Pediatric Sports Medicine Injuries: Lower Extremity Director,

Pediatric Sports Medicine
Injuries:
Lower Extremity
Tal Lassiter, MD,MHA
Director,
Bassett Shoulder and Sports Medicine
Research Institute
Disclaimer
I have no financial conflicts or interests
to disclose.
Outline
1. Who we are and what we do
2. STOP Sports Injuries Program
3. Two specific pediatric athletic injuries
ACL tears in Children
Hip labral injuries
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Academic All-American Gymnast at Cornell
AOA Brody School of Medicine
Orthopaedics and Sports Medicine
at Duke University
Best Clinical Science paper from AOSSM
AOSSM, AANA member
New England Shoulder and Elbow Society
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UNC undergrad
Harvard MD
Duke Surgery/Ortho
ECU Sports fellowship/team doc
Bern, Switzerland AO
fellowship
Sports CAQ
UNC MHA
Associate Professor, Duke Orthopaedics
AOSSM, AANA, NESES
Why?!
Bassett Healthcare is
a rural academic
medical center
committed to
providing excellence
in healthcare
services, educating
physicians and other
healthcare
professionals and
pursuing health
research.
Shoulder and Sports Medicine
Research Institute Activities
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Research and Teaching
Baseball Hall of Fame
NY State High School Baseball
Outcomes: Shoulder, Knee, Hip
Colleges: Hartwick, SUNY Oneonta
Fellowship
Education: CME, Medical Students
Sports Trauma and
Overuse Prevention
The Problem
• 30 million children participate in organized sports
(Source: Safe Kids USA)
• Participation in high school athletics is increasing, with
more than 7.3 million high school students participating
annually
(Source: National Federation of State High School Associations)
• High school athletics account for more than 2 million
injuries annually, including
o 500,000 doctor visits
o 30,000 hospitalizations
(Source: Centers for Disease Control)
The Problem
• Young athletes are specializing in sports (and positions)
at an earlier age, with more than 3.5 million children
under the age of 14 treated annually for sports injuries.
(Source: Safe Kids USA)
• Immature bones, insufficient rest after injury, poor
training and conditioning contribute to overuse injuries.
• Overuse injuries account for half of all sports injuries in
middle school and high school.
(Source: Safe Kids USA)
The Lasting Problem
A child’s history of injury is…..
1. A risk factor for future injury during both their youth and
adulthood
1. A contributor to long term degenerative diseases, such
as osteoarthritis.
The Lasting Problem – Part 2
70% of kids participating in sports drop out by the age of 13
because of
• Adults
• Coaches
• Parents
These children lose the benefits of exercise, teamwork
and healthy competition!
What is Overuse?
Overuse is considered excessive and
repeated use that results in injury to the
bones, muscles or tendons involved in the
action.
Why are Injuries on the
rise?
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Immature bones
Insufficient rest after an injury
Poor training or conditioning
Specialization in just one sport
Year-round participation
What Can We Do to Prevent
Overuse and Trauma Injuries?
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Promote injury prevention on multiple levels,
including:
Learning about the STOP Sports Injuries campaign and
visiting www.STOPSportsInjuries.org for resources
Take the Pledge on the website to prevent injuries
Holding ongoing discussions about the importance of
rest with athletes
Mandating pre-season physicals
Enforcing warm-up and cool down routines
Encouraging proper strength training routines
What Can We Do to Prevent
Overuse and Trauma Injuries?
Additional tips:
o Drink enough water based on activity and
temperature levels
o Educate athletes on proper nutrition for
performance
o Supervise equipment maintenance
o Encourage kids to speak with an athletic trainer,
coach or physician if they are having any pain.
Additional Prevention Strategies
Work with local athletic governing bodies to
mandate pitch counts and limit number of
matches or tournaments played.
More Prevention
Strategies
• Encourage participation for fun and limit
emphasis on winning
• Discourage early specialization
• Treat symptoms of problems/injury EARLY
Proper Technique is Key
• Provide proper instruction on throwing
mechanics
Discourage the teaching of curve balls until
high school (puberty)
o Ban the radar gun in youth sports
o Mandate a 3 month “rest-period” each year for
throwing athletes
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Organizational Partners for
STOP Sports Injuries
Campaign
Sports Medicine Organizations
• American Orthopaedic Society for Sports Medicine
• National Athletic Trainers’ Association
• American Medical Society for Sports Medicine
• American Academy of Orthopaedic Surgeons
• American Academy of Pediatrics -Sports Physical Therapy
Section
Related Organizations
• Youth Sports Leagues
Little League
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Professional leagues
Medical Institutions
Cleveland Clinic
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Safe Kids USA
STOP Sports Injuries
Council of Champions (Continued)
Joe Gibbs
Ian Lawson
Founder, Golf Channel
President, DePuy Mitek
Eric Heiden, MD
Dennis Lewin
Chairman, Board of Directors , Little League
Baseball International
Olympic Speed Skater and
Orthopaedic Surgeon
Jay R. Hoffman
President, NSCA
Bo Jackson
Professional Multi-Sport Athlete
James Justice
Owner, Greenbriar Resort
Stephen Keener
President & CEO, Little League
Howie Long
Former NFL Player, NFL Sportscaster, Fox
Network
Renaldo Nehimiah
Director, Track & Field Worldwide
Teri McCambridge, MD
Chairperson, AAP Council on Sports Medicine
and Fitness
Renaldo Nehimiah
STOP Sports Injuries
Council of Champions (Continued)
Jack Nicklaus
Golden Bear Enterprises/Professional
Golfer
Mitchell Stoller
President and CEO, SAFE Kids Worldwide
Jim Wilson
Jerry Pate
Former, Professional Golfer
Rick Peterson
Milwaukee Brewers Pitching Coach
Christie Rampone
WNT U.S. Soccer
John Smoltz
MLB Pitcher
Bart Starr
Former Green Bay Packer Quarterback
Chairman, Jim Wilson & Assoc.
