knee popping in newborn and childern.pptx

lecure about the causes and differnial diagnosis of knee poping

1. knee popping(click) in infant and children By Dr Magdy shafik Senior Pediatric and neonatology Consultant Egyptian Followship Trainer Diploma, M.S , Ph.D of Pediatrics

2. Case 1 4-month old Emma was brought to the pediatrician due to persistent knee clicking along with some concerning symptoms . Her mother reported that for the past month, Emma's knees made a loud popping noise several times a day, often when moving her legs while feeding or changing diapers.   Additionally, over the last week Emma seemed fussy and unwilling to move her right leg at times . Her knee also appeared slightly swollen on that side. During the exam, the doctor was able to elicit an audible pop from both knees but Emma cried when her right leg was manipulated.

3. Due to the ongoing clicking, new pain behaviors, and swelling , the pediatrician suspected Emma's knee issue was more significant than typical benign popping seen in infants. She referred Emma to an orthopedist for further evaluation .   The orthopedist examined Emma under anesthesia to fully assess knee stability and range of motion without her movements hindering the exam. X-rays showed evidence of joint laxity in the right knee. The orthopedist diagnosed Emma with juvenile ligament laxity causing intermittent knee dislocations . She placed Emma in a hinged knee brace دعامة ) )to support the right knee and limit motion while the ligaments heal.   At her follow up visits, Emma showed less clicking and pain over time as her right knee ligaments tightened with brace wear. The orthopedist was ultimately able to wean her out of the brace with good resolution of her knee laxity issues.

4. Case 2 Jenny is a 3 month old baby girl brought in for her routine well-child checkup . Her mother reports that over the past few weeks she has noticed Jenny's knees making a popping or clicking noise when the pediatrician moves her legs during the physical exam.   The doctor performs the exam and sure enough, as she gently bends and straightens Jenny's knees, an audible snapping can be heard coming from both knees . There is no sign of pain, swelling or redness. Jenny moves her legs easily and appears comfortable. The pediatrician explains to the mom that knee clicking is very common in infants Jenny's age due to still developing muscles and ligaments . She reassures that the sound itself is normal a nd benign at this stage. As long as Jenny can move her legs freely without difficulty or sign of injury, no treatment is needed .

5. At Jenny's next checkup 6 months later, her knees are re-examined . Now the clicking is less pronounced when her legs are manipulated. The pediatrician is pleased with Jenny's developing muscle tone and notes the knees appear stable with full range of motion.   The clicking has gradually resolved on its own as expected during Jenny's first year of life as she grows. Both the mom and doctor are relieved the prior knee sounds were a normal exam finding, not a cause for concern. Jenny continues to meet all her developmental milestones.  

6. Introduction Knee popping in newborns and infants can be a cause of concern for parents. However, in some cases, it can be a normal part of growth and development . .  In some cases, the cause of knee popping in infants can be related to muscle imbalances , poor flexibility , or alignment issues. .  Treatment options may include physical therapy , bracing , or, in more severe cases, surgical intervention

7. Normal knee anatomy and development:

8. Important structures in the knee include the menisci ( two C-shaped pieces of cartilage between the femur and tibia), ligaments (stabilize the joint), tendons, bursae (fluid-filled sacs), and synovial membrane (lines the joint). After birth, cartilage continues growing and thickening within the joints. Bones also grow in length during childhood / adolescence via growth plates located near the ends of long bones

9. Puberty triggers a growth spurt where the legs lengthen rapidly. This increased stress can sometimes cause issues ( مشاكل )like Osgood-Schlatter disease or Sinding-Larsen-Johansson syndrome in active youth. Growth plate closure occurs around ages 14-18 as the epiphyseal plates ossify fully. This marks the completion of long bone growth and transition to adult knee anatomy. Proper nutrition , activity levels , injury prevention and skeletal development are important for a healthy knee through all life stages

10. What is Osgood-Schlatter disease? Osgood-Schlatter disease is a condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the shinbone (tibia), a spot called the tibial tuberosity. There may also be inflammation of the patellar tendon, which stretches over the kneecap. Risk factors for OSD include the following: Age: female 8-12 years & male between 12-15 years. Male sex (3:1) Rapid skeletal growth. Repetitive sprinting and jumping sports.

