Adolescent Anterior Knee Pain (AKP), insidious onset, history of inflammatory arthropathy

15-year-old male, referred by pediatric rheumatology, had experienced a true polyarthropathy at 9, which resolved completely.

At 12 he noted bilateral knee pain of insidious onset, associated with his growth spurt. This slowly worsened over time (8 +/10) such that after 3 years, symptoms were so bad that he had to use the elevator at school and friends would deliver him lunch in the cafeteria.

There had been little improvement with optimization of conservative management which included physical therapy, analgesics, anti inflammatories, methotrexate, and steroids.

Examination

The findings of exam included parapatellar pain on palpation (positive Hoffa’s sign), palpable crepitus, and normal alignment, range of motion and stability.

Investigations

All investigations were normal (radiographs, MRI, hematology, rheumatologic screen).

Management

He underwent staged arthroscopies, with three months between. The fat pad was untethered in both instances, with no complications.

At follow-up, seven years, post-surgery he had pain-free knees, with outcome scores as follows: same score both knees:

Lysholm - pre 15, post 86;

ADLS   pre 31, post 93.

 

-