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| Preventing ACL Injuries in Kids |
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| By: Orthopaedic Surgeon, Garrett Tallman, M.D., Scripps Memorial Hospital Encinitas |
Posted: Wednesday, July 30, 2008 8:24 am
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Garrett J. Tallman, M.D., Scripps Encinitas
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Click here for an article by Slammers FC star Taylor Fallon, which appeared on our sister site, XK Orange County, describing her long road back from an ACL injury.
More than 30 million children participate in organized sports in the United States, with millions more participating in recreational activities such as skateboarding, in‐line skating, and bicycling. Each year, approximately 775,000 children are treated in hospital emergency departments for sports‐related injuries and about 25 percent of these injuries are considered serious.
According to the Journal of Bone & Joint Surgery, as female athletes near adolescence, muscular changes cause them to have less control of their knee joints, placing them at greater risk for injuries related to the anterior cruciate ligament (ACL). A study of sports injuries over 30 years showed that women sustain between four and eight times as many ACL tears or ruptures as men. The study also maintained that girls involved in jumping and cutting sports such as basketball and soccer are at the highest risk for ACL injuries. The study sought to determine what role growth and development play in the difference between the genders. And the primary finding in the studies showed that growth in height and bone length without increased strength and power in girls appeared to be related to decreased control of the knee and potentially, increased injury risk.
The ACL is one of the major ligaments in the knee. It connects the thigh bone (femur) with the shin bone (tibia), beneath the kneecap, and in sports that involve jumping and quick direction changes, it is more likely to be stretched or fully torn. The three theories about why there are differences between the genders when it comes to ACL injury have to do with the anatomical differences between the sexes, female hormones and their effects and neuromuscular development.
The female pelvis is typically wider than a male pelvis, creating a slightly different angle from the femur to the tibia. In turn, this makes their meeting at the knee sharper, which results in a more "knock‐kneed" alignment in women. As the knees rotate in and the bottom of the leg turns out, especially during quick direction changes, there is more potential for excess stress on the ACL.
The second theory suggests that female hormones may play a role. Ligaments, like many other tissues, may be affected by hormone levels. The study showed that on average, ACL injuries occur more frequently to women in the ovulation phase of their menstrual cycles. What happens is that the naturally occurring female hormones, estrogen and progesterone, relax the muscles, ligaments, and joints, resulting in an increase in joint movement that could potentially place women at risk.
The third theory is neuromuscular development differences in boys and girls. To make quick‐shifting movements, the muscles need to work in perfect synchronization. If this precision does not occur, the ligaments and bones take the brunt of the repetitive impacts instead of the muscles. For undefined reasons, women do not seem to have neuromuscular precision developed to the extent that men do.
Jump training has shown to be quite successful in girls and women who specifically work on form and jumping techniques, with specific attention paid to proper landing. Jump training also increases overall strength.
Unfortunately, ACL tears do not heal on their own, although many of the body's ligaments will heal after injury if the patient rests and keeps the area immobilized. Once the ACL is torn, stability becomes an issue and the knee is compromised and more prone to cartilage tears and can lead to subsequent arthritis.
Advances in arthroscopic surgical technology allow for minimally invasive surgery, resulting in smaller incisions, less post‐operative pain and quicker recovery. Studies have shown that the success rate of ACL reconstructive surgery is the same between men and women, so some equality is restored in this regard. Some patients who experience ACL tears are able to resume normal daily activities without surgical repair of this ligament. But, if a patient intends to resume participation in sports that stress the knee, surgery is generally required, and there is a postoperative rehabilitation period that is critical to the patient resuming activity, both for exercise and in sport.
In general, experts estimate that about half of the injuries children suffer during sports activities are preventable by following a few simple guidelines. These guidelines will help children stay safe, without taking all the fun out of the activities:
- Supply children with proper equipment, such as helmets, pads, protective eyewear, and mouth guards. Properly maintained equipment assures its effectiveness and can save a child from suffering severe injuries such as head trauma, eye damage or broken bones.
- Make sure playing surfaces are properly maintained and are appropriate for the activities being conducted on them. Playing fields that are full of holes and ruts could cause a child to fall and get hurt. In addition, basketball courts and running tracks should not be made of concrete. These types of surfaces could lead to injury after a fall or even cause shin splints or stress fractures, which may occur from constant running on hard surfaces.
- Adults should supervise activities at all times and be committed to safety. Qualified adults should always supervise team sports and other activities. A commitment to safety and injury prevention includes having people present who are trained in first aid and CPR.
Regardless of a parent’s best efforts to prevent a child from getting hurt while playing sports, injuries do occur. Children suffer from three common types of sports injuries: acute injuries overuse injuries, and re‐injuries.
Acute Injuries
Acute injuries in younger children typically include bruises, sprains, and strains, however older children commonly sustain more severe injuries, such as broken bones and torn ligaments. Acute injuries also include damage to the eyes and brain.
If an acute injury is affecting a child’s function, first aid should be administered immediately. The child should then visit a physician immediately for further assistance or, if the injury appears severe, they should be taken to the nearest hospital emergency department.
Overuse
Overuse injuries occur from repetitive actions that put too much stress on the musculoskeletal system. Child athletes often suffer from this type of injury because of the constant strain that is applied to developing bones and muscles. Overuse injuries range from “Little League elbow” and “swimmer’s shoulder” to shin splints.
If a child complains of pain associated with overuse, have the child examined by a physician who can then determine whether it is necessary to see a sports medicine or orthopaedic specialist. Prompt diagnosis and treatment of overuse injuries are crucial to preventing the development of a chronic problem. After recovery, adjustment in the child’s technique and/or training schedule may be necessary to prevent recurrence.
Re-Injuries
Re‐injuries occur when an athlete returns to a sport before a previous injury has sufficiently healed. An injured child‐athlete is at a great risk for re‐injury when recovery isn’t quite complete. Returning to the sport before a previous injury has completely healed places stress upon the injury and forces the body to compensate for the weakness, which may put the athlete at greater risk for injuring another body part.
This type of injury can be avoided by allowing the injury to completely heal. Once the doctor has given approval to return, you can help your child prevent re‐injury by properly warming up and cooling down during exercise.
Involvement in sports can be very important for children as exercise can reduce their chances of developing health problems related to inactivity, including obesity. Sports also help children build social skills, learn team skills, and develop a general sense of wellbeing. Encouraging safe sports participation with your children is great way to help them stay healthy and happy for years to come.
Click here for an article by Slammers FC star Taylor Fallon, which appeared on our sister site, XK Orange County, describing her long road back from an ACL injury.
Brought to you by the physicians at Scripps Memorial Hospital Encinitas. For more information or a physician referral call 1‐800‐SCRIPPS. |
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