Physeal Stress Injuries of the Knee

Participation in children’s and youth sports is widespread in the United States. With pressures from coaches, parents, and aspirations for college and professional competition, children are specializing in a single sport at earlier ages. As such, sport-related overuse injuries are becoming more prevalent. These injuries develop when there is a repetitive mechanical stress placed on an anatomical structure with insufficient rest to allow healing and adaptation. It is essential for the practicing physician to understand how various overuse injuries can present clinically in addition to understanding their management. Physeal stress injuries (PSIs) at the knee include both epiphyseal and apophyseal PSIs, the latter being more common. Overall, activity modification remains an essential treatment strategy for these injuries. In reference to epiphyseal PSIs, such as distal femoral PSI, strict rest from impact activity is advised, whereas in apophyseal PSIs such as Osgood–Schlatter’s disease or Sinding-Larson–Johansson syndrome, some activity may be permitted if it does not worsen symptoms or alter biomechanics.