Treating injuries in teen athletes

By: Peter Pollack

By Peter Pollack

An increased variety of sports options available to adolescents has resulted in a corresponding need for orthopaedic care when those athletes are injured. According to Col. Tom DeBerardino, MD, a 1998 survey of West Point cadets revealed that at least 10 cadets reported having major reconstructive surgery before entering college. A similar survey conducted in 2008 found that the number had risen to more than 50 cadets in the entering class. Current approaches to the care of adolescent sports injuries of the knee, shoulder, and elbow were discussed at a media briefing yesterday.

The briefing was moderated by Dr. DeBerardino, Sports Medicine Fellowship Director at Keller Army Hospital in West Point, N.Y.; Col. (ret.) Dean C. Taylor, MD, of Duke University, and Tetsuya Matsuura, MD, from the University of Tokushima in Japan, served as panelists.

Dr. DeBerardino explained that knee injuries can be among the most difficult problems to manage in teen athletes. He said that surgeons should remember that the primary goal of treatment is to help the adolescent regain function and to protect cartilage to prevent the onset of arthritis later in life.

A short list of common adolescent knee injuries includes growth plate fractures, stress fractures, Osgood-Schlatter disease, osteochondritis dissecans, patellofemoral arthralgia, meniscus injuries, and anteriorcruciate ligament (ACL) injuries. ACL injuries were once thought to be rare, but are now more widely recognized, although the true prevalence is still unknown.

Treatment for ACL tears has traditionally been nonsurgical, but surgical reconstruction has become more common, according to Dr. DeBerardino. Potential concerns of surgical treatment include premature physeal closure, leg length discrepancy, and angular deformity. He suggests that, with early adolescent patients, surgeons should avoid transphyseal techniques in the femur, and avoid transphyseal hard-ware in the tibia. In older adolescent patients, he suggests that transphyseal techniques in the femur are acceptable, but surgeons should still avoid using transphyseal hardware in the tibia.

Dr. DeBerardino suggests avoiding transphyseal hardware in the tibia.

An arthroscopic option for young shoulders?
Dr. Taylor suggested that arthroscopic surgery, while not appropriate for all patients, may be a preferable alternative for some shoulder dislocations, and emphasized that patients should be referred early to an orthopaedic surgeon to discuss treatment options.

The traditional treatment, he said, is to immobilize the patient in a sling until he or she is comfortable, to prescribe physical therapy to regain strength and motion, and then to allow the patient to return to sports activity. Unfortunately, studies have shown that the chance of redislocation can be as high as 66 percent to 100 percent.

Treating the shoulder surgically can reduce the redislocation rate to less than 10 percent, prevent further damage to the shoulder, and allow the soft tissue to be anatomically repaired. However, surgeons should keep in mind the associated risks of surgery, including shoulder stiffness and loss of motion. A surgical approach also entails a longer time to return to sport than a nonsurgical treatment.

Dr. Matsuura discussed the epidemiology of elbow osteochondral lesions in young baseball players. In a study of 1,802 players, 717 complained of elbow pain either during or after practice; of those, 121 were found to have elbow osteochondral lesions on radiographic examination. While a few players had either capitellum or trochlea lesions, they all had medial epicondyle lesions, making this the most vulnerable area.