April 29, 2014
News Review From Harvard Medical School -- Training Urged to Reduce Kids' ACL Injuries
Specific training methods can reduce the risk of anterior cruciate ligament (ACL) injuries in children by up to 72%, a new report says. The American Academy of Pediatrics (AAP) published the report. ACL tears are common knee injuries in sports. Rates have been rising among child and teen athletes, especially girls. ACL injury risk increases at age 12 for girls and at age 14 for boys. Female athletes ages 15 to 20 account for the largest numbers of these injuries. Training programs that involve repeated jumps and strengthening exercises for the legs can help prevent ACL tears, the report says. Teaching players how to avoid risky knee positions also helps, the AAP says. The AAP urges coaches to learn about these types of training and use them to protect young athletes. The report also discusses treatment. New techniques have helped make surgery an option for more young athletes. Surgery can restore knee stability for about 90% of those who receive it, the report says. The journal Pediatrics published the report. HealthDay News wrote about it April 28.
By Claire McCarthy, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
If you are a parent of an athlete, or a coach, you need to know about ACL injuries.
ACL stands for anterior cruciate ligament. It is one of the major ligaments of the knee, and it gets injured often in sports. That's why the American Academy of Pediatrics has issued a clinical report about ACL injuries. The journal Pediatrics published the report.
ACL injuries are most common in collegiate sports, especially in spring football, women's gymnastics, basketball and soccer. They occur slightly less often in high school sports. But they are still very common, especially in girls' soccer and boys' football.
ACL injuries are more common in girls until adulthood, when the numbers for both genders even out. Female athletes between the ages of 15 and 20 account for the largest number of ACL injuries reported. Unlike boys, girls don't get a whole lot of extra muscle when they go through their growth spurt. This means they have less support for their growing bones and joints.
It's important to know about ACL injuries because not only are they common, they can be very disabling. In fact, the clinical report states that "an ACL injury at an early age is a life-changing event." Medical costs average an estimated $17,000 to $25,000 per injury when you factor in all doctor's visits, surgery and rehabilitation. These injuries have a personal cost as well. They are more likely than most other sports injuries to keep kids out of sports and school. They have even been linked with a decrease in grade point average.
But most importantly, more than half of youth with ACL problems end up with osteoarthritis 10 to 20 years after the injury. That means a high school student who gets injured could be struggling with arthritis when she is in her 30s. Contrary to what many people think, surgery doesn't necessarily change this. In fact, surgery on an ACL injury may make future osteoarthritis more likely.
What Changes Can I Make Now?
As with most things in medicine, prevention is best. When it comes to preventing ACL injury, proper training and technique are crucial.
There is a particular position of the legs that makes ACL injury more likely. It's called "dynamic knee valgus." Basically, it's when someone slows down or comes to a stop with the knee straight (or almost straight) and turned in, with the foot behind. This is a very common motion as soccer players dart around a field, or gymnasts land a jump.
Teaching athletes to be aware of this risk can help prevent injury. So can specific techniques that improve leg balance and strength. Parents should ask coaches what they are doing with their athletes to prevent injuries, especially ACL injuries.
Other things that increase risk of ACL injuries include:
- Previous injury: Athletes should follow medical instructions carefully when returning to play.
- Being overweight: This is yet another reason to get to and stay at a healthy weight.
- Joint laxity: Athletes who have very loose, flexible joints have a higher risk of injury. They should talk to their doctors about ways to prevent injury.
What Can I Expect Looking to the Future?
With more and more young people playing competitive sports, many of them year-round, it's not surprising that ACL injuries are so common. I hope that this clinical report will help doctors, coaches, trainers and parents keep athletes safe.