ACL injuries on the rise in younger patients
According to a review article in the February 2013 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), ACL injuries once were considered rare in children and adolescents. However, the number of ACL injuries in young athletes is on the rise, "whether they result from year-round training, less free play or increased single sport concentration," said lead study author and pediatric orthopaedic surgeon Jeremy Frank, MD, with Joe DiMaggio Children's Hospital's Department of Pediatric Orthopaedics and [U18] Sports Medicine in Hollywood, Fla.
To avoid potential future complications, such as early onset osteoarthritis, the literature review outlines the optimal strategies for treating pediatric ACL injuries based on the specifics of the injury and the child's skeletal (bone), age and developmental maturity.
Among the recommendations:
-- Children should be treated by an orthopaedic surgeon who has expertise
in the operative treatment of pediatric ACL injuries.
-- For pediatric and adolescent patients with partial ACL tears
compromising less than 50 percent of the diameter of the ligament,
non-surgical management, including activity modification, bracing and/or
physical therapy, can be considered.
-- Treatment for complete ACL ruptures typically involves transphyseal ACL
reconstruction surgery that partially or completely spares the femoral
physis (the growth plate, contributing to 70 percent of thigh-bone
growth), and adult-type surgical or arthroscopic reconstruction in
adolescents at or nearing skeletal maturity.
-- Postoperative management may include weight-bearing and activity
modifications, bracing, and a progressive physical therapy program
emphasizing range of motion (ROM), closed-chain strengthening (exercises
on the knee while the foot remains stationary) and a gradual and
measured return to sport-specific maneuvers and activities.
"There are currently numerous safe and effective surgical techniques to reconstruct the ACL in the skeletally immature sportsperson to restore stability and forestall the early progression towards meniscal and chondral (cartilage) pathologies (disease)," said Dr. Frank. Complications from ACL surgery are rare in children when the appropriate operation is performed on the right patient.
Read about how Noah Korotzer, Christina Gordon, Anthony Risaliti and Samuel Wittwer overcame their pediatric, sports-related ACL rupture injuries on ANationInMotion.org.
February 1, 2013 Full JAAOS Table of Contents
-- Correspondence: Benign Tumors of the Spine
-- Worker's Compensation and Outcomes of Upper Extremity Surgery
-- ACL Injuries in the Skeletally immature Athlete: Diagnosis and Treatment
-- Fracture Dislocations of the Proximal Interphalangeal Joint
-- Patient-Reported Outcome Measures in Spine Venous Thrombosis in Athletes
-- Venour Thrombosis in Athletes
-- Giant Cell Tumor of Bone
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