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Does my child need surgery to fix an ACL tear?

Does my child need surgery to fix an ACL tear?

by | Jul 30, 2024 | Sports Medicine

Anterior cruciate ligament (ACL) injuries, continue to challenge young athletes, many calling it an epidemic. Because of the high cost of care and loss of playing time, Scottish Rite for Children’s Sports Medicine team is actively looking for answers to prevent these injuries. As we study the conditions that may contribute to the risk with programs like the Sports-specific Assessment and Functional Evaluation (SAFE) program, we also continue to evaluate and contribute to the available evidence for caring for ACL injuries in young athletes.

Medical director of clinical research and pediatric orthopedic surgeon Henry B. Ellis, M.D., led a multicenter team including others from the Scottish Rite Sports Medicine team just published a critical analysis of the literature pertaining to the management of pediatric ACL injuries. The article is available on the Journal of Bone and Joint Surgeries (JBJS) Reviews site.

Here are some key messages you should know when considering surgery for an ACL tear:

» Even though these are happening at a high rate, there is very little published evidence for managing ACL injury in a pediatric or skeletally immature case.

Studies suggest that as many as 3 out of 4 athletes return to play after completing a nonoperative plan of care after ACL injury, but there are times that surgery is necessary. A physical therapist or athletic trainer can guide rehabilitation with a comprehensive exercise program to prepare an athlete to return to competitive sports with an ACL tear.

» This review suggests that surgery for an ACL reconstruction is recommended when another condition is present. These include:

  • Repairable injury to the cartilage, soft tissue that covers the surface of the bone.
  • Repairable injury to the meniscus, a disc between the two major bones in the knee joint.
  • Symptoms of instability even after high quality rehabilitation.

Since both paths for care can be successful and come with some risk, a decision for surgical or nonsurgical approaches to care for a pediatric ACL reconstruction should include a broad team considering many aspects of the circumstances.

Learn more about individualized care for ACL injuries at Scottish Rite for Children.
 

Ellis, H. B., Jr, Zak, T. K., Jamnik, A., Lind, D. R. G., Dabis, J., Losito, M., Wilson, P., & Moatshe, G. (2023). Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. JBJS reviews, 11(8), 10.2106/JBJS.RVW.22.00223. https://doi.org/10.2106/JBJS.RVW.22.00223
Understanding Hip Impingement in Teens: How it Happens and How to Prevent It

Understanding Hip Impingement in Teens: How it Happens and How to Prevent It

by | Jun 17, 2024 | Sports Medicine

Also commonly referred to as hip impingement, femoroacetabular impingement is a painful condition that occurs in the hips of adolescents and young adults. Two bones fit together to make up this “ball and socket” joint including the head of the femur (ball), which is part of the thigh bone, and the acetabulum (socket), which is part of the pelvis.

Impingement, or pinching, causes pain when the bones in the hip joint pinch the labrum, the soft tissue on the perimeter/edges of the acetabulum.
There are three types of FAI:

  • Cam impingement occurs when the shape of the femoral head or ball is abnormal.
  • Pincer impingement occurs when the shape of the acetabulum or socket is abnormal.
  • Combined impingement occurs when both the ball and the socket are abnormal.

Pediatric orthopedic surgeon Henry B. Ellis, M.D., says, “Repetitive activities make changes in the joints. In the hip, either the soft tissues become damaged, the bone actually changes its shape or both of these occur.” The reason for abnormal bone shape is not known. It may occur during development or may be in response to activity.

Symptoms of hip impingement are more likely to occur in those who perform:

  • Repetitive maximal flexion (bending) of the hip, such as deep squatting or high kicking.
  • Repetitive movements in activities, such as running, dance, gymnastics and hockey.

What are the symptoms of femoroacetabular impingement?

  • Pain in the hip or groin, typically in the front.
  • Tenderness and/or swelling of the hip or groin area.
  • Stiffness or pain after sitting for long periods of time.
  • Aching or pain that worsens with certain activities.

