A case of anterior knee pain triggered by an inflammatory problem.
First published 2018, and reviewed August 2023 by Dr Sheila Strover (Clinical Editor)
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.