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ACL injuries on the rise for kids and teens

ACL injuries have increased over the past 20 years for kids and teens. Here are some prevention tips.

Today's guest blogger is Jeff Albaugh, PT, MS, ATC, Sports Medicine Physical Therapy Supervisor, Sports Medicine & Performance Center for the Children's Hospital of Philadelphia Care Network

Sports medicine professionals have noted that children involved in recreational and organized sports seem to be getting hurt at an ever increasing rate. A recent study published online in Pediatrics finally confirms this alarming trend.

The authors looked at injury to the anterior cruciate ligament (ACL), which is one of the main stabilizing ligaments in the knee and frequently torn during sports related activities. Injury to this ligament was once thought to be rare in children, but this paper notes the alarming trend of this adult injury in children. Since the implications of an ACL tear can include increased risk for arthritis in the knee, the fact that the rates of ACL tears in school-age children and adolescents have increased significantly over the past 20 years, may have very long-term effects for these children.

The authors found a 2.3 percent annual increase from 1994 to 2013 in the number of ACL tears in patients 6 to 18 years of age. Of particular note, females had significantly higher rates of injury in the younger ages, while males demonstrated higher incidence in the 17 to 18-year-old age group. This difference is consistent with previously reported data for injury rates between the sexes and may be attributed to several factors. These factors can include anatomical differences in females at the end of the femur (thigh) bone and an overall smaller ACL size. Additional gender related factors in risk of injury may be due to neuromuscular differences in the way female athletes control their trunk and legs for physical tasks such as squatting, cutting, and landing from a jump.

Researchers also found the percentage of ACL injuries in this population that were surgically reconstructed increased over the study period. ACL tear treatment recommendations for younger athletes with open growth plates and bones that are still growing have evolved over the years. Previously, it was recommended that younger patients delay reconstruction to allow bones to mature in order to avoid disturbing bone growth, however, this delay poses risk for additional damage to other structures about the knee. More recently, new surgical techniques have been developed to reconstruct the ACL to provide stability and restore function to the knee while preserving the growth plates in younger athletes.

Overall, traumatic and overuse injuries to children involved in youth, middle-school, and high school sports are on the rise due to increased participation, sports specialization and biomechanical predisposition. ACL tears, subsequent surgical reconstruction, and the lengthy rehabilitation required are physically and mentally demanding for a young athletes and their families.

Ultimately, the key to reversing this trend would hopefully be prevention. Unfortunately, it is very difficult to determine "at risk" athletes.  Prevention programs are available and have shown some promise in reducing risk, but they have not been universally adopted and when adopted, compliance can be an issue. Orthopedic and sports medicine specialists recommend monitoring participation and over-exposure to specific sports as well as participating in conditioning or prevention programs aimed at neuromuscular and balance training.

Here are prevention tips for parents and caregivers of pediatric and adolescent athletes:

  1. Avoid overuse and risks associated with participation in multiple sports on multiple teams in the same season.  The American Academy of Pediatrics recommends encouraging children to try a variety of sports, limiting participation in sports to five days a week,  and taking a combined 2-3 months off per year from a specific sport (see the AAP for more recommendations)

  2. Injury screening and prevention programs with an emphasis on neuromuscular training can help reduced the risk of lower extremity injuries. The following programs are recommended and can be incorporated into practice sessions as a warm-up for all youth and adolescent sports: FIFA 11+, Santa Monica Prevent Injury & Enhance Performance (PEP) program, and Children's Ready, Set, Prevent program

  3. Seek Orthopedic or Sports Medicine Specialist consultation for all traumatic and overuse sports injuries.  Accurate diagnosis, management, and rehabilitation is crucial for safe return to play and prevent further risk for injury.

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