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Health condition · Clinically reviewed

Paediatric knee injuries, ligament tears and growth-safe treatment.

Common in active children and teenagers, particularly in sport. Getting the diagnosis and the growth-plate-safe treatment plan right protects both the knee and future growth.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against British Orthopaedic Association and peer-reviewed sports medicine sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice on growth-plate-sparing reconstruction and paediatric sports medicine referral.

Key facts

Paediatric knee injuries at a glance.

The essentials, in plain English - what these injuries are, how they're found, and how they're treated in the UK today.

  • What it covers

    ACL, PCL, MCL and LCL ligament injuries, meniscal tears, patellar instability and growth-related conditions such as Osgood-Schlatter disease.

  • Who gets it

    Active children and adolescents, particularly those playing pivoting sports such as football, netball, rugby and skiing.

  • Classic sign

    A "pop" sensation with acute swelling suggests a ligament tear, while activity-related pain over the tibial tuberosity points to Osgood-Schlatter disease.

  • Key investigation

    MRI is central to assessment - it avoids radiation and characterises soft tissue and growth plate involvement in growing knees.

  • Growth plates

    Skeletally immature patients need growth-plate-sparing surgical techniques when ligament reconstruction is required, protecting future limb growth.

  • Usual outcome

    Most growth-related pain resolves with skeletal maturity, and most ligament and meniscal injuries do well with the right specialist pathway.

Why this guide matters

A growing knee needs a growth-safe plan.

Children's knees are not just small adult knees. The three points below shape everything else on this page.

  • Growth plates change everything

    Any surgical plan for a ligament tear must protect the growth plates - this is why paediatric-specific reconstruction techniques exist.

  • MRI is the key investigation

    It avoids radiation and characterises soft tissue and growth plate involvement clearly, guiding the rest of the treatment plan.

  • Preservation over removal

    Wherever possible, torn menisci are repaired rather than removed in children, protecting long-term knee function into adulthood.

How the diagnosis is made

From pitch-side injury to a clear plan.

The steps a UK paediatric orthopaedic or sports medicine team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History of the injury

    How the injury happened, whether a "pop" was felt, and whether the child could keep playing all help distinguish ligament tears from other causes.

  2. 02

    Assessing

    Clinical examination

    Stability testing looks for laxity and effusion, though findings can be harder to interpret in children than in adults with more developed ligaments.

  3. 03

    Assessing

    Assess weight-bearing and swelling

    Inability to weight-bear, a large effusion or a sense of the knee giving way all raise concern for a significant internal injury.

  4. 04

    Confirming

    X-ray of the knee

    Plain films assess the growth plates and exclude a fracture before any soft-tissue injury is assumed, especially important in an open growth plate.

  5. 05

    Confirming

    MRI scan

    The key investigation for suspected ligament or meniscal injury - it avoids radiation and shows soft tissue and growth plate detail clearly.

  6. 06

    Preparing

    Paediatric orthopaedic referral

    Suspected ligament tears, meniscal injury or persistent growth-related pain warrant referral to a specialist paediatric orthopaedic or sports medicine team.

  7. 07

    Preparing

    MDT treatment planning

    A multidisciplinary team of paediatric orthopaedics, sports medicine and physiotherapy agrees the management plan, balancing healing with protecting the growth plates.

Typical timeline: a first assessment to a settled plan within a few weeks.

Symptoms

What these injuries actually look like.

The classic signs of an acute ligament injury, and the different picture seen with growth-related conditions like Osgood-Schlatter disease.

  • A "pop" sensation

    Often reported at the moment of injury - a strong signal of a ligament tear, particularly the ACL, and worth taking seriously.

  • Acute swelling

    Rapid knee swelling within hours of injury suggests bleeding within the joint, commonly seen with ligament and meniscal tears.

  • Instability or giving way

    A feeling that the knee is unstable or gives way during activity points towards ligament insufficiency needing assessment.

  • Inability to weight-bear

    Difficulty putting weight through the leg after injury is a red flag for a significant structural problem, not a simple sprain.

  • Activity-related anterior knee pain

    Pain at the front of the knee that builds with running or jumping and eases with rest is typical of growth-related conditions.

  • Tibial tuberosity tenderness

    Localised tenderness and sometimes a visible lump below the kneecap is the hallmark of Osgood-Schlatter disease.

  • Locking or catching

    A knee that catches, locks or clicks during movement can indicate a meniscal tear or a loose fragment from osteochondritis dissecans.

  • Red flag - recurrent dislocation

    Repeated patellar dislocation or a knee that gives way regularly deserves early specialist assessment for instability.

Treatment

How these injuries are treated in the UK.

Growth-plate-sparing surgery when it's needed, conservative care for growth-related pain, and physiotherapy running through every stage.

  • Growth-plate-sparing ACL reconstruction

    For complete ACL tears in skeletally immature patients, techniques that protect the growth plates preserve future limb growth and length.

  • Physiotherapy-focused rehabilitation

    The backbone of recovery for almost every knee and ligament injury - restoring strength, control and confidence before returning to sport.

  • Bracing

    Used to protect a healing ligament, support activity, or manage instability while a definitive treatment plan is agreed.

  • Activity modification and analgesia

    The mainstay for Osgood-Schlatter disease - reducing aggravating activity, using ice, and simple pain relief while the growth plate matures.

