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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
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).

    Is Your Young Athlete Having Orthopedic Surgery? Five Suggestions to Prepare your Pantry for Recovery

    Is Your Young Athlete Having Orthopedic Surgery? Five Suggestions to Prepare your Pantry for Recovery

    by | Dec 11, 2023 | Sports Medicine

    Following surgery, the body experiences increased energy demands due to inflammation and tissue healing. Some patients may eat less due to reduced activity, an increased need for sleep and the use of medications. Not eating enough, when nutrition needs are highest, can prolong recovery time and cause muscle loss.

    For young athletes planning to return to sports, the demands can go beyond the early phase of surgery recovery. After knee surgeries to reconstruct ligaments, such as the anterior cruciate ligament (ACL) or after extensive activity restrictions for healing of osteochondritis dissecans (OCD), these nutrition tips should be used throughout physical therapy and return to sports training. These phases can last months and have high energy demands.

    Certified sports dietitian Taylor Morrison, M.S., R.D.N., CSSD, L.D., says, “Athletes have unique needs when there are healthy, but these needs change and continue to be unique as they are recovering from significant surgeries.” Morrison cares for young athletes in Scottish Rite’s sports medicine clinic and teaches principles of healing and muscle recovery that can help an athlete well beyond their care.

    Morrison offers these nutrition guidelines to help preserve and promote muscle health and support recovery in all phases:

    Eat regular meals and snacks to maintain energy levels and promote wound healing immediately after surgery. Eat a meal or a snack every three to four hours and around physical therapy sessions.

    Include quality protein to help with tissue repair and wound healing. Include foods rich in leucine, an amino acid that helps build and repair muscle, such as chicken, milk, yogurt, eggs and cheese, at each meal and some snacks and especially after physical therapy sessions.

    Include quality carbohydrates to provide energy. Carbs keeps protein available for healing and fiber, which can help with normal digestive function. Carbohydrates with fiber include whole grains, fruits and starchy vegetables. Other carbohydrates include milk and yogurt.

    Include healthy fats that are high in omega 3s to fight long-term inflammation. Healthy fats with Omega 3s include salmon and tuna. Other healthy fats include avocado, nuts, seeds, peanut butter, almond butter and vegetable oil.

    Include a bedtime snack that contains casein to support muscle protein synthesis throughout the night. Casein is a slow-to-digest protein found in milk, yogurt and cottage cheese.
    When you head to the store to stock up on recovery-friendly foods to have on hand, take this list with you for ideas.

    • Eggs
    • Greek yogurt
    • Protein bars
    • Peanut Butter, Almond Butter, SunButter®
    • Starkist® Tuna packs + crackers
    • String Cheese
    • Balanced nutritional supplements such as Boost®, Pediasure®, Carnation Breakfast Essentials®, Kate Farms® or Orgain®

    Nutrition after surgery is important for all patients to preserve muscle and provide the increased energy and nutrients the body needs to heal. Some patients will need a specific nutrition plan due to additional medical conditions. If you would like help with an after-surgery nutrition plan, ask your care team about a certified sports dietitian consult.

    To learn more from Morrison, visit the sports nutrition page on our website.

    Does a Discoid Meniscus Injury Need Surgery?

    Does a Discoid Meniscus Injury Need Surgery?

    by | Apr 25, 2023 | Sports Medicine

    A discoid meniscus is an abnormally shaped piece of cartilage found in the knee joint, and due to its shape, twisting knee movements can sometimes cause it to tear. When determining whether treatment for this injury is necessary, it is important to consider why, when and how the condition was discovered.

    What is a meniscus?
    The round end of the femur (thigh bone) sits on the flat top of the tibia (shin bone) to make up the knee joint. The femur is supported by the meniscus, which is composed of two soft “c” shaped cartilage structures. They act like soft cushions that help support the knee joint. The one that sits on the inner side is called the medial meniscus, and the one on the outer side is called the lateral meniscus.