How is it diagnosed?
A thorough history and physical examination are used to diagnose a hip impingement. In most cases, X-rays are used to further assess the shape and fit of the bones. If symptoms do not improve or worsen, additional imaging such as an MRI or MR arthrogram may be recommended to further evaluate the soft tissue, the acetabular labrum. An MR arthrogram uses MRI, fluoroscopy and sometimes an injected medication to show the structures inside the joint.
 
How is it treated?
Treatment depends upon the severity of the condition and typically begins with a nonoperative approach which typically includes resting from activities that cause pain or changing to activities that do not. Other treatment options include physical therapy, joint injections or arthroscopic surgery may be required.
 
In a recently published article “Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient”*, Ellis and others reported findings after reviewing 126 hips (114 patients) under the age of 18 who were being treated for symptomatic FAI. This work helps Ellis and his colleagues around the country provide better counseling to patients considering surgery for FAI.
 
Early recognition and treatment are important because hip impingement has been shown to be a risk factor for early development of osteoarthritis of the hip.
 
How can hip impingement be prevented?
Overuse injuries like hip impingement and FAI occur with a high volume of training, repetition of certain movements and early specialization in a sport.
 
“Hip impingement in a growing child is bad news. We need to help them monitor and modify their volume of repetitive activities to prevent the condition from worsening, or even better, developing.”

  • Henry B. Ellis

These suggestions can help to prevent FAI and other similar overuse conditions:

  • Avoid sports specialization and play multiple sports throughout high school.
  • Emphasize moderation with load and training.
  • Encourage free play and lifetime sports like cycling and hiking.
  • Avoid year-round participation and encourage weekly and seasonal rest from activities requiring repetitive maximal flexion of the hip.
  • Perform proper warm-up and conditioning for all activities.                                                           

Learn more from Ellis about Hip Injuries in Young Athletes.
 
*Yen, Y. M., Kim, Y. J., Ellis, H. B., Sink, E. L., Millis, M. B., Zaltz, I., Sankar, W. N., Clohisy, J. C., Nepple, J. J., & ANCHOR Group (2024). Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient. Journal of pediatric orthopedics, 44(3), 141–146.

Bryce’s Treatment is a Home Run

Bryce’s Treatment is a Home Run

by | Sep 30, 2023 | Sports Medicine

Header image courtesy of Eddie Kelly/ProLook.

When an injury threatened to keep Bryce off the baseball field for nine months, he and his family turned to Scottish Rite for Children to get him back in the game.

Bryce has always loved baseball. “I’ve been playing baseball pretty much ever since I could walk and get a ball in my hand,” he says. His mother, Johnette, first saw glimpses of Bryce’s outstanding athletic ability when he was 4. “When the other team was batting, it didn’t matter where Bryce was playing, he would go all over the field to get the ball,” she says. “He was kind of like a one-man-team.” Bryce started pitching when he was 8, and Johnette saw a drive and a passion that were unlike what she saw in other young athletes. When Bryce became a teenager, he played on select baseball teams, and he spent several summers traveling for games. Bryce’s drive and determination paid off his freshman year at McKinney High School when he made the varsity baseball team.

Like many star athletes, Bryce played several sports, and enjoyed football when he wasn’t playing baseball. Sport diversification can help prevent injuries caused by overuse, but unfortunately contact injuries are harder to prevent. In his junior year, he and his team had made it to the second round of the playoffs. During practice, to get ready for the big game, Bryce went for a block and, after contact, felt his arm go completely numb. “I thought it was just some bumps and a bruise because it’s football,” says Bryce. “So, I played that second round, and played every snap on offense and felt fine, but it turns out, it wasn’t too great.” The day after the game, he and a friend went to the baseball field to throw the ball around, but Bryce quickly realized that there was a problem. “I couldn’t even throw the ball five feet, because it was hurting so bad,” he says. 

