritis dissecans of the knee in the pediatric and adolescent population. Curr Rev Musculoskelet Med 2026;19(1):43 ### Earlier studies added in this update
  29. Wu IT, Custers RJH, Desai VS et al. Internal fixation of unstable osteochondritis dissecans: do open growth plates improve healing rate? Am J Sports Med 2018;46(10):2394-2401
  30. Wall EJ, Polousky JD, Shea KG et al. Novel radiographic feature classification of knee osteochondritis dissecans. Am J Sports Med 2015

For families: Osteochondritis Dissecans (OCD) of the Knee: Information for Families

  1. Masquijo J, Kothari A. Juvenile osteochondritis dissecans (JOCD) of the knee: current concepts review. EFORT Open Rev 2019;4:201-212
  2. American Academy of Orthopaedic Surgeons. The diagnosis and treatment of osteochondritis dissecans: clinical practice guideline, 2023 rapid update
  3. Heyworth BE et al. Transarticular versus retroarticular drilling of stable osteochondritis dissecans of the knee: a randomized controlled trial by the ROCK Group. Am J Sports Med 2023;51(6):1392-1402
  4. Crawford EA et al. Management and outcomes of osteochondritis dissecans of the knee in the pediatric and adolescent population. Curr Rev Musculoskelet Med 2026;19(1):43

Meniscus injury

For trainees: Paediatric Meniscal Injury: Trainee Guide

  1. Written by: [author name, role]
  2. Reviewed by: [clinical reviewer, role]
  3. Next review due: Oct 4, 2027 ### Core sources
  4. Liechti DJ, Constantinescu DS, Ridley TJ et al. Meniscal repair in pediatric populations: a systematic review of outcomes. Orthop J Sports Med 2019;7(5):2325967119843355
  5. Geffroy L. Meniscal pathology in children and adolescents. Orthop Traumatol Surg Res 2021;107:102775
  6. Asokan A, Ayub A, Ramachandran M. Pediatric meniscal injuries: current concepts. J Child Orthop 2023;17(1):70-75 ### Newer evidence
  7. Tagliero AJ, Kennedy NI, Leland DP et al. Meniscus repairs in the adolescent population: safe and reliable outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020;28:3587-3596
  8. Rohde MS, Shea KG, Dawson T et al. Age, sex, and BMI differences related to repairable meniscal tears in pediatric and adolescent patients. Am J Sports Med 2023;51(2):389-397
  9. SCORE Quality Improvement Registry, Ellis H. Pediatric meniscus repair: safety profile based on more than 2000 arthroscopic meniscus repairs (Poster 256). Orthop J Sports Med 2023;11(7 suppl 3)
  10. Agonias et al. Isolated meniscus repairs in youth have a 19% complication rate and 9% failure rate with variations by tear type, location, range of motion protocol, and sex at 8 months. Arthroscopy 2026
  11. Hiredesai et al. Ten-year post-traumatic osteoarthritis incidence is low after pediatric isolated meniscal surgery but lower after meniscal repair than meniscectomy. Arthrosc Sports Med Rehabil 2026 ### Cited within the core sources
  12. Jackson T, Fabricant PD, Beck N et al. Epidemiology, injury patterns, and treatment of meniscal tears in pediatric patients: a 16-year experience of a single center. Orthop J Sports Med 2019;7(12):2325967119890325
  13. Mitchell J, Graham W, Best TM et al. Epidemiology of meniscal injuries in US high school athletes between 2007 and 2013. Knee Surg Sports Traumatol Arthrosc 2016;24(3):715-722
  14. Patel NM, Mundluru SN, Beck NA et al. Which factors increase the risk of reoperation after meniscal surgery in children? Orthop J Sports Med 2019;7(5):2325967119842885
  15. Shieh AK, Edmonds EW, Pennock AT. Revision meniscal surgery in children and adolescents. Am J Sports Med 2016;44:838-843
  16. Krych AJ et al. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Am J Sports Med 2008;36:1283-1289
  17. Hagmeijer MH et al. Long-term results after repair of isolated meniscal tears among patients aged 18 years and younger: an 18-year follow-up study. Am J Sports Med 2019;47:799-806
  18. Pujol N et al. Amount of meniscal resection after failed meniscal repair. Am J Sports Med 2011;39:1648-1652
  19. Middleton S et al. Meniscal allograft transplantation in the paediatric population. Knee Surg Sports Traumatol Arthrosc 2019;27(6):1908-1913
  20. Riboh JC et al. Meniscal allograft transplantation in the adolescent population. Arthroscopy 2016;32(6):1133-1140
  21. Kocher MS et al. Am J Sports Med 2001;29:292-296 (diagnostic accuracy, see ACL page)

For families: Meniscus Injuries in Children: Information for Families

  1. Asokan A, Ayub A, Ramachandran M. Pediatric meniscal injuries: current concepts. J Child Orthop 2023;17(1):70-75
  2. Geffroy L. Meniscal pathology in children and adolescents. Orthop Traumatol Surg Res 2021;107:102775
  3. Liechti DJ et al. Meniscal repair in pediatric populations: a systematic review of outcomes. Orthop J Sports Med 2019;7(5):2325967119843355

