Youths: Knee Injuries

• Symptoms

• Treatment

• Long Term

What We Know...

Doctors who treat kids have all been seeing that tears are going up dramatically of the anterior cruciate ligament (ACL), the main ligament that stabilizes the knee joint, and the meniscus, the small pillows of cartilage that help to cushion the knee bones, in young athletes. Sports like soccer, basketball, football, and skiing are associated with a higher incidence of ACL tears.

There has been notable increase in ACL injuries in the last two decades. The difference was not a result of better equipment leading to better diagnoses of ACL tears. Which means that increasingly large numbers of young athletes, both boys and girls, are now suffering an injury to which doctors once thought they were almost immune.

A possible cause is kids are out there trying to emulate professional athletes. You have very young athletes playing sports at an extremely intense, competitive level, they didn’t play at 20 years ago. Consequently, their knees never had to withstand the kinds of repeated twists, sprints, loads and hard hits that young players now regularly absorb. Girls tend to have a higher rate of ACL tears compared to boys, possibly due to differences in anatomy, muscle strength, and landing mechanics.

Most of the ACL tears that occur also involve a concurrent meniscus tear, an indication of just how much wrenching and grinding the knee undergoes. Injury patterns have changed because childhood sports have changed. The stage of skeletal maturity can also influence the risk of ACL injury. The long-term effects of sports-related ACL and meniscus tears in youngsters remain largely unknown but there are signs that the consequences could be long-lasting.

Studies of adult soccer players who tore an ACL found that, within 12-14 years after the injury, 51 percent of the females and 41 percent of males developed severe arthritis in the injured knee. Many athletes who return to sports after an ACL tear say they don’t play as well and a third did not return to any activity afterward.

Knee injury prevention programs, including those that teach balance and proper landing techniques, have shown some utility in reducing the incidence of ACL tears, especially in girls. As children think explicitly about how to plant a leg or bend a knee while maintaining balance, they become less natural in their movement, more ungainly — and potentially ripe for injury.

The more you do a risky activity at a high level, the more likely you are to get hurt. It is suggested to 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.

Symptoms:

• A distinct audible "pop" sound or sensation in the knee is often the first sign

• Immediate pain and swelling are typical after an ACL tear

• The knee may feel unstable, giving way or shifting during activities

• The injured knee may have limited or decreased range of motion

Treatment and Management:

• In most cases, young athletes with ACL tears require surgical reconstruction to restore knee stability. Specialized surgical techniques (physeal-sparing or physeal-respecting) are used to minimize the risk of growth disturbances.

• A comprehensive rehabilitation program is crucial for regaining strength, flexibility, and function after surgery

• Neuromuscular training programs can help improve muscle control and movement patterns, potentially reducing the risk of future ACL injuries

• Athletes should participate in comprehensive training programs that address all aspects of physical fitness, including strength, flexibility, and agility

• Educating young athletes and their coaches about the risk factors for ACL injuries can help them take preventative measures

Long-term considerations

Young athletes who have had ACL reconstruction are at a higher risk of developing knee osteoarthritis later in life. The risk of re-injuring the same or the other ACL is also higher, especially after surgery.e are here to assist you in caring for your body as you prepare to spend time enjoying the outdoors