Campaign focuses on 12
Sports
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Baseball
Swimming
Football
Basketball
Cheerleading
Tennis
Dancing
Gymnastics
Soccer
Running
Volleyball
Softball
Educational Content
• Sports tips
o Sport specific information
• Video podcasts
• Specific educational tool kits
focused on various audiences
o Parents
o Athletes
o Coaches
o Healthcare providers
Other Resources
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www.STOPSportsInjuries.org
www.orthoinfo.org
www.nata.org
www.sportsmed.org
www.SAFEKids.org
Let’s Work Together to STOP Sports
Injuries
And Keep Kids in the Game for Life!
www.STOPSportsInjuries.org
ACL Injuries
ACL Tear Diagnosis
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Plant and change of direction
Non-contact > contact injuries
Unable to continue play
Swollen (bloody effusion)
“Knee dislocated”
95% by history
Lachman’s test
MRI diagnosis commonly
MRI
Bone bruises
ACL Injury Epidemic, Early
Specialization, YearYear-Round Play
May Be LinkedLinked- AAOS 2009
Dogma
Dogma:
Facts:
Don’t repair
ACLs in kids
Pediatric ACL
tears should be
reconstructed
Concern = Growth Plate Injury
• Mainly an issue for < 12 yo
• Tanner stages 1-2
J Bone Joint Surg Br. 2002 Jan;84(1):38-41.
The natural history and treatment of rupture of the anterior cruciate
ligament in children and adolescents. A prospective review.
Aichroth PM, Patel DV, Zorrilla P.
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60 patients
23 patients who were treated
conservatively revealed that the natural
history of the injury resulted in severe
instability and poor function of the
knee
Non-surgical treatment has bad results
Arthroscopy. 2002 Nov-Dec;18(9):955-9.
Associated injuries in pediatric and adolescent
anterior cruciate ligament tears: does a delay in
treatment increase the risk of meniscal tear?
Millett PJ, Willis AA, Warren RF.
Delay in surgical treatment was
associated with a higher incidence of
medial meniscal tears
Meniscal tears lead to DJD
Pediatr Orthop. 1997 Jul-Aug;17(4):505-11.
Anterior cruciate ligament tears in children: an analysis of
operative versus nonoperative treatment.
Pressman AE, Letts RM, Jarvis JG
• Ages 5-14 yo
• Complete tear of the anterior cruciate
ligament was best managed by intraarticular surgical reconstruction
Non-surgical treatment of ACL tears has bad results
J Pediatr Orthop. 2002 Jul-Aug;22(4):452-7.
Management and complications of anterior cruciate ligament
injuries in skeletally immature patients: survey of the
Herodicus Society and The ACL Study Group
• 15 reported cases of growth disturbance
• 8 cases of distal femoral valgus deformity with arrest
of the lateral distal femoral physis,
• 3 cases of tibial recurvatum with arrest of the tibial
tubercle apophysis,
• 2 cases of genu valgum without arrest
• 2 cases of leg length discrepancy
ACL surgery in children has had bad results
Physeal Sparing Soft
Tissue ACL
Reconstruction
Hip Arthroscopy
1. Labral Repairs
2. FAI (Femoral-acetabular Impingement)
Symptoms
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Groin pain
Antalgia
Catching, locking
Difficulty sitting with hips flexed, getting
out of a car
• May masquerade as back or pelvic pain
Signs and Symptoms
• The “C” sign
Impingement Test
FABER Test
Which athletes may need hip
arthroscopy?
Hip Labral Tears
Femoral-acetabular
Impingement
FAI
• Alpha angle
• CAM lesion
3 Imaging Studies
1. AP Pelvis
2. Lateral View of hip (Dunn)
3. MRA of the affected hip (10-15 cc
contrast) w/1.5 Tesla MRI
AP Pelvis
CAM
PINCER
Lat Hip
MRA
Arthroscopy
Questions
Pediatric Sports Medicine
Injuries:
Lower Extremity
Tal Lassiter, MD,MHA
Director,
Bassett Shoulder and Sports Medicine
Research Institute
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