Category Archives: AOC Physician Articles

ACL Injuries. What ESPN doesn’t tell you.

 

Knee injuries in sports are a common occurrence. One dreaded injury is a tear of the anterior cruciate ligament (ACL). Most ACL tears occur after a non-contact injury such as a wide receiver or soccer player making a sudden change in direction. The leg planted on the ground during the cutting move may experience enough force to tear the ACL. Seventy percent of acute hemarthosis (blood in the knee) after such injury is an ACL tear.

Non-surgical treatment for complete ACL tears in young, active patients has generally been met with less than satisfactory results. Loss of the ACL can result in instability or the feeling that the knee is loose. The knee wants to “give way” when a change in direction occurs.  This instability can result in further damage to the knee and the C-shaped cartilages called the meniscus. Rebuilding the ACL and restoring stability to the knee can protect the meniscus from further damage.

There are over 400,000 ACL reconstructions a year in the United States. Much research has occurred and is on-going into different techniques and choices of tissue to use to rebuild the damaged ACL. Two of the more common tissue (graft) choices are hamstrings and patellar tendon.  Both are usually taken (harvested) from the same knee and used in the reconstruction process. Other options include quadriceps tendon and tissue that has been donated to tissue banks (allografts). There are pros and cons to each graft choice, but analysis of multiple recent studies show little difference in long term outcomes between hamstring and patellar tendon autograft (tissue taken from the same patient.)

In part two of “ACL Injuries in Sports” we shall discuss current data on the return to sports after ACL reconstruction.

 

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Picking The Right Sports WITH Your Kids

 

When parents read stories of childhood “prodigies” such as Michelle Wie learning a sport as young as 3 years old, it is natural for us to wonder what sports are best for our child and at what age they should start. While there are no sure answers as to when a particular child is ready for a sport, there are well-studied developmental patterns that can guide us.

Infants and toddlers, for example, gain gross and fine motor skills along a predetermined path, and any attempts to speed this up with training will fail. That being said, there are windows of opportunity in which a toddler learns certain movements more readily and should not be missed. So, the best course in this age-group is to expose the child to a wide variety of interactive games so that they can have the tools to progress at their own pace. Mom and Dad can create a variety of activities with a ball and things around the house or get some ideas at the local toddler gym.
In preschool a child can follow simple instructions and has basic postural control and balance to allow sports participation. Soccer is a great activity at this level because it can be played by following one simple instruction; “kick this ball in that goal!” Preschoolers do not have the ability to engage in rapid decision-making to account for unexpected events. So, they all stick with the one thing they do get – kick the ball! The result is the “swarm” phenomena we see in all soccer games at this level. This is normal behavior and should not be a source of frustration to parents—and oh, by the way, kids this age cannot distinguish multiple instructions coming from the crowd, so you can save your breath!

A classic study has shown that by elementary school, 6 out of 10 children can throw, kick, run, jump, catch, strike, hop and skip. This opens the door to a wide variety of sports. However, children this age also become aware of their status among their peers and their own inadequacies (they know who is “cool”, who is “athletic”, etc.). Keep in mind that children of the same age and grade may be at very different developmental stages, so comparing them to their peers is misguided. For these reasons, confidence-enhancing activities for all children are important. Parents should choose at least one noncompetitive activity and always emphasize socialization and sportsmanship more than physical performance. Additionally, contact sports are not ideal because coordination is not fully developed and children have little ability to consider future consequences of current behavior. For example, they cannot think through the consequences of spear-tackling. Weight-training with light weights under strict supervision can begin as early as 8 years of age. Strength gains can be achieved in pre-pubescent children, but no gains in muscle size will occur until the hormones kick in at puberty.

As a child transitions to adolescence, their growth dramatically increases. Bones grow faster than tendons which can result in loss of flexibility and “growing pains”. This is a crucial time for skills development, and most are ready for organized sports of all types. However, precautions, such as pitch counts and cross-training, must be taken to avoid overuse injuries to the growth plates. This is the most appropriate time to begin weight-training. There is no evidence that a proper weight-training program during adolescence stunts growth. However, to avoid injury, explosive exercises such as clean-and jerk should not be done until skeletal maturity (15-16 years old).

