Knee Pain in Adolescents Linked With Long-Term Pain and Functional Deficits

Teenage boy having his knee examined at doctor's office
The aim of this study was to investigate prognostic factors in adolescents with knee pain using Individual Participant Data meta-analysis.

Knee pain among adolescents was associated with long-term pain and functional deficits, according to results from a meta-analysis, published in Pain.

Researchers searched publication databases through 2019 for prospective studies on nontraumatic knee pain among a minimum of 20 adolescents (aged 10-19 years) with a minimum follow-up of 6 weeks.

A total of 13 studies comprising 1516 adolescents were included in this study. The participants were aged between 12 and 17 years and, within each study, between 40% and 100% were girls.

Average knee pain decreased from 57 mm (95% CI, 49-64), on a 100-point scale, by -31 (95% CI, -38 to -23 mm; P <.0001). The change in knee pain was nonlinear (quadratic function, 9; 95% CI, 0.7-1.2).

At long-term follow-up, girls’ reported knee pain was 8 points higher (95% CI, 4-12) and their function was 8 points lower than boys (95% CI, 4-13) and for every 1-year increase in age, their function was 2 points lower (95% CI, 1-4).

Individuals with bilateral pain reported pain as 7points (95% CI, 1-13) higher and function as 6 points (95% CI, 0-12) lower. Compared with those who had almost daily pain, those with monthly or weekly pain reported a decreased pain of 12 (95% CI, 7-17) and 15 (95% CI, 9-22) points and increased function of 14 (95% CI, 9-18) and 20 (95% CI, 14-25) points, respectively.

For every 1-point increase in Heath Related Quality of Life, pain was reported to be 30 points (95% CI, 19-42) lower and function to be 42 points (95% CI, 20-64) higher. Patients with moderate anxiety or depression at baseline had a 5 point (95% CI, -1 to 11) decrease in pain and 8 point (95% CI, 3-12) decrease to function at follow-up.

This study may have been biased due to the fact many of the underlying studies had a moderate or high risk for attrition bias and because the investigators did not incorporate data on treatment for knee pain.

This study found that more than half of adolescents with knee pain continued to be in pain 12 months later. Pain intensity, frequency, and location were associated with lasting pain and decreased function, as was decreased quality of life.

These findings suggested additional studies of knee pain among adolescents are needed to determine which interventions decrease long-term consequences of knee pain early in life.


Holden S, Kasza J, Winters M, van Middelkoop M, Rathleff MS; Adolescent knee health group. Prognostic factors for adolescent knee pain: an individual participant data meta-analysis of 1281 patients. Published online January 11, 2021. Pain. doi:10.1097/j.pain.0000000000002184