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Did my 5 y.o. tear something in his knee?
August 6, 2014 6:33 AM   Subscribe

My son had two nasty playground falls within 30 minutes of each other yesterday. Since then he's complaining of pain in the space behind his knee, and walking stiff legged. Occasionally he'll put weight on the leg, and it buckles. You are not my pediatrician, but can you help tell me how worried I should be, and what questions I should ask at our appointment later today? (Please please please tell me my baby didn't tear an ACL).

According to his school, yesterday my five year old son first slipped and fell off a set of "stepping platforms" near the jungle gym. He was obviously upset and hurt, but seemed to recover and run around okay after that. About 20 minutes later, he went down a slide and "landed funny" and cried out a lot. He was stumbling and limping when I arrived. I had to carry him the whole way home (he usually walks). He continued to limp all night, though being an amazingly good sport about it, and kept pointing to the back of his knee when we asked what hurt.

This morning he's been a sweetheart, but the leg buckles when he tries to walk normally, and he's adopted a stiff legged gait. He still says the pain is behind his knee. We dosed him with ibuprofen, warned his school, and have a pediatrician appointment this afternoon.

Here are my questions:
1. Multiple members of my family have torn their ACLs, and I am FREAKING OUT. How likely is it that a kid his age has a torn ligament or other *serious* knee injury?
2. He is incredibly stoic about pain, and pediatricians have ignored serious problems in the past since they say "he'd be crying if it was that bad". What do I need to ask them to do or check or test? What should I insist on? What should I calm down about?
3. Any other advice? It's nearly impossible to get him to keep still, let alone "rest, ice, compression, elevation." His teachers are trying to entice him with sedentary activities, but should I be keeping him home today just in case?

As I write this, I'm getting defensive about overreacting, but he's never complained about pain this reliably or shown this much motion restriction before. I'm scared and feeling helpless.
posted by synapse to Health & Fitness (10 answers total) 1 user marked this as a favorite
 
Calm down.

The pediatrician will know what to look for. You don't need to direct them to test anything. Just let them do their job. Tell them about the ibuprofen so they know his pain is dulled.

Personally I would keep him home and ice it if possible. (Put on a cartoon.)

Something similar happened to a friend's 4yo son and it turned out it was a simple joint dislocation. The doctor said it happens often to kids this age because of joint flexibility or something like that. He popped it back into place and everything was fine.
posted by St. Peepsburg at 6:40 AM on August 6 [1 favorite]


How likely is it that a kid his age has a torn ligament or other *serious* knee injury?

Not that common - kids are too small and as a rule can't generate enough force to really tear something up. They are also lots more flexible than adults are.

I played sports (Hockey, baseball, football, etc.) every year since I could walk and I never heard about ACL injuries until middle school and later. Hell, I was at the emergency room/doctors office 2-3 times a year for sprains, strains, etc etc etc. Those were far more common than any other sort of injury.

Anyway, I'd keep him home today, throw some movies on the TV and try to have him rest and elevate as much as possible. I would put money on it being a strain/sprain and that it should clear up in a few days. Don't freak out. He'll be fine. Kids are pretty amazingly resilient.
posted by Pogo_Fuzzybutt at 6:59 AM on August 6


I would suspect that a muscle has been strained or a tendon is swollen, not that the ACL has been torn. As pogy-fuzzybutt says, it requires quite a lot of force tear the ACL, which force the mass of a 5 year old is not capable of generating.
posted by dfriedman at 7:03 AM on August 6


The pediatrician will know what to look for. You don't need to direct them to test anything. Just let them do their job.

The doctor knows a lot more than you, but they are human thus imperfect, and patient prompts can help them be better. Having some background knowledge to offer specific prompts ("Is there any chance it could it be X?") could be helpful, if offered respectfully.

But general prompts can also be helpful. Doctor and author Jerome Groopman suggests asking questions such as:
- "What else could it be?"
- "Is there anything that doesn't fit?"
- "Is it possible I have more than one problem?"
posted by Mr.Know-it-some at 7:50 AM on August 6 [4 favorites]


Your ped can tell you with a very high liklihood of accuracy if your child has torn an ACL with a Drawer test or a Lachman test.

Regardless of how likely it is that he's torn something in there, yes you should keep him home, yes you should put on a lot of movies and rest him.
posted by DarlingBri at 7:53 AM on August 6 [1 favorite]


And if you haven't already, outright and firmly tell the pediatrician that he seems to have a high pain tolerance/doesn't express pain easily. (I have a high pain tolerance and it took that interfering with a couple of serious diagnoses before I realized I needed to let my doctor know and also start reacting at a lower threshold myself. He's 5, so he can't do the latter, but you can do the former if you haven't already. However--note, not having kids myself--I wonder whether you can gently encourage him to be direct when he answers questions.) Hang in there!
posted by wintersweet at 8:23 AM on August 6 [1 favorite]


Sounds like a PCL tear. The PCL corresponds to the ACL inside the knee. If he tore his ACL I think you would know... the pain is excruciating compared to a PCL tear. To the doctor! And best of luck. He will be fine.
posted by stompadour at 11:55 AM on August 6


Simple knee injuries like strains and sprains are much more common than ligament tears, and they can also be plenty painful. This just happened yesterday, and it is normal for it still to be hurting today.

I would nth the advice to trust your doctor at first and not insist on any radiologic tests or referrals unless they are recommended - you might push them into doing something unnecessary just to calm you down. I also agree with telling the pediatrician about his high pain tolerance. If something doesn't seem right, like it's not healing up/getting better as expected, that's when you should push for a closer look at it.

Here's a link about ACL injuries in children: it points out that they have historically been considered to be extremely rare, they may not be as rare as once thought, but they're still definitely quite uncommon, and the initial treatment is similar to treatment for a strain/sprain (limiting sports, bracing, strengthening exercises) - stuff like surgery is only considered if that fails. So there would not be a reason to, for example, demand an MRI be performed right away to look for ACL tear, because it wouldn't change what would be done. Hope that's helpful!
posted by treehorn+bunny at 5:51 PM on August 6


First, thank you all for helping me keep my sanity. Nothing like parenting to turn a reasonably sane person into a raving lunatic. All your answers were very helpful and appreciated, I marked a few as "best" that we either used directly, or that predicted what happened at the pediatrician.

She did do the basic flexion/tension tests and found no evidence of tears. His limping and discomfort were clear enough that she took this pretty seriously. She felt a minor fracture was more likely and had us stay for an X-ray. The film looked pretty clear, but apparently signs can develop over days, so she suggested trying one more day at home, and then returning to the office if he was still in pain by Friday. A totally reasonable outcome, and far less scary than what I had conjured in my head.
posted by synapse at 8:00 PM on August 6


I am so glad synapse, that's great news and I hope he recovers quickly.

If he tore his ACL I think you would know... the pain is excruciating compared to a PCL tear.

Just because this Ask turns up a lot when people Google things, I think it's important to note this is not universally true. I simultaneously tore my ACL and my meniscus straight through. I had no pain and no indication anything was seriously wrong aside from a swollen knee and a limb that no longer worked properly. I had no idea I'd sustained a serious injury until the Lachman test was performed.
posted by DarlingBri at 7:05 AM on August 8


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