Bryce had sustained a labral injury to his shoulder, which likely occurred when he subluxated (shoulder almost dislocated) or possibly dislocated (shoulder completely out of the socket) his shoulder. When the shoulder joint is injured this way, it can cause damage to the structures around the joint, including the labrum. The labrum is a ring of cartilage around the socket part of the ball and socket joint of the shoulder. When torn, the labrum is commonly thought to need surgery, but not always. 

Bryce,-MVP-(1).jpg

Initially, Bryce was told that surgery was necessary in order to return to sports and may take as long as nine months. This news devastated Bryce, so when his parents returned, they turned to the Scottish Rite for Children Orthopedic and Sports Medicine Center for another opinion. Pediatric orthopedic surgeon Henry B. Ellis, M.D., reviewed Bryce’s files and MRI, and felt that they could get him back to baseball with physical therapy instead of surgery. He felt with proper rehabilitation (physical therapy) and allowing enough time to allow the labrum to heal, Bryce could avoid a surgery and possibly be back to baseball sooner. However, this did mean that Bryce would have to give his shoulder enough time to heal before throwing a ball again.

Though encouraged by the option to avoid surgery, Bryce remembers being a little shocked at how difficult physical therapy was from the start. “It kind of killed my confidence a little bit and frustrated me, because I’ve always played a lot of sports and I always want to be the best that I can be. But once I saw improvement in how my body and my shoulder felt, I finally started getting back my confidence, so it was good.” Scottish Rite coordinated with the McKinney High School athletic trainers on a program to get Bryce back on the field as soon as possible.

Bryce was cleared to play in February, right before the team began preparing for the upcoming season. After all the hard work he had put into building back his shoulder, he was very excited to be with his team again. They were glad to have him back too – in Bryce’s first week back, he hit three home runs. Things were going great until COVID-19 forced an early end to the season. “All this is a little different,” says Bryce. “It’s like a curveball being thrown at us. But you just have to adapt and be able to adjust and focus on what you are there for.”

Bryce has complete confidence in his shoulder now. “I feel like I can do anything and everything that I’ve always been capable of doing,” he says. “If it wasn’t for Scottish Rite, I wouldn’t be where I am now.” Bryce recently verbally committed to play baseball at Northeast Community College in Mount Pleasant, Texas, and plans to continue his journey to Major League of Baseball.

Bryce is very grateful to Dr. Ellis. When others were recommending surgery, Ellis presented the pros and cons of a nonoperative plan. Bryce says he learned a lot from his experience. “When you go through hard times, you always have to keep your head straight and focus on the main goal, because you are going to go through ups and downs, but you just have to focus on the end result, and that was big for me. Not focusing on the negatives, but on getting back to where I needed to be.”

 

Has your child been seen in the Sports Medicine clinic here? Fill out this form to tell us about your MVP. 

Individualized Care for ACL injuries

Individualized Care for ACL injuries

by | Sep 27, 2023 | Sports Medicine

The experts at our Center for Excellence in Sports Medicine see hundreds of young athletes for the treatment of knee and anterior cruciate ligament, or ACL, injuries every year. Our multidisciplinary team knows working together to tackle every angle of an ACL injury – from diagnosis using imaging techniques, surgical reconstruction with a pediatric orthopedic surgeon to rehabilitation in physical therapy and even checking in with a pediatric psychologist – will give our active and growing patients the best outcomes.

ACL injuries are on the rise. According to the National Institutes of Health, in the United States alone, approximately 100,000 to 200,000 experience an ACL tear or sprain every year. While ACL injuries may be treated nonoperatively in some cases, reconstruction is typically the treatment method for those with higher levels of activity such as young athletes. After surgical reconstruction, a careful plan for recovery and return-to-play is followed, involving the patient, surgeon and physical therapist. Since secondary ACL tears are a big concern, the recovery process takes nine to 12 months or more before an athlete can get back to their sport at their previous level.

