Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete…: Journal of AAOS(February 2013)

Written by admin on March 4, 2013 – 6:19 am -

Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete: Diagnosis and Management

Jeremy S. Frank, MD and Peter L. Gambacorta, DO

Abstract

Intrasubstance anterior cruciate ligament (ACL) injuries in children and adolescents were once considered rare occurrences, with tibial eminence avulsion fractures generally regarded as the pediatric ACL injury equivalent. However, with increased single-sport focus, less free play, and year-round training at younger ages, intrasubstance ACL injuries in children and adolescents are being diagnosed with increased frequency. As in the adult, a knee devoid of ligamentous stability predisposes the pediatric patient to meniscal and chondral injuries and early degenerative changes.

Management of ACL injuries in skeletally immature patients includes physeal-sparing, partial transphyseal, and complete transphyseal ACL reconstruction. Complications include iatrogenic growth disturbance resulting from physeal violation.

In the past 20 years, sports injuries in pediatric and adolescent athletes have dramatically increased. Approximately 38 million young athletes participate in organized sports annually in the United States. Of these, nearly 2 million high school students and almost twice as many athletes aged <14 years are treated for a sports-related injury each year. This new epidemic of sports-related injuries can be partially attributed to the dramatic surge in the number of participants since the passage of Title IX, along with increased emphasis on year-round competition, single-sport concentration, and more intense training.

Summary

ACL ruptures in skeletally immature patients are becoming more common with increased single-sport concentration, year-round participation, and less time spent in free play. It is the role of pediatric sports medicine providers to properly diagnose and manage these injuries. Nonsurgical management, including activity modification, bracing, and physical therapy, is best used for patients with partial tears involving <50% of the ACL diameter. In patients with complete ruptures, chronologic, physiologic, and skeletal maturity must be assessed to appropriately address the injury. Treatment options are predicated on assessment of the patient’s maturity and include physeal-sparing, partial and complete transphyseal, and adult-type anatomic ACL reconstruction. Postoperative management includes weight-bearing and activity modifications, bracing, and a progressive physical therapy protocol emphasizing ROM, closed-chain strengthening, and a gradual and measured return to sport-specific maneuvers. Surgical complications are rare.

Journal AAOS © 2013 (February)


Tags: , , , ,
Posted in Arthroscopy, Knee, Sports Medicine | No Comments »

Study: Autograft ACL repair better in young athletes

Written by admin on February 25, 2013 – 3:45 pm -

(FoxNews: May 3, 2012)

A new study suggests young athletes who need knee ligament surgery do better over the long run when their own tissue is used for the reconstruction procedure, rather than tissue from a donor.

The anterior cruciate ligament (ACL) connects the upper and lower leg bones and helps stabilize the knee. It gets the most use in athletes who play a sport such as basketball that involves quick cuts and changes in direction.

Those athletes are also the most likely to suffer a torn ACL — the same injury that took down Chicago Bulls player Derrick Rose in the first round of the National Basketball Association playoffs last weekend.

The new findings support past research suggesting that when those injuries occur, it’s better to use a person’s own tissue to repair their ACL — also known as an autograft, said Dr. Cassandra Lee, a sports medicine doctor at the University of California, Davis, who wasn’t involved in the new study.

Typically, the tissue for an autograft is taken from a person’s hamstring or patellar tendon. The alternative — an allograft — is donated tissue from a cadaver.

For the new study, researchers at the United States Military Academy in West Point, New York tracked members of their 2007 through 2013 classes who had ACL reconstruction before entering the Academy. The students ranged from 18 to 23 years old.

Dr. Brett Owens, the study’s senior investigator and chief of orthopedic surgery service at Keller Army Hospital in West Point, told Reuters Health the researchers started their study after noticing an increase in the number of reconstructions using donated tissue that had failed.

They identified 120 cadets who’d had a total of 122 ACL reconstructions. Of those, 106 had their ACLs reconstructed with autografts; the rest had donor tissue.

Since all cadets receive medical care at the Academy, the researchers knew 20 of the ACL reconstructions failed — meaning cadets had to have the surgery re-done. Those failures happened an average of a year and a half after students started at the Academy.

Of the reconstructions that failed, 13 were from surgeries using the cadets’ own tissue — about 12 percent of all autografts — and seven were from cadavers, accounting for 44 percent of reconstructions that used donated tissue.

The researchers reported that cadets who had ACL allograft reconstruction were almost seven times as likely to need a second surgery compared to when cadets’ own tissue had been used.

Owens and his colleagues also reported that ACL allograft reconstructions failed much earlier, on average, than autografts.

They wrote in the American Journal of Sports Medicine that they recommend the use of autografts in young athletes.

There are about 150,000 ACL injuries every year in the U.S., according to the American Orthopaedic Society for Sports Medicine. The cost of reconstruction surgery varies, but typically runs between $5,000 and $7,000.

