Jan 29, 2015
New Research on ACL Injuries

By Kristin Maki

The bad news is that ACL injuries in young athletes continue to rise. The good news is that new research is shedding light on prevention and treatment of this devastating injury. We’ve rounded up some of the latest findings.
Orthopedic surgeons from the Children’s Hospital of Philadelphia have seen a significant increase in children’s knee injuries. They reported their findings during the annual meeting of the American Academy of Pediatrics that was held in October.

The team of surgeons researched records for ACL and meniscus tears among patients who were under 18 years old. The review included records from January 1999-January 2011, and found a total of 996 meniscus tears, 914 ACL tears, and 155 tibial spine fractures. The study revealed meniscus tears increased by nearly 14 each year, while ACL tears increased by about 11 per year. These records were compared to patients who had tibial spine fractures during the same time period. The tibial spine fractures had increased by only one, annually.

One of the lead researchers in this group, J. Todd Lawrence, MD, PhD, told Science Daily,

“Since tibial spine fractures were once thought to be the pediatric equivalent of an ACL tear, this continued rise in ACL tears in children suggests that injury patterns are changing and that the true incidence of these injuries is increasing.”

The long-term effects of ACL and meniscus tears are still vastly unknown, since until recently, these injuries were rare in younger athletes. However, a study published in the British Journal of Sports Medicine, showed that in just over 10 years after injury, among Swedish soccer players, nearly half of the players developed arthritis in the injured knee.

As reported by the New York Times,

“within 12 to 14 years after the injury, 51 percent of the female players and 41 percent of the men had developed severe arthritis in the injured knee. The same time frame could have an injured 10 year-old dealing with a severely arthritic knee before he or she is 25.”

So how can we stop this disturbing trend? Citing the study from the surgeons at the Children’s Hospital of Philadelphia, the New York Times notes,

“A better solution would probably be to stop assuming that children can train like miniature Ronaldos or Kobe Bryants. ‘A lot of what we see in our injury data is almost certainly due to a statistical measure called exposure hours,’ Dr. Lawrence says. ‘The more you do a risky activity at a high level, the more likely you are to get hurt.’ His advice? Encourage kids to play multiple sports and not to do any one sport year-round, and especially not when they’re 5 or 6, or even 9 or 10. They’re kids. Let them play and have fun, like kids.'”

Other experts are taking more specific approaches, as several ACL-injury prevention programs have been developed over the past few years. The Chicago Tribune reported on one put together by Dr. Cynthia LaBella, an associate professor of pediatrics at Northwestern University, and implemented at Chicago Public Schools.

LaBella’s program aims to distribute the strength on the right and left sides of the body more evenly–an area in which females are more likely to lack, compared to male athletes. In order to accomplish this, the program focuses on strengthening muscles and keeping them warm, along with keeping the heart rate up. It also teaches participants plyometric exercises to mimic sports maneuvers.

Coaches were randomly selected from Chicago’s public schools, and those who participated in the intervention group were trained in orchestrating the 20-minute warm-up program at practices and a shorter version to use before games. Along with the neuromuscular training, the coaches taught their players jumping and landing techniques to minimize ACL injuries. According to Medical News Today, a total of 90 coaches and 1,492 athletes participated in the study, with 737 athletes in the intervention group and 755 in the control group.

In terms of the program’s success, The Chicago Tribune reported,

“By the end of the season, girls who participated in the exercises showed an 80 percent reduction in ACL sprains, a 70 percent reduction in knee sprains and a 62 percent reduction in ankle sprains, compared to girls in the control group, whose coaches did not learn the exercises and performed their own warm-ups.”

At the Washington University School of Medicine in St. Louis, sports medicine specialists have received a $2.6 million grant to research the causes for bad outcomes with second attempts at repairing ACL tears in the knee. Their study will compare techniques and outcomes for these second ACL surgeries.

In this study, patients who have a second tear will be recruited and followed for at least two years after the surgery. Along with noting the knee’s condition and original surgery methods and reconstruction, the researchers will compare rehabilitation techniques. The second surgery will also be studied.

The Washington University news release reports,

“If I reconstruct the ACL in your knee, and you go back to sports, and three years later you pivot on a basketball court and tear it again, that subsequent surgery often does not have results equal to the original surgery,” says Rick W. Wright, MD, the MARS study’s principal investigator. “In a previous study, we found that the strongest predictor for a bad outcome after ACL surgery was whether that surgery was the initial reconstruction or a subsequent procedure.”

The researchers plan to follow 1,000 patients across the country. They will be tracked for two years, to follow up on possible problems after surgery. While there is no maximum age, patients have to be at least 12 years old to participate in the study.

Kristin Maki is an Editorial Assistant at Training & Conditioning.

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