Discoid meniscus

For trainees: Discoid Lateral Meniscus: Trainee Guide

  1. Written by: [author name, role]
  2. Reviewed by: [clinical reviewer, role]
  3. Next review due: Oct 4, 2027 ### Core sources
  4. Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS 2021;6:14-21
  5. Saavedra M, Sepúlveda M, Tuca MJ, Birrer E. Discoid meniscus: current concepts. EFORT Open Rev 2020;5:371-379
  6. Kim JH, Ahn JH, Kim JH, Wang JH. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop 2020;7:81
  7. Lee RJ, Nepple JJ, Schmale GA et al. Reliability of a new arthroscopic discoid lateral meniscus classification system: a multicenter video analysis. Am J Sports Med 2022;50(5):1245-1253
  8. Geffroy L. Meniscal pathology in children and adolescents. Orthop Traumatol Surg Res 2021;107:102775
  9. Asokan A, Ayub A, Ramachandran M. Pediatric meniscal injuries: current concepts. J Child Orthop 2023;17(1):70-75 ### Cited within the core sources
  10. Watanabe M, Takeda S, Ikeuchi H. Atlas of arthroscopy. 2nd ed. Tokyo: Igaku-Shoin; 1969
  11. Klingele KE, Kocher MS, Hresko MT et al. Discoid lateral meniscus: prevalence of peripheral rim instability. J Pediatr Orthop 2004;24:79-82
  12. Good CR, Green DW, Griffith MH et al. Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy 2007;23:157-163
  13. Ahn JH, Lee YS, Ha HC et al. A novel magnetic resonance imaging classification of discoid lateral meniscus based on peripheral attachment. Am J Sports Med 2009;37:1564-1569
  14. Ahn JH, Kim KI, Wang JH et al. Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy 2015;31:867-873
  15. Carter CW, Hoellwarth J, Weiss JM. Clinical outcomes as a function of meniscal stability in the discoid meniscus. J Pediatr Orthop 2012;32:9-14
  16. Okazaki K et al. Arthroscopic resection of the discoid lateral meniscus: long-term follow-up for 16 years. Arthroscopy 2006;22:967-971
  17. Lee YS, Teo SH, Ahn JH et al. Systematic review of the long-term surgical outcomes of discoid lateral meniscus. Arthroscopy 2017;33:1884-1895
  18. Smuin DM, Swenson RD, Dhawan A. Saucerization versus complete resection of a symptomatic discoid lateral meniscus: a systematic review. Arthroscopy 2017;33:1733-1742
  19. Lee DH, D'Lima DD, Lee SH. Partial versus total meniscectomy in symptomatic discoid lateral meniscus: systematic review and meta-analysis. Orthop Traumatol Surg Res 2019;105:669-675
  20. Yamasaki S et al. Risk factors associated with knee joint degeneration after arthroscopic reshaping for juvenile discoid lateral meniscus. Am J Sports Med 2017;45:570-577
  21. Kinugasa K et al. Discoid lateral meniscal repair without saucerization for adolescents with peripheral longitudinal tear. Knee 2019;26:803-808
  22. Kocher MS et al. Diagnostic performance of clinical examination and selective MRI in children and adolescents. Am J Sports Med 2001;29:292-296 ### Recent reviews (2025 to 2026)
  23. Vivekanantha P, Thomas R, Kaplan GE et al. Surgical management of the discoid lateral meniscus: a systematic review of outcomes. Curr Rev Musculoskelet Med 2025. Abstract not available to us; read the full text before citing.
  24. Hartman H, Lessiohadi N, Saharan S et al. Outcomes of saucerization with or without repair for symptomatic discoid lateral meniscus in pediatric patients: a systematic review. Arthroscopy 2026 (now included above)

For families: Discoid Meniscus: Information for Families

  1. Tapasvi S, Shekhar A, Eriksson K. Discoid lateral meniscus: current concepts. J ISAKOS 2021;6:14-21
  2. Saavedra M, Sepúlveda M, Tuca MJ, Birrer E. Discoid meniscus: current concepts. EFORT Open Rev 2020;5:371-379
  3. Kim JH, Ahn JH, Kim JH, Wang JH. Discoid lateral meniscus: importance, diagnosis, and treatment. J Exp Orthop 2020;7:81
  4. Lee RJ, Nepple JJ, Schmale GA et al. Reliability of a new arthroscopic discoid lateral meniscus classification system. Am J Sports Med 2022;50(5):1245-1253