Read more


Tags: , , , , , , ,
Posted in Arthroscopy, Knee, Sports Medicine | No Comments »

Soccer players often recover fully from ACL surgery

Written by admin on February 24, 2013 – 7:48 pm -

(FoxNews: September 28, 2012)

Most soccer players are able to return to the field after surgery to repair torn knee ligaments, a new study suggests.

But out of 100 athletes who had reconstructive surgery on their anterior cruciate ligament, or ACL, researchers found female and older players were less likely than younger men and boys to get back in the game.

And by seven years out, 12 of the athletes had undergone a second ACL surgery on the same or opposite knee.

“The good news is, you can get back to a sport like soccer after an ACL reconstruction,” said Dr. Robert Brophy, an orthopedic surgeon from the Washington University School of Medicine in St. Louis, who led the study.

But athletes who’ve had an ACL tear, he added, “need to have a sense of the fact that they’re going to be at risk for future injury.”

The ACL, located in the middle of the knee joint, is most commonly injured during sports that require jumping or quick changes in direction, or when the knee gets overextended.

Female athletes are known to be at higher risk of ACL tears. Regardless of gender, those are typically thought of as season-ending injuries because rehab takes months of working to regain strength and range of motion.

For the new study, Brophy and his colleagues interviewed 100 soccer players who’d undergone surgery to repair a torn ACL in 2002 or 2003.

At the time of surgery, those athletes ranged in age from 11 to 53 years and included high school and college players as well as recreational athletes. Forty-five of them were female.

After surgery, 72 of the athletes returned to playing soccer, usually after a year or so, with most reaching their pre-injury level of play. That included 42 male athletes and 30 female athletes who said they’d gone back to the sport.

People who were younger at the time of injury were more likely to return to the field.

Seven years after surgery, 36 out of the 100 initial athletes were still playing soccer, the researchers reported in The American Journal of Sports Medicine. By then, nine female athletes and three males reported having had another ACL surgery.

The American Orthopaedic Society for Sports Medicine estimates there are about 150,000 ACL injuries in the U.S. every year.

Brophy said there are many reasons why athletes may never return to their sport of choice after an ACL tear. They may not get their conditioning back to where it once was, or they may feel okay running but have trouble with the type of knee function required for soccer or football.

In addition, “they may be afraid of re-injury or feel like it’s not worth the risk,” he told Reuters Health.

That may be especially true for older athletes, he said.

“Life demands may make the rehabilitation more challenging and more difficult to get through, as well as make it more difficult to say, ”(It’s) worth it to go back and play.’”


Tags: , , , , , ,
Posted in Arthroscopy, Knee, Sports Medicine | No Comments »

Josh Baker’s (NY Jets) ACL Injury

Written by admin on September 2, 2012 – 10:33 am -

Josh Baker

The NFL pre-season has yet to begin. Unfortunately for Josh Baker, a NY Jets tight end, the season has already ended. In only the third preseason game of the year; Baker received a blow to his right knee by an opponent’s helmet when attempting to catch a touchdown pass Sunday night in the Jets 17- 12 loss to the Carolina Panthers. The injury may be seen at http://assets.sbnation.com/assets/1316218/kneeinjury.gif
Baker was assisted off of the field. The results of the diagnostic tests concluded that Baker had torn the anterior cruciate ligament (ACL) in his right knee. The ACL is one of the commonly injured ligaments of the knee. Other ligaments of the knee include the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and the lateral collateral ligament (LCL). Although not all ACL injuries require reconstruction; it is recommended that those who tear their ACL have reconstructive surgery if he/she plans to return to sports/activity in the future. If the individual does not receive surgery he or she may need to wear a brace for support and/or modify their activities to accommodate the instability of the knee, and Osteoarthritis of the knee is certain to follow.
Dr. Galland is Board Certified in Orthopedic Surgery and in Orthopaedic Sports Medicine., Dr. Galland recommends and performs the Anatomic-Double Bundle Technique over the traditional “trans-tibial” Technique. These techniques are very different as the traditional trans-tibial technique only reconstructs the anterior-medial portion of the ACL and ignores the posterior-lateral portion of the ligament. The double-bundle technique reconstructs both the anterior-medial and posterior-lateral portions of the ACL. Dr. Galland prefers this technique as it has been shown to improve stability, range of motion and performance while promising to decrease the risk of degenerative arthritis in the joint, and decreases the chance and severity of post-surgical complications.
Galland, M. (2012). Restoring the knee after anterior cruciate ligament (acl) injury using the anatomic-. Retrieved from http://www.orthonc.com/articles/DB_ACL_final_revision_vype.pdf
Posted by Caitlin Davis, ATC/LAT, resident, GOSM program.

Tags: , , , ,
Posted in Arthroscopy, Knee, Sports Medicine | No Comments »