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Prevention of ACL Injury in Our Young Athletes

Prevention of ACL Injury in Our Young Athletes

by | Jul 17, 2019 | Sports Medicine

Article originally published by pediatric orthopedic surgeon Henry B. Ellis, M.D., and Assistant Chief of Staff Philip L. Wilson, M.D., in second quarter, 2019 issue of the Pediatric Society of Greater Dallas newsletter. Key messages were also presented by Philip L. Wilson, M.D., at Coffee, Kids and Sports Medicine. 

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Sports and ACL Injuries: Epidemics in Pediatrics
The dramatic increase in anterior cruciate ligament (ACL) injuries, particularly in female athletes, and an increase in surgeries in young athletes requires attention by all of us. Our research has demonstrated almost a two-fold increase in ACL reconstruction performed in female athletes since 2009. In a large epidemiology study reported by the American Academy of Pediatrics (AAP) in 2014, female soccer, basketball and gymnastics are among the top sports with highest ACL injuries rates. Male football is also considered a high-risk sport for ACL injuries.

Although there are obvious benefits of youth sport cultures, annual increases in participation rates of children and adolescents in organized and year-round sports now allows for more opportunities for injuries to occur. Youth that play soccer or other sports that require pivoting may be especially vulnerable. Although most of us want to see our kids (and patients) win, a healthy and safe attitude towards organized sports is wise.

How do ACL Tears Occur?
The ACL, which is located in the center of the knee, serves to limit rotation and forward movement of the tibia. When overloaded in a vulnerable position, without the support of coordinated muscles, the ACL (with linear collagen similar to a rope) tears or stretches when stressed beyond capacity. Often, this occurs when stopping suddenly, landing with an off-centered pelvic position, cutting or twisting movements or with a direct hit to the knee. Youth might feel a painful pop within the knee, experience their knee giving way and observe swelling when an ACL tear occurs.

The knee is often unstable with a torn ACL. Participating in sports with an unstable knee may lead to damage of other soft tissues (menisci and articular cartilage) in the knee. Therefore, surgery may be necessary.

ACL Injury Treatment
An ACL injury can often be successfully treated. An athlete who wishes to return to sports that involve jumping, cutting and pivoting, may require surgery to re-build the ligament. Even though almost all kids will return to sports, surgery in a young athlete can be stressful, traumatic and may take up to one year of rehabilitation. Although risk to the growth plate exists during this surgery, orthopedic specialists who are trained in pediatric orthopedics and routinely treat growing children with these injuries can minimize these risks to a negligible incidence.

Pediatric Sports Injury Prevention Programs
ACL Injuries and sports-related knee injuries are preventable. This has been established in numerous studies. The risk of a non-contact ACL injury may be reduced if the muscles of the central and lower body are strong and well-coordinated. Programs centered around coordination and balance, strengthening and falling techniques can improve biomechanics and help prevent injury. While there is a role for “old school” warm-ups, such as running, research has confirmed that training to improve the efficient and timely contraction of muscles to stabilize the knee (neuromuscular control) may reduce ACL injury or re-injury.

What Can Pediatricians Do to Evaluate for ACL Injury Risk? 
While evaluating an athlete’s safety to participate or return to high-risk sports following an ACL injury, the pediatric sports medicine community often employs balance and strength testing. Single leg squat endurance while maintaining proper in-line knee form, drop-landing knee form, and ability to perform single leg balance maneuvers at an appropriate age and symmetry level (Y balance testing -YBT) are common measures for knee safety evaluation.

Pediatricians may consider simple screening techniques to establish high risk patients or in those who play high risk sports. Some techniques include a single leg balance assessment or a standing double or single leg squat in the office, while observing for diminishing in-line knee control (see photo). Another examination of core strength that may also be useful is to have the patient hold a plank for 60 seconds. This might best serve as a conversation starter for families with pubescents and adolescents in pivoting sports, such as soccer or basketball. A “when in doubt – refer for knee injury prevention training” strategy may be safest in this high-risk population.

