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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
What’s in an ACL Injury Prevention Program?

What’s in an ACL Injury Prevention Program?

by | Jan 2, 2024 | Sports Medicine

In a study conducted by members of Scottish Rite’s sports medicine research team, we have found that one in five parents are not aware of injury prevention programs that can reduce the risk of anterior cruciate ligament (ACL) injuries. This is alarming because studies show that these injuries can take an athlete out of sports for at least nine to 12 months and increase the risk of a second injury and knee problems as an adult. Many say they would participate in these programs if they knew how. Here are three elements of day-to-day training that align with sport-related injury prevention and can be implemented individually or as a team.

    1. Wake Up Your Brain and Muscle Connection

    This step is called muscle activation and is focused on waking up small but very important muscles that maintain core stability during activity. From planks to squats, controlled movements that engage specific abdominal, spinal, shoulder and hip muscles are a key to a safe start for practice or competition. This step is rooted in principles of neuromuscular coordination, and with repetition, it is believed to improve stability and reduce injury risk during activities.

    1. Warm Up Your Muscles

    Now that your brain and muscles are talking, you need to get the blood flowing into those muscles and move them through their full range of motion. Athletes are familiar with dynamic warm-up exercises like soldier walks and knee hugs, and learning ways to maximize these exercises can help improve the effectiveness and reduce the time needed for the warm-up. Make sure you’re warm before you take off at full speed or make large movements with force like jumping, throwing a long distance or kicking a ball.

    Physical therapist Jessica Penshorn has put together a great easy to follow program for basketball players that combines mobility, activation and dynamic warm-up. Watch the short video, or read a summary of the program and download a handout here.

    1. Wind-down

    After the training or competition session is over, abruptly stopping can leave muscles confused and angry. Post-activity recovery strategies like foam rolling, contrast baths and gentle stretching can reduce the onset of muscle soreness and setting the body up for a quick turnaround to activity the next day.
    Email bridgeprogram@tsrh.org to sign up for our Athlete Development program for group training sessions that use all of these strategies to build solid foundations and strength, power and speed for high performance.

    1. Warm Up Your Muscles

    Now that your brain and muscles are talking, you need to get the blood flowing into those muscles and move them through their full range of motion. Athletes are familiar with dynamic warm-up exercises like soldier walks and knee hugs, and learning ways to maximize these exercises can help improve the effectiveness and reduce the time needed for the warm-up. Make sure you’re warm before you take off at full speed or make large movements with force like jumping, throwing a long distance or kicking a ball.

    If you want to learn more about injury prevention programs for your young athlete, check out these resources:

    *Sparagana, P., Selee, B., Ellis, H., Ellington, M., Beck, J., Carsen, S., Crepeau, A., Cruz, A., Heyworth, B., Mayer, S., Niu, E., Patel, N., Pennock, A., VandenBerg, C., Vanderhave, K., Williams, B., & Stinson, Z. (2023). Parental Awareness and Attitudes Towards ACL Injury Prevention Programs in Youth Athletes: Original Research. Journal of the Pediatric Orthopaedic Society of North America, 5(4).

    Four Tips to Prevent Injuries in Youth Lacrosse

    Four Tips to Prevent Injuries in Youth Lacrosse

    by | Apr 28, 2023 | Sports Medicine

    Lacrosse is one of the oldest sports in North America and is also one of the fastest growing sports in the United States. In 2021, there were more than 40,000 collegiate and more than 450,000 youth lacrosse players. Boys’ and girls’ lacrosse follow different rules and require different equipment, which may impact the types of injuries seen in these young athletes.

    “Lacrosse is an intense and demanding sport,” orthopedic surgeon John E. Arvesen, M.D., says. “Athletes who are prepared can dramatically reduce the risk of injury.” Coaches and parents can use these tips to guide young athletes in the right direction.

    FOUR WAYS TO REDUCE INJURY RISK IN LACROSSE

    Wear proper equipment. Protective gear that meets standards and fits correctly will provide the most benefit. Poor-fitting equipment may not offer the same protection or support.

    Perform a dynamic warm-up. This involves continuous movement to raise the body’s core temperature in preparation for training or competition. Perform this before each practice or game to increase elasticity in the muscles, tendons and ligaments around the joints.

    Learn and implement effective hydration strategies. Mild dehydration can worsen performance. Ideally, players should drink water every 15 to 20 minutes. Add a sports drink during intense activities lasting longer than one hour or in very hot environments to replace electrolytes lost through sweat.

