Sports injuries: On the issue of children with ACL tears

THe NYT has an article highlighting the flood of kids with ACL injuries requiring surgery or bracing to restore knee stability. Conventional wisdom is that children break bones more easily than incur ligament damage. At stake is the mythic strength of children's ligaments. The article opens up many more questions.

An obvious question is how far have imaging studies contributed to a correct diagnosis? What used to be called a 'trick' knee is now correctly an ACL injury, which means that this increase in incidence could potentially be a false positive.

Is the popularity of soccer taking its toll on children's health? In other words, the rise of soccer could have a less salubrious effect too. The article does not breakdown the sports which cause these injuries. It would be helpful to establish a comprehensive database.

Interestingly, the majority of these injuries is non-contact, i.e., they occur off the field and involve twisting of the knees. Have potholes become more numerous or attention spans decreased?

Actually, one could argue that these ligament tears are possibly an accumulation of a series of microtears incurred on the field which compromise ligament integrity. Twisting your knee falling into a pothole is the last straw. One should try and correlate these non-contact injuries with the frequency and intensity of sports played to get a clearer understanding of whether and if ligament injuries are really on the rise.

This much is clear, ligament transplant surgery involving children's growth plates can potentially throw the leg out of alignment leading to shortening. Alternative methods are more cumbersome and the long term efficacy of these procedures are not known. Bracing runs into compliance issues and children are notoriously brace aversive. So methods of restoring knee stability in children have systemic problems.

However, this highlights the prevention is better approach. Most children are sent to the field without proper muscle conditioning. Muscles serve a protective function when it comes to prevention of injuries in unguarded moments. A half hour of plyometrics, e.g., jumping on a trampoline, on and off wooden blocks of different heights, with and without weights, with different knee and body angles, in a fun and festive atmosphere would be better than just lifting weights. Lower muscle tone might be one of the reasons girls seem to be more prone to knee injuries than boys.

And parents. Living life out vicariously or padding a child's resume becomes a bit less palatable when confronted with these injuries and their long term damage. So stop pushing them onto the field when the child complains of knee pain or swelling. It might be serious.