11. Osgood-Schlatter disease will almost always go away on its own once the child stops growing. Treatment includes: Resting the knee and decreasing activity when symptoms develop. Putting ice over the painful area 2 to 4 times a day, and after activities.

12. Etiology Knee popping in newborns and infants can be attributed to various factors. Some possible causes include : . 1 - Normal joint movement : Painless popping sounds in knee and ankle joints are often normal and not a cause for concern. 2. Hip dysplasia : Improper placement of the thigh bone in the hip can cause popping sounds, which may indicate the need for further examination and possible treatment. 3. Articular cartilage injuries : Injuries to the cartilage in the knee can cause popping sensations with knee movement.

13. 4. Knee instability: This occurs when the kneecap pops out of the groove, usually due to the knee being extended and twisted, or from direct collisions to the knee.. 5.Muscle imbalances : Imbalance of thigh muscles that support the knee joint can lead to knee pain and popping sounds. 6. Poor flexibility: Inadequate flexibility can contribute to knee pain and joint popping .

14. Is knee popping in newborns and infants a sign of a medical condition   Painless popping sounds of knee and ankle joints are most likely nothing to worry about in newborns and infants[. However, popping sounds coming from the hips may be more serious and need to be checked quickly, as it may indicate improper placement of the thigh bone (femur) in the hip. If you notice knee popping in your infant, especially if it is accompanied by pain, swelling, or limited mobility , it is essential to consult a healthcare professional for a proper evaluation and diagnosis[

15. However, if the knee popping is accompanied by other symptoms such as pain, swelling, or limited mobility , it may indicate an underlying medical condition such as hip dysplasia, knee instability, or cartilage damage. Other signs of a medical condition that may accompany knee popping in newborns and infants include kneecap= ( Patella) slipping to the outside of the knee , limited motion of the knee, weakness of the knee , and a feeling like the knee is locking up or getting stuck in place

16. Common causes of knee popping in children include Overuse: Knee pain in children can result from overuse, especially in active teenagers Muscle imbalances : Imbalance of thigh muscles that support the knee joint can lead to knee pain and popping sounds Poor flexibility : Inadequate flexibility can contribute to knee pain and joint popping Alignment issues : Problems with alignment, such as pressure pulling the kneecap sideways out of its groove , can cause pain around the kneecap and popping sounds

17. Traumatic injuries : Knee injuries, such as fractures, dislocations, sprains, and tears of soft tissues like ligaments and tendons , can result from a specific trauma or direct collisions to the knee Patellar dislocation and instability : Kneecap instability can occur when the kneecap pops out of the groove, usually due to the knee being extended and twisted, or from direct collisions to the knee Osteochondritis dissecans (OCD): This condition can cause popping or clicking sounds in the joints of children, such as the knee

18. Diagnosis Medical history and physical exam - The doctor will ask about any injuries, activities , and symptoms. On exam, they will evaluate for swelling, instability, range of motion, joint laxity, bumps/deformities . X-rays - Basic x-rays can identify fractures, dislocations , abnormal growths , or other bony abnormalities that may be causing popping.

19. Ultrasound - Useful for evaluating soft tissues like ligaments, tendons , cartilage in infants where imaging radiation is limited. Can identify tears, injuries.   MRI - The gold standard imaging to evaluate cartilage , ligaments, tendons, joints in more detail without radiation. Helps diagnose injuries like meniscus tears .  

20. Arthroscopy – The only way to directly visualize the inside of the knee joint . May be used if physical exam and imaging aren't conclusive. Allows inspection of cartilage, removal of loose bodies, and treatment of small injuries.

21. Management Conservative treatment approaches The goal of conservative care is symptom relief through several months to determine if the popping resolves on its own with growth/maturation before considering surgical options . Surgery would only be considered if popping persists and limits function Rest/modified activity - Limit activities that cause or exacerbate the popping, such as high-impact sports. Use rest, ice, compression, and elevation as needed. Physical therapy - Work with a physical therapist to perform stretching, range of motion, and strengthening exercises to improve flexibility and support around the knee.