    What is a discoid meniscus?
    Instead of having the typical “c” shape, a discoid meniscus forms as a solid piece, like a disc or a Frisbee®. The tissue grows thicker and larger than a normal meniscus and also has an abnormal texture, which makes it more likely to cause problems.

    What causes a discoid meniscus?
    A discoid meniscus is a congenital (at birth) defect and does not grow into the normal shape. This defect is not caused by trauma (i.e., an accident) or an injury. One to two out of every 100 children have a discoid meniscus. The condition is found more often in boys.

    A discoid meniscus cannot be prevented. As the child grows, injuries and/or changes in the alignment of the hip, knee and ankle may cause symptoms.

    What are the symptoms?
    A discoid meniscus does not always cause symptoms. It may go unnoticed until symptoms begin. Symptoms can include pain, popping or snapping, limping, inability to bear weight (stand or walk) and inability to straighten the knee.

    How is a discoid meniscus diagnosed?
    A thorough history and physical examination are used to diagnose a discoid meniscus. Common findings on the outside of the knee (lateral joint line) include a bulge that can be seen or a “snap” that can be felt and heard.
    X-rays are used to look at the alignment of the bones in the knee and leg. Other imaging, such as an MRI, may be used to look at the condition of the meniscus and other tissues in the knee.

    What is the treatment?
    For children who do not have symptoms or if they have a “clunk” when they move their knee, yet do not experience pain or difficulty conducting daily activities, no treatment is needed.

    Early symptoms, such as swelling and pain, can be managed by resting, elevating the leg and other common strategies for knee injuries, such as ice and anti-inflammatory medications.

    Surgical treatment is needed if there is a concern regarding the development of the knee with a large discoid or when symptoms begin to interrupt daily activities.

    A knee arthroscopy, a type of minimally invasive surgery, may be recommended. The goal of surgery is to improve the shape of the meniscus and remove any loose or extra tissue that may cause the joint to become stuck. Rehabilitation and a slow return to sports may be necessary after surgery to change the shape of the meniscus.

    A discoid meniscus increases the risk of a meniscal tear, and therefore, the condition is often found when evaluating an MRI of the knee after an injury. In these cases, treatment may be recommended to improve the shape of the meniscus. This can be done at the same time as surgery for other problems diagnosed in the knee.
    What is the long-term outlook?

    A discoid meniscus should not prevent normal daily activities or participation in sports. Diagnosis and management of symptoms can reduce the risk of further damage in the knee joint and prevent long-term problems. Regular follow-up to monitor the growth and health of the developing joint is very important after diagnosis, even if treatment is not needed in the early stages.

    An important initiative of the Center for Excellence in Sports Medicine team at Scottish Rite for Children is a quality improvement registry designed to learn about the care and outcomes of treatment for discoid meniscus, among other conditions. This multi-center collection of data is led by pediatric orthopedic surgeon and director of clinical research Henry B. Ellis, M.D., is called the Sports Cohort Outcomes Registry (SCORE).

    “This large collection of data allows us to compare surgery findings and outcomes across different age groups. The data set is unlike any other and will help to define care for this condition and many others. Early results were shared at the Pediatric Research in Sports Medicine annual meeting in 2022 and have already shaped more studies and better patient care.”        
    – Henry B. Ellis, M.D.

    Each institution in the SCORE group may take care of a handful of patients with this condition each year. The compiled data, reviewing nearly 300 patients and their outcomes helps to provide better education to patient-families, improve surgical decision-making and setting better expectations for outcomes.

    Differences in the appearance of the meniscus as well as the ability for the meniscus to be repaired were apparent. In younger patients, the meniscus:

    • Is larger and covers more of the bone.
    • May have loose, unstable edges.
    • Is more likely able to be repaired.

    These early findings help pediatric orthopedic surgeons know what to expect and how to counsel parents about who may or may not need surgery. Ultimately, the registry will be able to provide standard outcome expectations which will further improve the patient experience and outcomes.