Recently, our sports medicine experts and pediatric orthopedic surgeons Henry B. Ellis, M.D., and Philip L. Wilson, M.D., helped author a study looking at how young athletes in different sports recovered from their ACL injury and reconstruction. In the study, findings showed that young athletes, especially females, demonstrated sport-specific differences in functional testing scores. They also found that soccer players were cleared to return to play sooner than football players and that the level of competition influenced functional testing scores in all athletes. These results point to a clear need for individualized treatment and recovery for ACL injuries.

For our sports medicine experts, this study validates efforts that customize ACL treatment and recovery for each athlete. Our sports medicine team continues to conduct research to improve the treatment strategies, recovery timelines and patient outcomes. Additionally, our experts actively share what they learn about ACL treatment and recovery with others in the medical and sports fields to help update the standards of care for young athletes everywhere.

Learn more about our Center for Excellence in Sports Medicine.

Share Your Story: Bria’s Big Break

Share Your Story: Bria’s Big Break

by | Aug 25, 2023 | Sports Medicine

Bria is a 12-year-old girl who stays busy with a variety of activities. From cheerleading, playing on her trampoline, hanging out with her friends and swimming, she is always on the move. After being diagnosed with Osgood-Schlatter disease, a condition that causes inflammation of the patellar ligament and creates a painful bump just below the knee, Bria and her family came to the Scottish Rite for Children Orthopedic and Sports Medicine Center for treatment. Bria’s mom, Krista, shares their experience in this Share Your Story:

Written by mom – Krista Cardenas

We came to Scottish Rite for Children’s Center for Excellence in Sports Medicine a few years ago for treatment of Osgood-Schlatter disease in Bria’s knee and various cheer-related aches and pains. We really loved Stephanie De Jager, M.S.N., CPNP, and she became our go-to “person” when Bria had injuries.

Last year at an open gym one evening, Bria was tumbling and broke her tibia and had emergency surgery at another Dallas hospital. She fractured it through the growth plate and had compartment syndrome to make things worse. Once she was finally discharged, as the mom, I fell apart when we got home. I didn’t have our “people” to tell me everything was going to be ok, so I called Stephanie. She called me and talked to me at length, reassuring me that we could always switch and follow up later at Scottish Rite. We tried to give the other hospital a chance, but our heart was at Scottish Rite.

At our follow up, their plan of care was hasty, and they didn’t listen to me in discussing her projected growth before scheduling surgery, so we transferred Bria to Scottish Rite for further care. Thank goodness we did, because we got to meet Dr. Ellis, and we absolutely adored him. He really listened and took the time to look at Bria’s realistic growth based on our family heights and her puberty. We watched and waited for almost a year, and each appointment he was conservative and not quick to operate.

Finally, almost a year later, we pulled the trigger and had to do some growth plate modification for limb inequality and to correct a valgus. Our experience was completely different from the first surgery at the other facility. They took the time to explain at length every detail and answer all my million questions, never judging me for my hesitation. Child life specialist Marissa Willis sat with Bria and acknowledged the trauma of her first experience last year. She reassured her that this would be so much different, explaining every step she would experience on surgery day.

Finally on surgery day, we were impressed by every single person we encountered. From Nancy at the desk with her calming and friendly personality, to the volunteer cooking up fresh cookies and tending to my son and Bria’s grandfather, to each nurse we encountered having a kind and reassuring demeanor. Everyone put us so much at ease that we as a family were completely confident in sending her off. We really appreciated Falco’s visit, and he went straight to Bria’s dad to put his head in his lap because Dad was the most anxious. Wow! What an amazing dog! The facility was impeccably clean, updated and everything was so organized.

I can’t say enough about how amazing Scottish Rite is, and we will forever sing your praises. My husband and I both said we want to work at Scottish Rite! Bria’s grandfather couldn’t stop talking about how impressed he was with the facility. He kept saying, “This place is FIRST CLASS!” From the smell of popcorn the moment we walked in, to the kind nurses helping her into the car, this day could not have been any more perfect (for a surgery day that is!).

Learn more about our Center for Excellence in Sports Medicine.DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US.