In summary, children are not just “little adults”. They react to physical and emotional stress at different developmental stages in different ways. Moderation should always rule, and as my grandmother used to say about raising children, “the best that we can hope for is to not mess ‘em up.”

 

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“Just” A Headache? Maybe Not.

Concussions: “When in doubt, sit them out.”

An estimated 300,000 sports-related traumatic brain injuries occur in the United States each year. 63,000 of these injuries occur at the high school level. Football causes 63% of these injuries, and girls’ soccer is the second leading cause. Most of these types of head injuries recover within a week, but some can take a month or longer to recover. However, unfortunately, there are still approximately 900 deaths a year from sports-related traumatic brain injuries (concussions).

So, what can be done to decrease these numbers? Makes sure athletes, coaches, and parents know the signs and symptoms of concussion. Athletes should be encouraged to speak with someone (teammate, parents, coaches or healthcare professional, etc.) if they “don’t feel right” after a hard hit to the head. If at all possible, make sure your school has a Certified Athletic Trainer (ATC) present at games and practices. ATCs are trained to recognize, evaluate, and treat athletes who show signs and symptoms of concussions. They work closely with the team physician to get athletes the care they need quickly and to keep them safe. They will also work with the treating and/or team physician, coaches, parents and athlete to transition them back into the game once their symptoms have resolved and have been cleared by the physician. If your school does not have an ATC, make sure the coaches follow the general guideline, “When in doubt, sit them out.”

March is Alabama Brain Injury Awareness Month and National Athletic Training Month.

For more head injury information, please go to nata.org or alabamabraininjuryawareness.org

Click here for more information about Alabama Orthopaedic Clinic, P.C.

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The Difference In Shoulder Separations and Shoulder Dislocations

A shoulder separation is often confused with a shoulder dislocation.

A shoulder separation is technically an injury to the acromioclavicular joint. This joint is located at the top of the shoulder just under the skin and is often a visible bump in thin individuals. A shoulder separation or AC injury occurs as a result of a direct blow to the top of the shoulder such as might be experienced by an athlete during a shoulder tackle in football or a fall onto the top of the shoulder. The ligaments that support the AC joint may be sprained or completely torn resulting in varying degrees of pain and disability. Continue reading

Forearm Fractures

Forearm fractures are the most common long bone fracture in children. They usually result from a simple fall onto an outstretched hand while running or playing sports. When this injury occurs, it is arguably more traumatic to the parents than it is to the injured child! Here are some basic first aid techniques and things to expect to help parents be prepared in case the unexpected happens. Continue reading

The Achilles Heel

The Achilles tendon is the strongest tendon in the human body and owes its name to the great, invulnerable warrior of Homer’s Iliad. Invulnerable, that is except at his heel. Greek mythology has it that, Thetis, Achilles’ mother dipped him in the Styx River making him invincible at all points on his body but the heel by which she grasped him as he was being immersed. This proved to be his undoing when Paris, the brother of Hector, shot him in the heel with a poisoned arrow. Continue reading

Stress Fractures In Athletes

With the increase in participation in recreational and competitive sports, the incidence of overuse injuries has risen substantially. One such overuse injury is a stress fracture. A stress fracture is a break in a bone as a result of repetitive force that exceeds the bone’s ability to repair itself. The break may be partial or complete and can have varying symptoms. Prompt diagnosis and proper treatment is imperative in order to minimize loss of playing time and prevent irreversible damage to certain joints. Continue reading

Anterior Cruciate Ligament (ACL) and Meniscal Tears

Two of the most common causes of swelling of the knee after an injury playing sports are tears of the ACL and the important C-shaped cartilages of the knee called the meniscus. While both can cause symptoms of pain, swelling, and ‘giving way’, the treatment of these common injuries can be different and involve different lengths of recovery times. Continue reading