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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
Making a Game Plan for a Safe Season – Tips for Parents and Coaches

Making a Game Plan for a Safe Season – Tips for Parents and Coaches

by | Jun 18, 2024 | Sports Medicine

The to-do lists for coaches and sports administrators preparing for sports seasons are long. It’s time to meet new players, evaluate the condition and skills of each player, inform the parents of rules and schedules and get the playbook finalized. What may get overlooked is the emergency plan and training. Pediatric sports medicine physician Shane M. Miller, M.D., who has a background as a firefighter and EMT, offers some safety tips for parents and coaches. “Many organizations have the best of intentions to keep athletes safe, says Dr. Miller. “Preparation and practice can make all the difference in emergencies.”

Miller is passionate about helping athletic trainers and others in sports. He conducts training for several school districts including Frisco ISD and Irving ISD. From handling heat illness to spine injuries, athletic trainers are an invaluable resource on the sidelines. Young athletes may be in settings where athletic trainers are not available, so it’s important for parents and coaches to be aware of safety protocols.

Tips for Parents

  • Take the preseason sports physical process seriously. With an accurate and thorough history and exam, the family doctor can identify conditions that may need special attention before and during the season.
  • Get to know the athletic trainer, if available. From emergency care during sporting events to rehabilitation after injury, these health care professionals are knowledgeable about sport-related injuries.
  • Ensure your team/organization has an emergency action plan. These include protocols for lightning safety, preventing heat related illness and communication plans for all emergency situations.
  • Ensure your child’s equipment fits correctly and is worn properly. Poorly fitting equipment misses the mark for protecting the child in the way it is designed. In some cases, this can even cause an injury.
  • Learn signs and symptoms of problems that put young athletes at risk. No one knows your child better than you do. Learn the signs and symptoms of a concussion, heat illness and overuse injuries. Taking the right steps when you recognize these can make all the difference for your athlete.
  • Check the condition of the field and access to emergency personnel. When arriving at practice or a competition, assess the conditions. Is the field in good condition? Is there an automatic external defibrillator (AED) present and accessible? Is there an ambulance or athletic trainer on-site, or will 911 be used for emergencies?

 
Tips for Coaches

  • Review safety guidelines provided by the league and other reputable national sports organizations. These are designed to keep all participants safe.
  • Know your athletes’ major medical conditions and injuries. Because each athlete is unique, it has become more important to recognize individual needs. For example: An athlete with exercise-induced asthma may require use of an inhaler. For someone with an overuse injury, ignoring activity restrictions can shorten his or her season rather than improve performance.
  • Plan rest and water breaks for all activities, these should be modified when the environment is hot. Learn the signs and symptoms of heat illness and heat exhaustion.
  • Review and practice critical decisions and emergency procedures. Establish a plan for making and communicating decisions about weather conditions from heat and humidity to lightning. Identify what resources are available for first aid at each event and how to respond in various emergencies. In many organizations, this is documented in a comprehensive Emergency Action Plan (EAP).

 
“Teamwork is as important in the game as it is in when it comes to emergencies,” says Miller. “When the game plan is clear, situations can be avoided or handled with the best possible outcomes. Take time to prepare for the upcoming season.”

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

Supporting the Mental Aspects of Recovery after an ACL Reconstruction

by | Jan 9, 2024 | Sports Medicine

Anterior cruciate ligament injuries (ACL) continue to be a problem in youth sports such as basketball and soccer. Many athletes and families are very aware of the lengthy physical aspect of returning to sport after an ACL injury and surgery. Some are surprised by the mental challenges and demands that come along with an injury. Patients, like Johanna, are supported by our multi-disciplinary team from the moment they walk into our sports medicine clinic.

Watch Johanna tell her story.

Physical therapist Rushi Patel says, “a lot of times people talk about the physical aspect of an ACL initial injury but you could argue the mental aspect is just as hard.”

