March 2022 • DALLAS MEDICAL JOURNAL | 19
faces of the medial femoral condyle, lesions
have been found on the lateral femoral condyle
and less often on the articular surface
of the patella and femoral trochlea. Understanding
of the condition of osteochondritis
dissecans has evolved in the past decade,
with many questions still unanswered. The
Scottish Rite for Children sports medicine
group is involved in a national, multicenter
organization called Research in Osteochondritis
dissecans of the Knee (ROCK). This collaboration
of pediatric orthopedic specialists
aggregates data across large numbers of
patients to study etiology of these lesions,
correlate healing outcomes and identify effective
strategies for treatment.
These lesions are often recalcitrant and
present challenging scenarios for treatment.
Eff orts from this multicenter group hold
promise for improving treatment of these osteochondral
conditions in our young athletes.
Despite this work advancing our understanding
of natural history and treatment strategies
even in our youngest patients, these
lesions may often fail attempts at primary
healing and require salvage or reconstructive
procedures of the joint surface. In a study
published this month, results following osteochondral
grafting for bulk replacement of
these defects performed within the Scottish
Rite Sports Center were compared between
patients with open physes and those in an
older group. This salvage strategy has proven,
in early outcomes, to be a good option for
even these youngest patients.
OCD lesions certainly represent a unique
and challenging subset of overuse-related
conditions in this population, but there are
many others for which treatment and research
is ongoing.
Repetitive Stress on Growing
Structures
Musculoskeletal structures in a skeletally
immature and growing athlete are sensitive
to repetitive compressive and traction forces.
Traction Forces
Though sprains and strains become
more common in adolescents, apophyseal
infl ammation or fractures may present as
medial elbow pain (Little Leaguer’s elbow) or
shoulder pain (Little Leaguer’s shoulder) from
repetitive throwing. At the knee, a running
and jumping athlete may present with pain
caused by patellar apophysitis (Sinding Larsen
Johansson syndrome) or tibial tubercle
apophysitis (Osgood Schlatter syndrome).
Compressive Forces
Much like OCD’s, the repetitive compression
inside the joint or through the bone can
lead to a stress reaction or stress fracture
in the bone. This is common in the lower leg
and foot of runners and distal femur in soccer
players.
Prospective study is ongoing currently
at the Scottish Rite Sports Medicine Center
musculoskeletal ultrasound to evaluate
physes of both symptomatic and asymptomatic
youth athletes. This data may lead to
injury prevention strategies for these growth
plate injuries. A second, grant-funded study is
currently being launched utilizing the Sports
Movement Science Lab within the Scottish
Rite Sports Medicine Center evaluating
movement displayed by dancers with and
without an injury history to evaluate correlates
of motion and loading with known
dance injuries.
Anterior Cruciate Ligament
Injuries
Even an injury such as the anterior cruciate
ligament (ACL) tear – which has been noted
more frequently during the past decade in
our youth athletes and is commonly thought
of as a single traumatic event during play –
may have a correlation to overuse and overexposure.
Pediatric and adolescent athletes
may commonly have relatively underdeveloped
neuromuscular control and/or play
through times of fatigue. As a result, muscular
forces around the knee required to slow and
stabilize the knee may be insuffi cient to protect
the ACL during high-speed pivoting that
often occurs during the level of training and
play common with increasing sport specialization.
While studies have shown increasing
neuromuscular control and improving landing
strategies may reduce some ACL injuries, they
continue to be diagnosed at an alarming
rate within our youth athletes. Work from
the Scottish Rite Sports Medicine Center
has resulted in surgical techniques to add
stabilization to traditional ACL reconstruction
with demonstrated reduction in reinjury risk,
and ongoing work within the physical therapy
department to improve sport readiness prior
to return to play is ongoing.
Injury Prevention and Education
Injury surveillance, injury prevention and
education are keys to making progress in
protecting young athletes. Further research is
ongoing regarding correlates and risk factors
for the development of these conditions in
sport-specifi c populations. Much of the research
is very promising but just hitting the tip
of the iceberg. As we know is most often the
case, strategies to promote prevention will be
the most powerful medicine and will remain a
focus for pediatric sports medicine research
in future decades.
Partnership throughout the care team for
kids and families involved in youth sports,
as well as eff ective parental education, will
remain a key factor in keeping our kids active
in a happy and healthy way. DMJ
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