    Plan for rest and cross-training. Early sport specialization increases an athlete’s risk of injury and inhibits their athletic development. Focusing on one sport at an early age may lead to movement imbalances, an increased risk of injury and overtraining. A one- or two-month break between seasons and a day or two of rest each week in-season is recommended.

    Some injuries in lacrosse are more difficult to prevent, such as those that occur from sticks, collisions and falls. Non-contact injuries are considered to be more preventable. As a sports physical therapist and youth lacrosse parent and coach, Michael Losito teaches young athletes the importance of learning fundamental movements to prepare their bodies for non-contact injuries. “When an athlete has control over the trunk and lower extremities, he or she can produce more power, which may help to protect the joints from minor and serious injuries,” Losito says.

    Common Injuries in Lacrosse

    Despite efforts to reduce the risk of injury, some accidents are going to happen. Make sure you recognize and respond to injuries promptly. Many conditions can be treated with rest and a short round of rehabilitation if they are recognized early.

    SPORT-RELATED CONCUSSIONS
    Concussions in girls’ lacrosse players are often the result of stick contact, or a blow with a stick to the head. Boys’ lacrosse has a higher risk for concussion due to player-to-player contact. An athlete with any concussion symptoms, including change in behavior, thinking or performance after a collision or a blow to the head, neck or body, should be removed from play immediately and not return to play the same day. A medical professional with experience managing concussions should determine when it is safe to return to play.

    KNEE AND ANKLE INJURIES
    Sudden changes in direction, stopping and jumping can place a lot of stress on the knee.  This can stretch and tear ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament (MCL). A swollen knee is a sign of a joint injury that needs to be evaluated.

    In lacrosse, sudden direction changes, stepping on another player’s foot or landing from a jump can result in an ankle injury. Ankle sprains and injuries to the growth plate are common in growing athletes and should be evaluated to optimize treatment and return to sport.

    BACK AND CHEST INJURIES
    Player-to-player collisions or falls may cause back injuries. Powerful and repetitive rotation while running, cradling, shooting and passing is more likely to cause activity-related pain in lacrosse. Overuse injuries, such as stress fractures (spondylolysis), are also common in young athletes. Persistent back pain from overuse injuries needs to be evaluated by a medical professional. The equipment and high-speed movements in lacrosse increase the risk of a rare injury from a direct blow to the chest from the ball, a stick or player collisions. The condition, called commotio cordis, can be life-threatening. Chest protectors may reduce the impact and risk of this injury.

    ARM INJURIES
    The design of lacrosse protective gear allows the arm to move freely but leaves the shoulder open to injury. Clavicle (collar bone) fractures and ligament injuries, or “separated shoulders,” may occur. A change in the appearance of the shoulder, pain, swelling or limited motion after a collision or fall should be evaluated.
    Body checks, stick checks and slashing may cause hand and wrist injuries. Soft tissue injuries such as ligament sprains may heal with rest and ice. Others may need a brace or other treatment.

    Download the PDF.

    Basketball Research at Scottish Rite for Children Revealing New Trends in Basketball Injury Prevention

    Basketball Research at Scottish Rite for Children Revealing New Trends in Basketball Injury Prevention

    by | Feb 1, 2023 | Sports Medicine

    Our Sports Medicine research team is collecting data to learn more about injury prevention in young basketball players. As part of the SAFE program at Scottish Rite for Children, young athletes perform various tasks, including a movement screen and assessments of speed, agility and strength. Additionally, athletes complete surveys specific to their sport participation and injury history. As the research team tests more athletes, the information collected will provide evidence-based guidance for developing injury prevention programs specific for the youth athlete. The ability to identify movement patterns or behaviors that may increase the risk of sustaining a sport-related injury is imperative. Studies have shown that sports injuries can often lead to the athlete discontinuing their sport participation, negatively impacting their overall health and wellness. Therefore, this research is helping to develop more advanced screening tools to mitigate those risks, which is instrumental for keeping athletes healthy and out on the court.

    Watch the MavsMan try out the SAFE testing activities.

    In partnership with the Mavs Academy, our team has tested hundreds of basketball players throughout the past two years at events, such as the Mavs Youth Combine, Mavs Academy Development Camp and the Mavs SAFE Tip-Off. Coaches, athletes and parents expressed that they learned valuable information from the experience as well as asking how they can connect other athletes to the opportunity. The shared desire to make an impact on injury prevention is obvious in these conversations.

    “The work that is being done by Scottish Rite has the potential to impact athletes now and well into their futures. We are excited to partner with them in making youth basketball safer.”