The following training tips may also reduce the risk of an ACL injury:

  • Encourage kids to play for fun first, and then play to win.
  • Recommend variation in their sports throughout the year. This will help maintain long term athletic development and minimize overuse injuries.
  • Train for activity, but be cautious of fatigue that may develop during year-round single sport play.
  • Perform core body, hip and thigh strengthening exercises.
  • Practice wide-based, flexed-knee squatting, jumping and landing techniques.

Education to families and youth athletes regarding these injury prevention strategies and programs is an important wellness initiative for all of us who care for these children. Contacting a community pediatric sports medicine partner is an effective way to gain more information and access to available programs. As participation in youth sports continues to rise exponentially, all of us caring for these children will continue to be challenged to provide valuable and timely “ounces of prevention” for their knees.

D CEO: Scottish Rite’s Frisco Facility is Open for Business

D CEO: Scottish Rite’s Frisco Facility is Open for Business

by | Oct 16, 2018 | Press Coverage, Research & Innovation

Read the original story on D CEO’s website here.

The Scottish Rite for Children Orthopedic and Sports Medicine Center started accepting its first patients this week, and the entire building is a testament to movement and recovery.

Color-coded floors, bands of shifting color on the facade, colorful spiral staircases, and dynamic floor and wall art are designed to reflect movement and encourage children toward recovery. HKS designed the center and partnered with general contractor Beck in construction of the building.

Texas Scottish Rite Hospital for Children is building its second facility after 96 years in its Dallas location. Located at the corner of Lebanon Road and the Dallas North Tollway in Frisco, the facility will mirror the population boom in the northern suburbs and fit in well with other athletic facilities in the area such as The Star and FC Dallas. Conversations about the new center began in 2014, with construction breaking ground in 2016.

According to Scottish Rite, around 25 percent of their patient families live north of Dallas, and the ambulatory surgery facility will be an extension of the Dallas campus and will offer clinic visits and orthopedic day surgeries for children.

The five-story building offers views of Lake Lewisville from the upper floors, and will include 345,000 square feet of space, which includes one and a half floors of unused space so that the healthcare giver can grow with the area. If desired, the facility can be a full service hospital in the future.

Imaging will include MRI and three X-ray units with potential for a CT scan and additional MRI and X-rays. The second floor clinics are positioned around the imaging for convenience, and include a walk in clinic for fractures and centrally located admin space separated from patient rooms. There are two operating rooms with room for more, an infusion lab and space for other ancillary clinics. Surgeries will begin November, and families will be able to wait in apartment style family waiting rooms with furniture and sibling play areas.

The physical therapy gym is more reminiscent of a professional gym than a healthcare facility, and it will be accompanied by a Movement Science Lab built for sport-specific training and testing to focus on sports injury or general orthopedic rehabilitation.

The building also includes a conference center with smaller meeting rooms, a 150-seat auditorium, and courtyard that will serve community needs as well as academic gatherings. The adjacent U-11 soccer field can be used for group rehab sessions, injury prevention demonstrations and coaching clinics, and is accompanied by a playground with adaptive play equipment (which should be complete in December) and a half-mile walking and running trail that ties in to local trails.

Scottish Rite anticipates more than 22,000 clinical visits in year one for sports medicine, orthopedics and a fracture clinic, and 13,000 for physical therapy. Around 50 staff relocated from Scottish Rite’s Plan facility, while 30 relocated from the Dallas campus and 50 new staff were hired for the center.

“We are on the forefront of what is happening,” says Jeremy Howell, Vice President, North Campus at Texas Scottish Rite Hospital for Children.”We want to focus on the growing child.”

Scottish Rite continues the growth of Frisco’s sports medicine healthcare facilities, joining the Baylor Scott & White Sports Therapy & Research at The Star, which opened earlier this year.

#SRHaccess Facebook LIVE Recap: The Future Frisco Campus

#SRHaccess Facebook LIVE Recap: The Future Frisco Campus

by | Oct 25, 2017 | Sports Medicine

On this week’s Facebook live, Vice President of North Campus Jeremy Howell and Assistant Chief of Staff Philip L. Wilson, M.D. joined us to discuss the future Frisco campus. Below is a recap of the conversation.

Watch this segment on Facebook.

Construction update:

  • The construction is running right on schedule.
  • Opening in the Fall of 2018

Who are our Frisco neighbors?

