Anterior cruciate ligament injuries in the young athlete: evaluation and treatment

Injuries to the pediatric and adolescent athlete are becoming more common as increasing numbers of this patient population are participating in year-round sporting activities. As these figures continue to rise, there have been an escalating number of patients with both traumatic and nontraumatic, sports-related knee injuries presenting to orthopedic surgeons for evaluation. Anterior cruciate ligament injuries in these patients, specifically in the skeletally immature, represent a complex problem. Treatment of these patients requires a thorough understanding of anatomy and physiology of the pediatric patient, the natural history of this injury, and knowledge of the potential complications of surgical intervention. This review will address these topics and will describe the presentation, diagnosis, and most commonly used surgical techniques currently being used with these patients. Future directions and advances in care of these injuries will also be discussed.     

Anterior cruciate ligament injuries in the young athlete with open physes

From 1980 to 1985, 40 patients under the age of 14 with open physes were treated for midsubstance tears of the ACL at the Methodist Sports Medicine Center. In this series, 16 were treated conservatively with rehabilitation, bracing, and counseling on activity modification. The remaining 24 patients underwent arthroscopic examination and either an extraarticular or intraarticular reconstruction based on growth potential. The average followup was 27 months for the conservative group and 26 months for the surgical group. In the conservative group, six patients underwent arthroscopy for meniscal tears, four medial and two lateral. Only seven patients returned to sports, all experiencing recurrent episodes of giving way, effusions, and pain. In the surgical group, 12 medial and 6 lateral meniscal tears were found at arthroscopy. There were 10 extraarticular reconstructions and 14 intraarticular reconstructions. All 24 returned to sports activity, and 22 of the 24 are still competing. The two remaining patients both suffered reinjury 3 years after their surgery. We recommend arthroscopy and examination under anesthesia for the young patient with ACL tears. Based on the amount of instability, presence or absence of meniscal tears, and athletic desires of the patient and his or her family, a treatment plan can be undertaken.     

Non-operative management of ulnar collateral ligament injuries in the throwing athlete

Medial ulnar collateral ligament (UCL) injuries have become increasingly prevalent in overhead athletes. The orthopaedic literature contains a wealth of information on operative management of these injuries. However, there are few high-quality longitudinal studies on non-operative care of UCL injuries. The purpose of this review is to describe the non-operative approach to managing UCL injuries, including recommended rehabilitation strategies and predictors of successful non-operative treatment.     

Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete

Medial ulnar collateral ligament (UCL) injuries are common and are seen most frequently in baseball pitchers. Appropriate recognition, treatment, and rehabilitation are necessary to ensure the best chance for return to preinjury levels of participation. Participation in competitive sports may be disrupted for 6 months to 1 year when treated optimally. Abstinence from play may be prolonged when treatment is delayed or if conservative treatment fails; this delay carries significant consequences to the professional, collegiate, and high school athlete. The orthopedic literature is replete with recommendations for the care of these athletes. These recommendations are generally based on retrospective reviews. The purposes of this paper are 3-fold: to provide background knowledge on this injury, to synthesize the current knowledge on the diagnosis, treatment, and rehabilitation of athletes with medial UCL injuries, and lastly, to provide a treatment algorithm for athletes with UCL injuries.     

Posterior cruciate ligament injuries in the athlete: an anatomical, biomechanical and clinical review

Recently, the posterior cruciate ligament (PCL) has become an increasingly popular subject of orthopaedic research and debate. In the past several years, anatomic and biomechanical studies have provided invaluable information concerning the structure and function of the PCL. However, many aspects of PCL injury are still not fully understood. Diagnosis of the injury is often missed because of subtlety of symptoms and clinical findings, and current management strategies of PCL injury have experienced relatively poor clinical outcomes. Controversy exists concerning the most appropriate treatment, especially in cases of isolated PCL injury. The purpose of this review is to present a complete overview of the current knowledge regarding the basic science and clinical aspects of PCL injuries, with a specific focus on the athletic population.     

Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete

The long-term results of 25 patients treated nonoperatively with isolated posterior cruciate ligament (PCL) injuries were evaluated. Mean followup was 6.2 years (range, 2.2 to 16 years). All patients were evaluated both subjectively (questionnaire) and objectively (clinical examination, x-ray films, Cybex II dynamometer, and KT-1000 Knee Arthrometer). At followup, 80% of the patients were satisfied with their knees and 84% had returned to their previous sport (68% at the same level of performance, 16% at a decreased level of performance). Mean torque Cybex II quadriceps values for three velocities of testing (45, 90, and 180 deg/sec) in patients fully returned to sport and satisfied with their knees was greater than 100% of uninvolved quadricep; conversely, those not satisfied with their knees all had values less than 100% of uninvolved knee. The amount of knee instability as determined by the KT-1000 Arthrometer was not related to the patient's return to sport nor to knee satisfaction. We concluded that the majority of athletes with isolated PCL injuries who maintain strength in musculature return to sports without functional disability.     

Thoracolumbar injuries in the athlete

Acute thoracolumbar injury in the athlete can be a disabling condition that requires thorough evaluation and treatment. Although most thoracolumbar spine injuries are benign myofascial strains that respond well to nonsurgical management, the spectrum of injuries is broad and includes fractures and bony instability, ligamentous instability, and neurologic compromise. Evaluation of thoracolumbar injuries requires a rapid and focused evaluation at the time of injury to rule out catastrophic and neurologically threatening injuries; a detailed history and physical examination carried out at a later point in time should be paired with appropriate imaging studies. Initial radiographs may be combined with dynamic radiography, bone scanning, computed tomography, or magnetic resonance imaging to delineate the structural extent of injury. Acute treatment may be required and initiated at the time of injury; further treatment should be carried out once the nature and extent of the injury is fully understood. Nonoperative treatment is successful in most of the injuries. Operative treatment is applied in selected cases of structural instability or neurologic compromise.     

Back injuries in the athlete

In summary, the approach to the athlete with low back pain must include an emphasis on aggressive nonoperative intervention, education, and rehabilitation. A diligent attempt must be made to establish a correct diagnosis, though this may be difficult at first. A firm diagnosis allows individualized treatment that meets the strenuous needs of the athlete. Work-up should be standardized to avoid missing what will appear obvious in retrospect. Unlike most of the general patient population, athletes are unlikely to tolerate a long period of "wait and see" therapy. It is necessary to have qualified allied health personnel who can perform a full spectrum to have qualified allied health personnel who can perform a full spectrum of exercise, mobilization, and modality therapies. Return to competition should be gradual but steady, as previous performance levels can usually be obtained following lumbar injuries.     

踝关节骨折合并三角韧带损伤时修复三角韧带的疗效分析

目的 探讨踝关节骨折合并三角韧带损伤时修复三角韧带的疗效.方法 回顾性分析2017年12月—2019年9月北京中医医院顺义医院骨伤科收治的踝关节骨折合并三角韧带损伤患者70例,根据是否修复三角韧带分为未修复组(不行三角韧带修复,32例)和修复组(行三角韧带修复,38例).两组踝关节骨折均给予切开复位内固定治疗.比较两组...     

韧带吻合联合半腱肌转位修复膝内侧副韧带断裂

15例膝关节内侧副韧带断裂的患者采用韧带吻合联合半腱肌转位的方法修复,全部得到随访,优良率93.3%.     

Overuse injuries in the young athlete

Overuse injuries are now well known to sports enthusiasts at any age or level of competition. The seeming explosion of overuse stress fractures of lower extremity bones in high-profile professional basketball players has brought about widespread media attention and a better understanding of the phenomenon of "overuse syndrome" by the public. However, the spectrum of overuse injuries in the child or adolescent athlete has only recently been recognized. These injuries can range from the permanent disability of osteochondritis dissecans of the elbow to the completely nonspecific "growing pains" of active youngsters.     

