Evaluation and Management of Knee Pain in Adolescents

Initial Diagnostic Approach

The American College of Radiology recommends starting with three-view knee radiographs (anteroposterior, lateral, and tangential patellar) for all patients ≥5 years old presenting with knee pain 1, 2, 3
Proceed to MRI without IV contrast if radiographs are normal or demonstrate only joint effusion but symptoms persist, as recommended by the American College of Radiology 1, 2, 4, 3
MRI accurately detects meniscal tears, ligament injuries, articular cartilage abnormalities, bone marrow lesions, and popliteal cysts that may not be visible on radiographs, according to the American College of Radiology 1, 4

Osgood-Schlatter disease (tibial tubercle apophysitis) and Sinding-Larsen-Johansson syndrome (inferior pole patella apophysitis) are common diagnoses in adolescents, as noted by the American College of Radiology 2
Osteochondritis dissecans is a condition that may cause activity-related pain and possible mechanical symptoms, according to the American College of Radiology 1, 2

The American Academy of Family Physicians recommends initiating physical therapy emphasizing quadriceps and hip strengthening exercises, neuromuscular education, and movement retraining 7
The American Academy of Orthopaedic Surgeons suggests using NSAIDs (oral or topical) or acetaminophen (≤4 g/day) for pain control unless contraindicated 7, 8
Avoid glucosamine, chondroitin, and acupuncture as they lack evidence of effectiveness, as stated by the American Academy of Family Physicians and the American Academy of Orthopaedic Surgeons 7, 8

Refer to orthopedics when osteochondritis dissecans is identified on imaging, as recommended by the American College of Radiology 1, 2
The American College of Radiology also recommends referral to orthopedics when recurrent patellar dislocations occur or significant ligamentous injury (ACL/PCL tear) is confirmed 2