Tibial spine fracture

For trainees: Paediatric Tibial Spine Fractures: Trainee Guide

  1. Written by: [author name, role]
  2. Reviewed by: [clinical reviewer, role]
  3. Next review due: Oct 4, 2027 ### Core sources
  4. Tibial Spine Research Interest Group (Orellana KJ, Houlihan NV, Carter MV et al). Tibial spine fractures in the child and adolescent athlete: a systematic review and meta-analysis. Am J Sports Med 2024;52(5):1357-1366
  5. Salvato D, Green DW, Accadbled F, Tuca M. Tibial spine fractures: state of the art. J ISAKOS 2023;8:404-411
  6. Kushare I, Lee RJ, Ellis HB Jr et al. Tibial spine fracture management: technical tips and tricks from the Tibial Spine Fracture Research Interest Group. J Pediatr Orthop Soc North Am 2020;2(1)
  7. Johnstone TM, Hollyer I, McFarlane K et al. Improved biomechanical performance of tibial spine fracture repair with suture and anchor fixation in pediatric cadaveric knees. Orthop J Sports Med 2025;13(2):23259671241306194 ### Cited within the core sources
  8. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959;41-A:209-222
  9. Green D, Tuca M, Luderowski E et al. A new, MRI-based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and McKeever. Knee Surg Sports Traumatol Arthrosc 2019;27(1):86-92
  10. Kocher MS, Micheli LJ, Gerbino P, Hresko MT. Tibial eminence fractures in children: prevalence of meniscal entrapment. Am J Sports Med 2003;31(3):404-407
  11. Feucht MJ et al. Meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures. Knee Surg Sports Traumatol Arthrosc 2017;25(2):445-453
  12. Mayo MH et al. Anterior cruciate ligament injury at the time of anterior tibial spine fracture in young patients. J Pediatr Orthop 2019;39(9):e668-e673
  13. Bram JT et al. Four risk factors for arthrofibrosis in tibial spine fractures: a national 10-site multicenter study. Am J Sports Med 2020;48(12):2986-2993
  14. Patel NM, Park MJ, Sampson NR, Ganley TJ. Tibial eminence fractures in children: earlier posttreatment mobilization results in improved outcomes. J Pediatr Orthop 2012;32(2):139-144
  15. Vander Have KL et al. Arthrofibrosis after surgical fixation of tibial eminence fractures in children and adolescents. Am J Sports Med 2010;38(2):298-301
  16. Callanan M et al. Suture versus screw fixation of tibial spine fractures in children and adolescents: a comparative study. Orthop J Sports Med 2019;7(11):2325967119881961
  17. O'Donnell R et al. Anterior cruciate ligament tear following operative treatment of pediatric tibial eminence fractures in a multicenter cohort. J Pediatr Orthop 2021;41(5):284-289
  18. Shimberg JL et al. A multicenter comparison of open versus arthroscopic fixation for pediatric tibial spine fractures. J Pediatr Orthop 2022;42(4):195-200
  19. Zhang K et al. Management and complications in nonoperative fractures of the tibial spine: a systematic review. J Pediatr Orthop 2021;41(3):e272-e278
  20. DeFrancesco CJ et al. Pediatric tibial spine fractures: exploring case burden by age and sex. Orthop J Sports Med 2021;9(9):23259671211027237
  21. Ellis HB et al. Classification and treatment of pediatric tibial spine fractures: assessing reliability among a tibial spine research interest group. J Pediatr Orthop 2021;41(1):e20-e25 ### Additional sources
  22. Smith HE, Cruz AI Jr, Mistovich RJ et al. What are the causes and consequences of delayed surgery for pediatric tibial spine fractures? A multicenter study. Orthop J Sports Med 2022;10(3):23259671221078333
  23. Bram JT, Aoyama JT, Mistovich RJ et al. Four risk factors for arthrofibrosis in tibial spine fractures: a national 10-site multicenter study. Am J Sports Med 2020;48(12):2986-2993
  24. Gupte CM. Tibial spine fracture fixation. Instructional lecture, British Association for Surgery of the Knee (BASK), January 2026. Includes the unpublished Imperial series and unit rehabilitation protocol.

For families: Tibial Spine Fractures in Children: Information for Families

  1. Tibial Spine Research Interest Group. Tibial spine fractures in the child and adolescent athlete: a systematic review and meta-analysis. Am J Sports Med 2024;52(5):1357-1366
  2. Salvato D, Green DW, Accadbled F, Tuca M. Tibial spine fractures: state of the art. J ISAKOS 2023;8:404-411
  3. Kushare I, Lee RJ, Ellis HB et al. Tibial spine fracture management: technical tips and tricks from the Tibial Spine Fracture Research Interest Group. JPOSNA 2020;2(1)
  4. Johnstone TM, Hollyer I, McFarlane K et al. Improved biomechanical performance of tibial spine fracture repair with suture and anchor fixation in pediatric cadaveric knees. Orthop J Sports Med 2025;13(2):23259671241306194
  5. Smith HE, Cruz AI Jr, Mistovich RJ et al. What are the causes and consequences of delayed surgery for pediatric tibial spine fractures? Orthop J Sports Med 2022;10(3):23259671221078333