    Brad Freeman
    Senior Director
    Mavs Academy & Mavs Gaming
    Dallas Mavericks

     

    Early results from this work are already pointing to a few messages your young athlete may want to know. Here are preliminary findings from a subset of this data that included 105 participants with an average age of 13 years.

    • 66% of athletes have limited ankle motion
    • 20% of athletes reported a prior knee injury
    • 39% of athletes reported a sport-related injury within the past 12 months

     

    • Stronger athletes jumped higher with more power and strength on a single-leg vertical jump. Athletes with more overall strength may perform better during single-leg basketball movements.
    • Faster athletes exhibited better coordination leading to improved performance on the triple hop for distance. Speed deficiencies may hinder single-leg hop performance.
    • Athletes with a prior knee injury exhibited greater single-leg vertical jump height asymmetry and larger side-to-side power deficits, which is an indicator of future injury risk. To avoid injury, it is important to land from a jump with proper technique and symmetry between limbs.
    • Limb symmetry observed in jump distance metrics were not reflected in jump height symmetry. Given basketball involves single-leg jumps, an assessment of injury risk via limb asymmetry may be more informative using a hop for height and not a hop for distance.
    • Limited ankle flexion was found to influence single-leg hop height (but not hop distance). Achieving adequate jump height is important for basketball-specific movements. For safer and more efficient running and jumping, ankle flexion should be at least 40 degrees. A lower number can indicate tightness in the calf muscle that may improve with stretching.

    “The results from a complex data set like this may sound confusing to parents and coaches, however, through this research initiative we are already discovering trends that allow us to take action in community education.”

    Ashley Erdman, B.S., M.B.A.
    Lead Biomechanist
    Movement Science Lab, Frisco

     

    Scottish Rite for Children is continuing to partner with the Mavs Academy to learn more about injury prevention. Participants will be invited to participate in on-site testing when it is offered, but testing is also conducted at Scottish Rite for Children.

    If you are interested in participating in this project individually or as a team, please email Sophia.Ulman@tsrh.org.

    Moment of Impact: Keeping Young Athletes SAFE

    Moment of Impact: Keeping Young Athletes SAFE

    by | Nov 28, 2022 | Sports Medicine

    Article previously published in Rite Up, 2022 – Issue 3.

    What if you could prevent a sports injury before it happens? That is exactly what the experts in the Center for Excellence in Sports Medicine at Scottish Rite for Children aim to achieve. Led by Sophia Ulman, Ph.D., the SAFE (Sports-specific Assessment and Functional Evaluation) program uses 3D motion capture technology — the same technology used to create special effects in movies and video games — to assess injury risk by studying the movements of young athletes.

    The goal of the SAFE program is to develop injury prevention tools that will reduce sport-related injuries in young athletes here and beyond, creating a new standard of care. “Current injury prevention methods are falling short, as sports injuries in young athletes are skyrocketing,” Ulman says. “We are the first to use machine learning techniques to assess a young athlete’s risk for injury by considering risk factors such as movement characteristics, demographics, sports participation characteristics, psychological measures, nutrition, and sleep patterns.”

    Uninjured athletes are invited to the Scottish Rite’s Movement Science Laboratory, where they are fitted with reflective markers. The markers are used to collect the athlete’s movement patterns to evaluate their mobility, speed, agility, and power in 3D. Participants are asked to jump, squat, run, pivot, and perform sport specific movements like penalty kicks, layups, or back handsprings. “The data is analyzed to learn more about how young athletes move and to determine if certain movement patterns lead to future sports injuries that would require treatment,” Ulman says.

    The SAFE program has tested the movements of approximately 340 athletes across sports, such as baseball, basketball, gymnastics, softball, track, and more. “After initial testing, we follow athletes for one year and note if any athlete experiences an injury,” Ulman says. “This data is helping us compare the movements of athletes who remained healthy versus athletes who were subsequently injured to determine what may have led to the injury.”

    Researchers at Scottish Rite have already identified findings that might help predict injury risk in young athletes. “We have found that current tools for assessing injuries of the knee may be unreliable in some instances,” Ulman says. “Current methods commonly rely on 2D video to assess injury risk, but our research using 3D modeling is identifying potential risk factors that the 2D assessment cannot.” Through this innovative program, Scottish Rite researchers collaborate with medical professionals and sports medicine experts across the field to advance the treatment of young athletes throughout the country.

    The SAFE program is poised to change the way health care professionals assess athletes for injury risk and, best of all, will help keep young athletes in the game.

    To learn more about Movement Science, please call 469-515-7160 or email MSL.Frisco@tsrh.org.

    Read the full issue.