  • The Frisco campus is located on the northeast corner of Lebanon Road and Dallas North Tollway.
  • To the north, our direct neighbor is Frisco High School.
  • To the south is the new Wade Park development and the Frisco Star.

What is the difference between the Plano and the future Frisco campus?

  • Increased space to utilize more resources for expand services.
  • Operating rooms for day surgeries
  • Motion science lab
  • Physical therapy gym space
  • Overall clinical care advancements and updates to current services.

Facts about the structure:

  • 5 stories tall
  • 1st floor:
    • Conference rooms for community and physician education and outreach
    • State-of-the-art motion science lab for clinical and research purposes
    • Physical therapy gym to rehab sports injuries and general orthopedic conditions
  • 2nd floor:  
    • Outpatient clinics (sports medicine, fracture clinic, general orthopedics, orthotics and prosthetics)
  • 3rd floor: shelled for future growth
  • 4th floor: day surgery
  • 5th floor: offices for staff

What are the general orthopedic services that will be provided?

  • An expansion of what the team currently cares for at the Plano campus.
  • Hip disorders, scoliosis screening, foot and ankle, shoulder care, etc.

What is the benefit of being in Frisco?

  • 25% of the hospital’s patient population lives in a surrounding areas of Frisco.
  • The opportunity to enhance customer service by providing another point of access for our patients and their families to be cared for by our world-renowned specialists.
  • Frisco is a strong sports community. The Center for Excellence in Sports Medicine will be the anchor to the future campus, which will allow us to care for more athletes.

What will the state-of-the-art motion science lab offer at the new campus?

  • The lab will provide a better understanding of clinical problems of lower and upper extremity conditions whether a sports injury or general orthopedic condition.
  • The ability to analyze the function of each joint and muscle of a patient’s walking gait or throwing mechanics.
  • The opportunity to expand on various research projects.

Will the Scottish Rite Hospital traditions be present at the future campus?

  • Popcorn – yes, on the first floor in the atrium.
  • Volunteers – yes, in red coats just like at the main campus.
Hospital Staff Attend 33rd Annual Orthopaedic Trauma Association Meeting

Hospital Staff Attend 33rd Annual Orthopaedic Trauma Association Meeting

by | Oct 12, 2017 | Research & Innovation

Orthopedic staff from Scottish Rite Hospital are attending the 33rd annual Orthopaedic Trauma Association (OTA) meeting in Vancouver, British Columbia. Established in 1985, OTA now has over 2,000 members, including medical professionals in all areas of the world. Members gather each year to share the latest research and collaborate with fellow colleagues to bring better care to the injured patient.

At this year’s meeting, 950 abstracts were submitted, with just over 250 being accepted for presentation. Scottish Rite Hospital is being represented by several orthopedic staff and past fellows, with four projects selected for presentation. The research being presented from the hospital:

  • Is Less More? Assessing the Value of Early Clinical and Radiographic Follow-Up for Operative Supracondylar Humerus Fractures
  • The Utility of Intra-Operative Arthrogram in the Management of Pediatric Lateral Condyle Fractures of the Humerus
  • Does Delay to Surgery in Type III Supracondylar Humerus Fractures Lead to Longer Surgical Times and More Difficult Reductions?
  • Does a delay in treatment of displaced pediatric lateral condyle fractures increase the risk of complications?

In addition to scientific presentations, hospital faculty work closely with the OTA to assure ongoing education of colleagues and trainees in the discipline of pediatric orthopedic trauma management. Assistant Chief of Staff Philip L. Wilson, M.D. and staff orthopedists Anthony I. Riccio. M.D. and Lane Wimberly, M.D. continue to direct the pediatric module at the annual OTA Comprehensive Resident Fracture Course. Staff orthopedist Christine Ho, M.D. also serves as faculty for a newly developed trauma symposium for advance practice nurses and physician assistants.

As members of the Orthopaedic Trauma Association, our doctors can be a part of a world-wide medical community that is dedicated to advancing the treatment and prevention of musculoskeletal injuries. Scottish Rite Hospital is honored to have the opportunity to present the most recent research on a global stage to ultimately bring better care back to our patients and children everywhere.