Elbow injuries in the young athlete

Young athletes sustain fractures, dislocations, and overuse injuries to their elbows. Overuse injuries are particularly troublesome because they begin insidiously. The majority of elbow overuse injuries can be attributed to excessive baseball pitching and are part of the “Little League elbow” syndrome. Elbow overuse problems also occur in overhead racquet sports and in gymnastics. The key to diagnosis, treatment, and prevention is knowledge of the forces about the elbow, strengths of the growing tissues and sequelae to the elbow if injuries are left untreated. Although most of the conditions are managed nonsurgically, arthroscopic techniques are useful to correct those requiring surgical intervention.     

Shoulder injuries in the childhood athlete

Shoulder dysfunction in the young athlete usually is manifested differently than the adult counterpart. The physiology and biomechanics of a growing child and adolescents result in different injury patterns that require different and thoughtful approaches to diagnosis and treatment. Most of these conditions are served well by nonsurgical treatment modalities. Judicious use of surgical interventions, however, can significantly improve patient outcome and return them to their sport of interest. Postoperative rehabilitation, and proper training techniques are essential to ensure continued participation of the athlete.     

Acromioclavicular injuries in the throwing athlete

Acromioclavicular injuries in the overhead or throwing athlete are frequently encountered by team physicians. Treatment regimens vary greatly, depending on dominant versus nondominant arm, injury in-season or out-of-season, and the athlete's goals for future seasons. This article focuses on each of these unique issues with regards to acromioclavicular separations and fractures, acromioclavicular arthritis, and acromioclavicular osteolysis.     

Ankle injuries in the young athlete

Ankle injuries in the young athlete are quite different from those of an adult. Because the epiphyseal plates of the distal tibia and fibula are significantly weaker than surrounding ligaments, failure on stress occurs through the growth plates rather than through soft tissue. Growth-plate injuries can assume a distinct pattern based on the maturity of the physis. Leg length inequality and angular deformity are potential sequelae from significant injury to the ankle in the skeletally immature but, fortunately, occur infrequently. Soft-tissue injuries about the ankle are rare, but with advanced, rigorous training techniques a new pattern of overuse injuries appears to be emerging.     

Back injuries in the pediatric athlete

Pediatric and adolescent athletes presenting with back pain are much more likely to have a pathologic cause for their symptoms than are adult patients. For this reason, it is important for those caring for younger athletes to maintain a high index of suspicion for some of the more common pathologic causes of back pain in this population. Diagnostic evaluation should be undertaken more quickly in pediatric and adolescent athletes. Sports-related diagnoses that must be considered include disc-related back pain, atypical Scheuermann’s kyphosis, spondylolysis, and spondylolisthesis. Patients of this age may also present with conditions not associated with activity, including discitis, classic Scheuermann’s disease, rheumatologic disease, and spinal tumors. History and physical exam provide valuable information to help guide further diagnostic studies which, in turn, will determine necessary treatment. No definitive studies are available regarding the diagnosis and treatment of spondylolysis and spondylolisthesis. Health professionals need to consider the expertise of a local radiologist when deciding upon diagnostic imaging procedures. The athlete’s age and sport played can contribute to the appropriate treatment plan.     

Shoulder injuries in the throwing athlete

Shoulder injuries in the throwing athlete are becoming more frequent. Sports specialization at a younger age, playing multiple seasons, increased awareness of injury and injury prevention, advances in diagnosis, and surgical treatment all play a part in the increase in diagnosis of these injuries. Understanding the biomechanics of throwing and pathologies that are encountered in the throwing athlete can aid the clinician in successful diagnosis and nonoperative/operative treatment of the throwing athlete. This article discusses the relevant anatomy, biomechanics, and pathoanatomy of the throwing shoulder. Additionally, understanding the kinetic chain can assist in the nonoperative rehabilitation of the injured shoulder. Surgical reconstruction is indicated when nonoperative efforts have been exhausted and is directed based on the extent of the pathology to the capsuloligamentous structures, labrum, and rotator cuff.