22. Bracing - Use an open-patella knee brace to provide support and help align the knee joint, reducing stress that causes popping.   Oral medications - Over-the-counter anti-inflammatories like ibuprofen can help reduce swelling and pain.   Lifestyle modifications - Ensure proper shoes with good arch support. Maintain a healthy weight .

23. Viscosupplementation injections - For older children, hyaluronic acid injections into the knee can help lubricate the joint and reduce popping.   Proprioceptive/balance training - Exercises to improve coordination, stability, and neuromuscular control of the knee.   Manual therapy - Soft tissue massage, joint mobilizations , and trigger point release to improve mobility and decrease joint stiffness.   Cryotherapy - Ice application after activity to reduce swelling and popping.

24. surgical treatment

25. Case 3 Johnny is a 10-year-old boy who plays football . Over the past few months, he has noticed his left knee popping or clicking when he runs . At first it didn't hur t, but now it is starting to feel uncomfortable .   His parents took him to see his pediatrician. On examination, the doctor noticed that Johnny's knee clicks when he bends and straightens it . An x-ray was done which did not show any fractures or abnormalities in the bones.   Johnny was then referred to an orthopedic surgeon for further evaluation. The surgeon did a physical exam and noted increased joint laxity in Johnny's knee compared to the other side. An MRI scan was ordered which showed a tear in his medial meniscus cartilage.

26.   The surgeon explained to Johnny and his parents that the meniscus tear is likely the cause of his knee popping . Left untreated , it could lead to further damage and arthritis in the knee later in life. Surgery was recommended to repair the meniscus tear by removing the torn portion .   Johnny had arthroscopic knee surgery a few weeks later. During the procedure, the surgeon was able to locate and remove the torn piece of meniscus. Johnny's recovery went well with physical therapy. Six months post-op, his knee is no longer popping and he has been cleared to return to full soccer activities without restrictions.   In this case, the knee popping was a symptom of an underlying meniscal tear in the child. Arthroscopic surgery was needed to address the tear and prevent long-term knee issues from developing

27. surgical treatment 1-Ligament or cartilage repair/reconstruction - If the popping is due to an injury like a torn meniscus, ACL, or PCL, these structures may need to be repaired or reconstructed surgically. Things like meniscal repairs, ACL reconstructions, etc. can be done in children. 2-Arthroscopic loose body removal - If the popping is caused by loose fragments or pieces of cartilage floating around in the knee joint, arthroscopic surgery can be performed to remove these loose bodies.   3-Synovial plica excision - Some children have a plica, which is an extra band of tissue inside the knee that can get irritated and cause popping. An arthroscopy can be done to remove the plica tissue.    

28. 4-Tibial tubercle osteotomy قطع - In some cases of Osgood-Schlatter disease (inflammation at the tibial tubercle growth plate), the tibial tubercle may need to be surgically adjusted through an osteotomy. This realigns pressure away from the area that was causing popping.   5-Articular cartilage restoration procedures - For children with cartilage injuries or defects, options like microfracture, drilling, or cartilage grafting may help restore the damaged cartilage and reduce popping  

29. Conclusion   1-Knee popping in infants and young children is very common and usually nothing to worry about . As joints, tendons and muscles develop, some popping may resolve on its own.   2-However, popping accompanied by pain, swelling, or limits in movement could indicate an underlying condition needing attention . Careful exam and sometimes imaging help diagnose the cause.

30. Common etiologies include bone/joint abnormalities , injuries , muscle imbalances or flexibility issues . Osgood- Schlatter disease is a common overuse cause.   Conservative management is the first-line, focusing on rest , physical therapy, bracing or medications . Surgery is reserved for unresolved issues or injuries.

31. With appropriate treatment and monitoring, most knee popping issues in kids can be successfully managed without long-term problems . But seeking medical guidance is important to identify any serious underlying causes.

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