Morgan O’Regan was skiing with her family when she fell and hurt her right knee. “It was a bit swollen, so we thought she’d twisted it,” says her mother, Kathy. But when it failed to improve with ice and elevation, she took Morgan for an MRI. The images showed what is properly known as a tibial eminence fracture, the childhood equivalent of an anterior cruciate ligament (ACL) injury, the knee injury seen all-too-commonly in the adolescent athletes.
Morgan, who was only 7 when she was injured, also takes gymnastics and dance lessons. She is part of a new trend in pediatrics: young athletes, sometimes younger than Morgan, are sustaining sports-related injuries with greater frequency.
“The traditional ACL patient used to be the 15-year-old female soccer player, but that stereotype is changing,” says Cordelia Carter MD, the pediatric orthopaedic surgeon and sports injury specialist who operated on Morgan’s knee. “Patterns of sports participation are changing both qualitatively and quantitatively. Kids are participating in sports at higher levels from younger ages. As a result, we’re seeing ruptured ACLs and other injuries in much younger patients. ”
Emergency departments across the United States treat approximately 2.6 million children from birth to 19 years for acute sports- and recreation-related injuries each year, according to the Centers for Disease Control and Prevention. Overuse injuries, which develop over time, may be even more prevalent.
Treating more young patients
To better serve these young patients, Yale Pediatric Orthopaedics is growing its sports medicine practice beyond New Haven, to offices in Guilford and in the Yale-New Haven Children’s Hospital Pediatric Specialty Center that opened in Norwalk last year. In addition to Dr. Carter, the group includes three other pediatric orthopaedic surgeons: Brian Smith, MD, director and a specialist in scoliosis and the spine; Dan Cooperman, MD, who treats children with cerebral palsy; and Melinda Sharkey, MD, who specializes in deformity correction in addition to her general practice.
They treat patients up to age 25 for a wide spectrum of conditions, from overuse injuries to such acute injuries as fractures, sprains and strains. Many of their patients are teenagers who are active in a wide variety of sports, although injuries in much younger athletes have become increasingly common.
When a child sustains a sports injury, “the whole family is invested,” Dr. Sharkey says. “You have to address the fears, goals and expectations of everyone involved. Team building between the patient, the family and the physician is critical to a good outcome,” she says.
Protecting the growth plate
Many of the young patients who visit the practice with sports-related injuries can be treated without surgery, using casting, bracing or other therapeutic techniques.
For those who need surgery, a key goal is to protect the growth plate—the cartilaginous tissue at both ends of long bones in children and adolescents that determines the future length and shape of the bones. When growth is complete, typically in mid-to-late adolescence, the growth plate closes and is replaced by bone. If the growth plate is compromised by injury or a surgical repair, it may result in one bone being longer than the other or by the bone growing at a “crooked” angle.
“As a pediatric orthopaedist, you have to pay close attention to the growth plate and its proximity to the injury,” says Dr. Sharkey. One example of this is “physeal-sparing” ACL reconstruction, a surgery that avoids and therefore protects the growth plate. “This is different from the standard adult-type technique that uses bone tunnels drilled right through the growth plate. Damage to the growth plate puts kids at risk for problems with limb length discrepancy or angular deformity,” says Dr. Carter, who has performed this surgery for athletes as young as 7 years old.
Avoiding injuries in the first place
Of course, the best strategy is to avoid injuries in the first place. Prevention programs aimed at safeguarding against ACL injuries are very successful, Dr. Carter says. “We can’t change the angle of your bones without surgery, but by using specially designed training programs we can improve your muscle strength and flexibility, and your awareness of risky landing postures during athletics, all of which contribute to ACL injury. ”
Kathy O’Regan appreciated that Dr. Carter took the time to tell Morgan what she was going to do and why. “She showed us X-rays, explained what incisions she would have to make and told us why she couldn’t do what she would do on adult,” O’Regan says. Dr. Carter performed arthroscopic-assisted surgery, using a camera inside the knee so that she could watch her progress as she put the piece of broken bone back in place, using stitches. At the same time, she repaired the torn meniscus.
Morgan’s cast has since been removed. She now wears a brace and recently started physical therapy. “She had to stop gymnastics and dance, but by the summer she should be ready to get back into everything,” her mother says.
To make an appointment at Yale Pediatric Orthopaedics call 203-737-5656.