Journal Club: Knee pain? Don’t forget SCFE!

The diagnosis of slipped capital femoral epiphysis (SCFE) in children whose presenting symptom is knee pain is often missed initially, causing a significant delay in treatment. These were the primary findings of a retrospective study in patients who underwent surgery for SCFE after an initial presentation of hip or knee pain. 

Of 724 patients with an average age of 11.5 years who underwent SCFE surgery, 571 presented with hip pain and 153 with knee pain. Patients in the hip group underwent imaging after an average of 7 days compared with those in the knee group, who were imaged after 99 days. 

As for surgery, those in the hip group averaged 24 days after presentation compared with 106 days for patients in the knee group. Further, patients in the knee group were at 1.68 times greater risk of requiring reconstructive surgery and also were at higher risk of developing chondrolysis or osteoarthritis. 

Investigators concluded that these findings reinforce the importance of maintaining a high index of suspicion for SCFE in children from 9- to 16-years-old with knee pain. They noted that given the high body mass index of many of these patients, suspicion should be especially high for children who are overweight.

THOUGHTS FROM DR. FARBER

I was always taught to think of the hip when evaluating knee pain. I’m surprised (and disappointed) to see so many of these cases missed. Always look for external rotation and limited abduction of the hip with knee pain and, if there is any doubt, get an X-ray of the hip.

Reference

Momtaz D, Hosseinzadeh S, Mittal MM, et al. Impact of Hip Versus Knee Pain as the Presenting Symptom of Slipped Capital Femoral Epiphysis on Time to Imaging, Surgery, and Complications. J Pediatr Orthop. 2025;45(9):e810-e817. doi:10.1097/BPO.0000000000003016