Upon arrival, our team begins assessing a new patient from the “inside out.” We ask questions about how the athlete was injured, what level of competition they want to return to and what challenges they are facing physically and mentally in addition to the injury. These help us decide who needs to be involved in the athlete’s care from day one. Here are three tools we implement in our care of young athletes:

  • Certified child life specialists assist children and teens in understanding diagnoses and medical procedures, this helps to keep anticipation and fear under control.
  • Psychologists are available to consult when our clinic team or responses to screening questionnaires suggest an athlete may need more individualized guidance on pain management, coping with the injury and fears related to returning to sports.
  • Many of our patients receive stress management and pain management skill instructions to help them navigate day to day moments and the progression of rehabilitation. Download PDF.

Every team member, from nurse to physical therapist is focused on caring for kids and teens all day, every day. We use age- and developmentally appropriate strategies when we talk to kids, formulate treatment plans and create our educational materials.

Johanna says, “Scottish Rite has been like no other care I’ve gotten at a medical facility I truly feel loved and cared for and not just seen as a number or a patient with an issue to get resolved but they truly care about who I am what my goals are and ultimately what I want to accomplish in life.”

Check out how you can help us learn to prevent ACL injuries.

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).

    Strength and Conditioning Training: It Is Not Just About Getting Strong

    by | Oct 10, 2023 | Therapy Services

    What is strength and conditioning?
    Strength and conditioning may better be referred to as “physical preparation.” An athlete needs to be physically capable of accomplishing the goals set by the coach to compete in the game. Benefits of strength training go beyond just getting an athlete bigger, stronger and faster. Proper training improves an athlete’s resiliency and confidence in their performance as well. Though preventing injuries may not be directly related to movement and strength training, there are studies that suggest that overuse injuries may be reduced by as much as one-half with appropriate training.

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    Ideally, an athlete participating in a strength and conditioning program is:

    • At a developmentally appropriate level.
    • At a physically appropriate level.
    • Receiving proper instruction and supervision.
    • In a setting with equipment that is appropriate for both the athlete and the sport.

    KEISER YOUTH TRAINING CLASSES KE 0000000 D 10 10 45 St PB 48KG. A group of young boys squatting in a gym

    What is training age?
    An athlete’s training age may vary across skills or activity. The “training age” is typically much lower than the chronological age. A soccer player may have started playing soccer at age 4 but didn’t start resistance training until age 12. Therefore, that athlete should not begin a strength and condition program at the level of an athlete with five years of resistance training who may be lifting weights and using other forms of resistance.

    How should goals be set for a young athlete?
    The goals of the program should also be individualized and progress should be tracked. Measures for strength, power, endurance and speed are commonly used. More importantly, an assessment of movement quality should be integrated in the progression. Proper form in fundamental movements should always precede increased resistance or other challenging elements of an exercise.

    Younger athletes should learn that “bulking up” is not an appropriate goal for them. These changes will not occur until developmental stages where hormones are present to create those visual changes. What is more likely to occur with movement and strength training in this population are neurological changes that lead to improved neuromuscular control, which is believed to reduce the risk of knee and ankle injuries common in young athletes.

    What happens after an injury?
    After proper diagnosis, a transition to a supervised strength and conditioning program is ideal only after treatment and rehabilitation for a musculoskeletal injury. An athlete often completes formal physical or occupational therapy before they are ready to return to sport. Therefore, a continued progression of sport-related and other activities help the athlete to complete recovery and prepare for realistic sport environments. Complex movements and distractions that are common during competitions can be integrated into training sessions where variables are controlled.
    People squatting in front of a matrix squat rack | HEME 10 45 S 17 18 13 14 15 ᏣᏃ Ec A Ec 16 16 MATRIX 18 14 10 SCOTTISH RITE FOR CHILDREN PORTS MEDICINE Jasirs 处

    In a recent program for medical professionals, strength and conditioning coach Justin Haser, M.S., CSCS, and physical therapist Daniel Stokes, P.T., D.P.T., CSCS., explained how strength and conditioning is integrated in the continuum of care for healthy and injured athletes. Watch now on YouTube.