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Does my child need surgery to fix an ACL tear?

Does my child need surgery to fix an ACL tear?

by | Jul 30, 2024 | Sports Medicine

Anterior cruciate ligament (ACL) injuries, continue to challenge young athletes, many calling it an epidemic. Because of the high cost of care and loss of playing time, Scottish Rite for Children’s Sports Medicine team is actively looking for answers to prevent these injuries. As we study the conditions that may contribute to the risk with programs like the Sports-specific Assessment and Functional Evaluation (SAFE) program, we also continue to evaluate and contribute to the available evidence for caring for ACL injuries in young athletes.

Medical director of clinical research and pediatric orthopedic surgeon Henry B. Ellis, M.D., led a multicenter team including others from the Scottish Rite Sports Medicine team just published a critical analysis of the literature pertaining to the management of pediatric ACL injuries. The article is available on the Journal of Bone and Joint Surgeries (JBJS) Reviews site.

Here are some key messages you should know when considering surgery for an ACL tear:

» Even though these are happening at a high rate, there is very little published evidence for managing ACL injury in a pediatric or skeletally immature case.

Studies suggest that as many as 3 out of 4 athletes return to play after completing a nonoperative plan of care after ACL injury, but there are times that surgery is necessary. A physical therapist or athletic trainer can guide rehabilitation with a comprehensive exercise program to prepare an athlete to return to competitive sports with an ACL tear.

» This review suggests that surgery for an ACL reconstruction is recommended when another condition is present. These include:

  • Repairable injury to the cartilage, soft tissue that covers the surface of the bone.
  • Repairable injury to the meniscus, a disc between the two major bones in the knee joint.
  • Symptoms of instability even after high quality rehabilitation.

Since both paths for care can be successful and come with some risk, a decision for surgical or nonsurgical approaches to care for a pediatric ACL reconstruction should include a broad team considering many aspects of the circumstances.

Learn more about individualized care for ACL injuries at Scottish Rite for Children.
 

Ellis, H. B., Jr, Zak, T. K., Jamnik, A., Lind, D. R. G., Dabis, J., Losito, M., Wilson, P., & Moatshe, G. (2023). Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. JBJS reviews, 11(8), 10.2106/JBJS.RVW.22.00223. https://doi.org/10.2106/JBJS.RVW.22.00223
Shouldering an Injury: What AC Joint Separation Recovery Looks Like

Shouldering an Injury: What AC Joint Separation Recovery Looks Like

by | Dec 6, 2023 | Sports Medicine

Young athletes can experience many shoulder injuries while playing sports, one of which being AC joint separation. Sometimes called shoulder separation, this injury affects the acromioclavicular joint, which rests where a part of the shoulder blade called the acromion connects to the clavicle, or collarbone.

If your child recently sustained an AC joint separation, you both are likely wondering how long it will take to recover and get back in the game. Athletes can usually return to sports and physical activities after 12 weeks. However, each child’s experience with AC joint separation is different. Your child’s recovery will depend on several factors, including how severe the injury is and the treatment your child receives. 

Understanding AC Joint Separation 

To understand the recovery process, it helps to understand what an AC joint separation is and how it impacts your child’s activities. 

AC joint separation typically occurs when your child experiences a strong blow to the shoulder during a game or falls on his or her arm. The impact can strain or tear the ligaments attached to the underside of the clavicle — the AC and coracoclavicular (CC) ligaments — separating the collarbone and shoulder blade (scapula). Your child may have intense pain, swelling, bruising and limited range of motion in the shoulder and arm. Your child may also develop a bump above his or her shoulder.

Sports medicine specialists categorize AC joint injuries into several types, including: 

·       Type I injuries: These injuries are generally mild. The AC ligament is sprained, and the CC ligament is still intact.

·       Type II injuries: These occur with a complete tear to the AC ligament, a sprain in the CC ligament and slight separation between the clavicle and acromion.

·       Type III injuries: Both the AC and CC ligaments are torn, and the separation between the clavicle and acromion is more pronounced.

·       Type IV, V and VI injuries: These involve tears in the AC and CC ligaments, and the clavicle is pushed further into the shoulder and neck.

Recovering From AC Joint Separation With R&R

An AC joint separation can often heal naturally using nonsurgical treatments, such as rest and temporary activity restrictions. Your child’s sports medicine specialist may recommend:

·       Cold packs to reduce pain and swelling 

·       Immobilizing your child’s arm with a sling for resting the shoulder as it heals 

·       Medication for pain relief 

Kids can often heal without surgery, even with severe AC joint injuries. Your child’s provider may start with conservative remedies before moving to surgery. 

Surgery for AC Joint Separation 

Surgery is generally used only with more severe AC joint injuries, and it may help if your athlete continues to experience pain despite nonsurgical treatment. Surgery can also help address bumps (deformities) that form after AC separation. 

Surgical procedures involve removing a small portion of the collarbone to prevent it from rubbing against the acromion. Minimally invasive or open reconstructive surgery on the AC and CC ligaments may allow your child’s surgeon to reattach them to the collarbone. These procedures may involve plates or other materials to hold the ligaments in place. 

Children who have nonsurgical treatments typically regain shoulder function within six weeks, while those who have surgery will have a longer recovery. Your child may need rehabilitation before returning to sports. Surgical recovery can take about six months.

Many children recover well from AC joint separation, and very few have complications.  

