HEALTH ALLIES
THE ORGANIZED YOUTH
SPORTS MOVEMENT
PROCEED WITH CAUTION
By Philip L. Wilson, MD, Director, Sports Medicine Center and Assistant Chief of Staff – Scottish Rite for Children,
Professor of Orthopaedic Surgery – UT Southwestern Medical School, and Brandee Schmidt, PT, MS, DPT, Clinical
Program Coordinator, Sports Medicine Center – Scottish Rite for Children
We know that participation
in physical activity and
sports has widespread
benefi ts for young athletes.
While studies suggest
that many children and adolescents are
not achieving sixty minutes of daily physical
activity as recommended by the U.S.
Department of Health and Human Services,
the available outlets for organized sports
participation beyond traditional schoolassociated
activities have continued to
increase over the past several decades.
Optimizing activity levels and participation
across all social and geographic subsets of
the pediatric population continues to be an
elusive social and public health goal.
Numerous studies point to the positive
psychosocial eff ects of organized sports in
the growing athlete. Consistent with other
published reports, a recently published
survey conducted by our team at Scottish
Rite for Children Sports Medicine found that
kids tend to have less anxiety and may be
more resilient if they are involved in multiple
sports. Public health leaders, musculoskeletal
developmental experts and even
parents themselves recognize the benefi ts
of early exposure to a variety of sports and
diff erent activities during childhood and
adolescence, but school-based, progressive
physical education may be decreasing
in frequency. Furthermore, kids themselves
often report the desire to participate in
multiple activities at a young age. To that
end, a variety of organizations collaborate
to raise awareness and improve access
to youth sports with a goal of increasing
participation rates in all ages.
The Youth Sports Industry –
Double-Edged Sword
The increasingly competitive nature and
monetization of youth sports often leads to
a counter-result in which growing athletes
tend to commit to a single sport at an early
age and, in many cases, over-commit to
training. Parents and youth athletes often
become enamored with the thought of
exceptional achievement in sports, and
dream of a sports career. As of 2021, even
college athletes are now being off ered
astronomical payments for their “name,
image and likeness.” Unfortunately, they
often follow a misguided perception that
early specialization will result in achieving
the professional athlete goal. While many
youth athletes may have the skill and drive
to achieve these perceived rewards at the
end of the sports rainbow, the reality is that
only a very small percentage may reach
that level. Studies have demonstrated that
early sports specialization is most often not
the way to achieve this result.
Pediatric Musculoskeletal
Overuse Injuries
The unintended response to these modern
demands includes behaviors such as
early specialization, year-round participation
and overtraining even in the youngest
athletes. These are known contributors to
conditions referred to as overuse injuries.
These injuries that are felt to be secondary
to high repetitions of supra-physiologic
loading without variation and appropriate
rest intervals. Conditions caused by overuse
may often be preventable.
Overuse Injuries of the Elbow
While overuse injuries can manifest
throughout the developing pediatric musculoskeletal
system, the elbow in throwing
and upper extremity weight-bearing
youth athletes serves as a prime example
of a susceptible area for overuse. Hours of
repetitive forces on vulnerable, developing
cartilage structures of the elbow lead to
overload on these structures and contribute
to stress injuries.
Capitellar Osteochondritis
Dissecans
Repetitive impact directly on the
articular cartilage of the humeral capitellum
of the elbow can lead to shear-force
structural injury and decreased vascularity
within the developing epiphyseal cartilage
and subsequent alteration of subchondral
bone formation – often leading to instability
of the cartilage surface. The resultant
condition referred to as an osteochondritis
dissecans (OCD) lesion can result in fragmentation
and degradation of the articular
surface.
Radial Head Stress Fractures
Alternatively, forces may result in overload
on the opposing radial head surface
can lead to stress fractures of the developing
radial head epiphysis.
A recently published investigation of
gymnasts treated at the Scottish Rite
described unique features of subjects and
elbows (N = 58) of these two conditions.
Diff erences in elbow anatomy, skeletal
maturity and activity level were identifi ed
and correlated with the diff erent injuries.
This foundational data will facilitate further
investigations, including injury surveillance
and/or injury prevention strategies to
reduce the risk of these types of injuries in
young athletes playing upper-extremitydominant
sports.
Osteochondritis Dissecans
of the Knee
Similar stresses have been found to affect
the knees of athletes in other sports.
Overuse injuries aff ecting the joint surface
of the knee are more common in high-volume
running, pivoting and jumping sports.
Osteochondritis dissecans lesions may also
occur in the developing knee and lead to
similar, unstable bone and cartilage lesions.
Most commonly on the weight-bearing sur-
Figure 1 – PubMed search February 2022 results for “Osteochondritis
Dissecans Knee” since ~1950. N=1178.
Figure 2 – PubMed search February 2022 results for “Osteochondritis
Dissecans Elbow” since ~1950. N=525.
18 | DALLAS MEDICAL JOURNAL • March 2022