  • Meniscal repair

    Preferred over removal wherever possible in children, preserving the meniscus to protect long-term knee function and reduce future arthritis risk.

  • Growth-related condition management

    Osgood-Schlatter disease and similar conditions are usually managed conservatively, resolving as the child reaches skeletal maturity.

  • Graduated return to sport

    A staged, physiotherapy-guided programme rebuilds strength and control before a return to pivoting or contact sport is agreed.

  • Multidisciplinary specialist care

    Paediatric orthopaedics, sports medicine and physiotherapy work together, particularly where surgery or growth-plate protection is involved.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your child's GP, physiotherapist or paediatric orthopaedic team knows their history and can tell you which parts apply to them. If in doubt, get seen.

  • British Orthopaedic Association / British Society for Children's Orthopaedic Surgery. Guidance on paediatric ligament injuries.

  • NICE. Assessment and management of knee injuries in children and young people.

  • British Journal of Sports Medicine. Paediatric ACL injury and growth-plate-sparing reconstruction.

  • Royal College of Paediatrics and Child Health. Sports injury guidance for children and adolescents.

Red flags

When a child's knee injury needs urgent attention.

Most knee pain in children settles with simple care. These are the situations that need a same-day or urgent specialist opinion.

  • Inability to weight-bear

    A child who cannot put weight through the leg after a knee injury needs prompt assessment to exclude a fracture or major ligament injury.

  • A "pop" with immediate swelling

    This combination strongly suggests a significant ligament tear, most often the ACL, and should be assessed by a specialist promptly.

  • Locked knee

    A knee that becomes stuck and will not fully straighten can indicate a displaced meniscal tear or a loose osteochondral fragment requiring urgent review.

  • Recurrent patellar dislocation

    Repeated kneecap dislocation increases the risk of cartilage damage and warrants early orthopaedic assessment for instability.

  • Suspected growth plate injury

    Tenderness directly over a growth plate after injury needs an X-ray to exclude a growth plate fracture, which can affect future growth if missed.

  • Fever with a swollen knee

    A hot, swollen, painful knee with fever raises concern for septic arthritis and needs same-day emergency assessment.

  • Neurovascular symptoms

    Numbness, tingling or a cold, pale foot after a knee injury needs immediate emergency assessment to check the blood supply and nerves.

  • Persistent pain beyond expected healing

    Pain that fails to settle as expected, or a limp that continues for weeks, deserves specialist reassessment rather than continued rest alone.

  • Suspected osteochondritis dissecans

    Vague, activity-related knee pain with intermittent swelling in an active adolescent should prompt assessment for this growth-related cartilage condition.

Living with it

Back to sport, the right way.

Four things that make the biggest difference for a child recovering from a knee or ligament injury - patience, a proper rehab plan, and the right team behind them.

A quiet reminder

A rushed return costs more time than a patient one.

Re-injury after going back too soon almost always sets a child back further than a properly staged recovery would have.

  1. 01 Rehab

    Stick with the physiotherapy plan

    Consistent, guided rehabilitation is what rebuilds strength and confidence - it matters more than any brace or gadget.

  2. 02 Patience

    Let growth-related pain run its course

    Osgood-Schlatter disease and similar conditions settle with skeletal maturity - activity modification buys time rather than fixing things overnight.

  3. 03 Return

    Follow a graduated return to sport

    Going back too soon after a ligament or meniscal injury raises the risk of re-injury - a staged plan protects the long-term outcome.

  4. 04 Support

    Keep the whole team involved

    Paediatric orthopaedics, sports medicine and physiotherapy working together gives the best chance of a full return to the sport your child loves.

Frequently asked

Everything we get asked about children's knee injuries.

Quick answers on ligament tears, growth plates, meniscal repair and returning to sport.

  • What are the most common knee and ligament injuries in children?

    ACL, PCL, MCL and LCL ligament injuries, meniscal tears and patellar instability or dislocation are the most common significant injuries. Growth-related conditions such as Osgood-Schlatter disease and osteochondritis dissecans also cause knee pain in active children and are increasingly recognised in youth sport.

  • How is a ligament injury diagnosed in a child?

    Clinical examination with stability testing is the starting point, though it can be harder to interpret in children than adults. MRI is the key investigation, as it avoids radiation and clearly characterises soft tissue and growth plate involvement, while X-ray is used to assess the growth plates and exclude a fracture.

  • Why does a torn ACL need special treatment in children?

    Children have open growth plates that must be protected during surgery. For complete ACL tears in skeletally immature patients, growth-plate-sparing reconstruction techniques are used to repair the ligament while minimising the risk of disturbing future limb growth.

  • What is Osgood-Schlatter disease and how is it treated?

    It is a growth-related condition causing pain and tenderness over the tibial tuberosity, driven by traction from the patellar tendon during growth spurts. It is usually managed conservatively with activity modification, ice and analgesia, and typically resolves once the child reaches skeletal maturity.

  • Is a meniscal tear treated differently in children than in adults?

    Yes - repair is preferred over removal wherever possible in children. Preserving the meniscus helps protect long-term knee function and reduces the risk of early arthritis later in life, which is a bigger consideration in a growing child than in an older adult.

  • When can my child return to sport after a knee injury?

    This depends on the injury and follows a graduated, physiotherapy-guided programme rather than a fixed timeline. Returning too early increases the risk of re-injury, so the pace is set by strength, control and confidence rather than by how the knee simply looks or feels on a given day.

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