With spring well underway, our sons and daughters are taking to the fields, diamonds and courts for another season of outdoor sports. With the growing interest in competitive youth sports, there has been a rise in injuries that come with playing these sports at a high level and they're happening at increasingly younger ages.
In the past decade or so, one of the injuries often requiring the need for surgery among young athletes is a tear of the ACL (anterior cruciate ligament). The ACL, which connects the thigh bone (femur) and shin bone (tibia) inside the knee joint, is a crucial stabilizer during sports like basketball, football, soccer and lacrosse. The ACL protects the knee from shifting, rotating and hyperextending as an athlete runs, jumps or lands-movements which tend to occur with great frequency in many sports. Typically, the ligament tear involves simultaneous deceleration and twisting.
Orthopedic specialists estimate that approximately 200,000 ACL-related injuries occur each year among all ages. However, the incidence of an ACL tear in children and teens seems to be occurring at a higher rate. Findings reported at the American Academy of Pediatrics 2011 annual meeting noted that researchers at Children's Hospital of Philadelphia found a 400 percent increase in youth ACL injuries over the last decade. Females have an estimated two to eight times increased risk of an ACL tear as males. The reason for the increase risk in females is not fully understood, but it is thought to be related to the increased angle from the hips to the knees and a decrease in neuromuscular control during explosive sporting activities.
An ACL injury can be associated with a contact or non-contact incident and presents with pain, swelling, and the feeling of knee instability. The diagnosis of an ACL tear is usually confirmed with a clinical exam as well as an MRI. For the first few weeks after an ACL tear, the most widely accepted treatment involves reducing the swelling, performing range-of-motion exercises and bracing. Bracing has found to be beneficial for the recovery period after an injury or surgery, but studies do not show any benefit for the use of bracing to prevent an ACL injury in the general population. Football linemen playing at a high level are the only population that has shown a slight benefit for prophylactic bracing of the knee.
Reconstructing a torn ACL is fairly common but it involves different techniques and is more labor intensive in children. It requires fashioning a new ligament from other parts of the child's leg or from a donor. There is concern surrounding growth plates that, if not handled properly, could result in premature closing of the growth plates in the knee.
For the young athlete, I prefer using the patient's own tissue to reconstruct the ACL, as opposed to a using donor tissue. A number of studies have shown that these tissues, which are frozen and sterilized to kill any infections, tend to be less capable of withstanding the forces applied to them during sports like football, basketball and soccer. There is believed to be up to a three-fold increase in rupture of donor grafts in the young population. This is not as true for adults, whose activity level is less involved than young athletes. Most adults can be treated with donor tissue replacement, or based on the patient, sometimes-just physical therapy. For younger athletes who still intend to compete, recovery from ACL surgery varies, but can take up to a year.
The current data indicates there may be a solution to reduce the risks of this injury: exercises to strengthen the muscles around the knee and to help improve muscular control when jumping and landing. Proper warm up exercises are important as well as plyometric exercises such as box jumps and other explosive movements that strengthen the knee under specific stress to help your child to gain fuller control of his or her lower body. Teaching athletes how to land properly, to come to sudden stops safely and other muscle education for the lower extremities can significantly reduce the risk of ACL injuries.
Growing evidence shows a well-rounded calisthenics program as well as a plyometric program that helps with neuromuscular control can help reduce ACL injuries. Now the goal is persuading coaches (and parents) across the United States to implement these types of training programs.
Dr. Kevin Witte, DO, is with Orthopedic Surgeons, Inc. at St. Mary's and can be reached at 816-220-8727.