AC Joint Separation or Clavicle Fracture?

Although older children and teenagers can experience AC joint separation, a more common shoulder injury in children is clavicle fracture.

Like AC joint separation, a clavicle fracture can occur after a hard fall or an impact from an accident. The two injuries cause similar symptoms, as well, including:

·       A bump near the break

·       A drooping shoulder

·       Pain, swelling or bruising around the collarbone

·       Pain that occurs when your child tries to move the shoulder or arm and that causes them to not use the arm as much as they normally might

Your child’s provider may recommend imaging to determine whether your child broke a bone or experienced an AC joint separation. Fortunately, clavicle fractures, like AC joint separation, can often be treated without surgery.

Whether your child has AC joint separation or a clavicle fracture, it’s essential to follow the provider’s recovery instructions and ensure your child fully recovers before getting back to the field or playground. 

At Scottish Rite for Children Orthopedic and Sports Medicine Center, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work collaboratively to develop personalized treatment plans for each young athlete. Call 469-515-7100 to learn about our sports medicine program. 

What Is Turf Toe? 7 FAQs About This Common Sports Injury

What Is Turf Toe? 7 FAQs About This Common Sports Injury

by | Nov 6, 2023 | Sports Medicine

A serious condition with a funny-sounding name, turf toe can sideline aspiring and professional athletes alike. It’s a condition that targets one of an athlete’s most important tools — their feet. Learn how you can identify turf toe in your child and the steps you can take to keep it from ruining their season.

What Is Turf Toe?

In very basic terms, a turf toe injury is a sprain that impacts the big toe’s main joint — the metatarsophalangeal joint. It occurs when the joint gets bent beyond its normal range of motion, leading to stretches or tears in the ligaments, tendons and tissues that hold the joint in place.

What Causes Turf Toe?

Turf toe got its name because it was first seen in football players who play on artificial turf. The firm and less forgiving surface can contribute to strains on the big toe during play.

Nowadays, doctors see this injury in athletes who play any sport that involves running, jumping and other activities that place a lot of strain on the foot and big toe. Those sports include basketball, dance, gymnastics, soccer and wrestling.

In those sports, as with football, footwear can play a role in causing turf toe. Wearing shoes with flexible soles that do not adequately support the big toe joint can increase the risk, whereas stiff-soled shoes offer better protection.

What Are Common Symptoms of Turf Toe?

Common symptoms include:

  • A feeling of instability or weakness in the big toe
  • Bruising
  • Difficulty walking or bearing weight on the affected foot
  • Limited range of motion in the big toe
  • Pain, tenderness, and swelling at the base of the big toe

If your child experiences discomfort or pain in the big toe joint after activity or playing sports, schedule an appointment with a sports medicine specialist. It can take time to recover from turf toe, so treating the condition at the first signs of pain can reduce your child’s time on the sidelines.

Diagnosing turf toe begins with a physical exam. Your child’s doctor will measure the toe’s range of motion and look for signs of tenderness and instability. Your child may have an X-ray to rule out any fractures, but sometimes the doctor will order an MRI scan. This type of imaging provides detailed views of the foot’s soft tissues, helping to confirm the extent of the injury.

How Long Does Turf Toe Take to Heal?

The recovery time for turf toe can vary depending on the severity of the injury and how well it is managed. In general, mild cases of turf toe may heal in a few weeks, while more severe cases can take several months for full recovery. To help your child heal as quickly as possible, follow their treatment plan and doctor’s recommendations.

Treating turf toe typically involves a combination of the following:

  • Rest, ice, compression and elevation, a.k.a. “RICE.” The RICE method starts with letting the joint rest and allowing it to heal. Your child should avoid activities that put strain on the big toe joint. Applying ice, compressing the affected area with a bandage, and elevating the foot can help reduce pain and swelling.
  • Anti-inflammatory medications. Over-the-counter anti-inflammatory medications can help manage pain and reduce inflammation, but ask your child’s doctor which medications to use. Aspirin and adult-strength medications may not be safe for your child.
  • Custom orthotics. Depending on your child’s injury and sport, their doctor may recommend custom orthotic inserts to support and protect the big toe.
  • Physical therapy. Physical therapy can restore strength and range of motion in the big toe. A physical therapist can provide exercises and techniques to promote healing and prevent future injuries.

Is It Safe to Walk on Turf Toe?

In mild cases of turf toe, it may be possible to walk with some discomfort, although rest is still recommended. Your child should listen to their body and avoid activities that worsen their pain or discomfort.

What Happens to Untreated Turf Toe?

If left untreated, turf toe can lead to complications and chronic issues, including:

  • Increased pain and discomfort
  • Limited range of motion in the big toe
  • Reduced athletic performance
  • Risk of future injuries or damage to the joint

Can You Prevent Turf Toe From Coming Back?

You can reduce your child’s risk of getting turf toe again by helping them take some simple preventive measures:

  • Wear proper footwear with stiff soles that adequately support the big toe joint.
  • Use orthotic inserts if your child’s doctor recommends them.
  • Practice exercises that strengthen the muscles around the big toe joint to provide additional support.
  • Learn proper running and movement techniques to limit strain on the big toe.

Scottish Rite for Children has the experience necessary to help your child overcome (or prevent) turf toe. Call 469-515-7100 to schedule an appointment with one of our experts.