As disturbing as it can be, we're all fairly accustomed to seeing professional and top-level athletes get injured. Watch the average NFL game and you're bound to see a major injury occur.  The same can be said for the ladies at the highest level of skiing-- you don't have to take it from me because you can tune in and see it yourself... injuries to the knee occur on almost a weekly basis.

So it's probably true that we've become a bit "de-sensitized" to injuries to high level performers. Unfortunately, knee injures are not exclusive to world-class or professional athletes.  We see a number of high school and child athletes who also experience injuries to the Anterior Cruciate Ligament (ACL).  

Keeping Kids Healthy For the Long Haul #kidsacl
 

Some people may think that having an injury early in life gives the young athlete a heightened ability to heal. But what I worry about is not only the short-term health of the child (getting them back into activities), but also the long-term health of their knees.  We want these kids to be going through life pain-free and doing the activities they love well past middle age. 

I've talked a lot recently about the concept of Activity Preservation, which focuses on keeping people doing the activities they love for a long time, rather than just focusing on relieving pain.  For pediatric knee injuries, we want to make sure we are blessing these young athletes with the ability to do the things that they love for their entire lives.

For the Parents - Let's Review the Knee

If your reading this article, you're probably concerned with injuries to the ligaments from an anatomical standpoint, because those are the portions of the knee that most often require surgery in athletes. 

What's a Ligament?

A Ligament is a cable of strong tissue which serves the major purpose of connecting your bones with other bones. 

Here are the 4 Main Ligaments:
 

• Medial Collateral Ligament (MCL): The MCL connects the femur with tibia along the inside of the knee. It helps to keep the inner part of the knee stable and also helps control sideways motion, keeping the knee from bending inward.

• Lateral Collateral Ligament (LCL): connects the femur to the tibia along the outside of the knee. It keeps the outer part of the knee stable and helps control the sideways motion of the knee, keeping it from bending outward.

• Anterior Cruciate Ligament (ACL): connects the femur to the tibia at the center of the knee. It helps control the knee's rotation.

• Posterior Cruciate Ligament (PCL): connects the femur to the tibia at the back of the knee. It helps control the knee's backward motion.

What are the common types of knee injuries among children?
 

As I mentioned before, knee injuries among children can be quite common, but, of course, don't always require surgery.  The knee is one of the most complex joints in the human body. Couple that with the fact that the knee is under constant use, and you've got a recipe for potential injury. 

Knee injuries in athletes can often occur from:
 

• Sudden, harsh stops
• Unexpected twists
• Repetitive overuse
• Direct shots to the knee

Knee Sprains

Knee Sprains

Sprains to the knee can be worrisome for kids because they often involve damage to the MCL and/or the ACL.  Complete tears to knee ligaments are something I mentioned earlier and will talk about in a bit here-- these more serious sprains may require surgery and rehabilitation. Symptoms of a knee sprain may include:

• A SNAP or POP sound in the knee when the injury occurs
• Inability to hold one's weight upon the leg with the inured knee
• A feeling of "looseness" or lack of stability within the knee
• Pain in the injured knee
• Post-injury swelling of the injured knee

Knee Strains

If a child tears a muscle or tendon partially, we've got a knee strain on our hands. Bruising around the knee is a good indication of a knee strain.

Tendonitis

Irritated or inflamed tendons cause by overuse or lack of proper technique in the young athlete is called tendonitis. Kids that have tendonitis will probably experience tenderness and pain while bending, walking, lifting, extending or even while at rest.
 

Meniscal Cartilage Tears
 

Kids playing sports are required to make very quick, sudden, direct changes in speed and direction. This is where we can see damage to the menisci. We often see cartilage tears to the menisci in tandem with severe sprains to the ACL-- causing swelling, tightness, tenderness, and sometimes leading to effusions (when fluid collects around the knee).
 

Fractures and Dislocations in Children

A fracture is a cracked, broken, or shattered bone. Kids may have trouble moving the bone and are likely to have a lot of pain. Patellar dislocation happens when the patella is knocked off to the side of the knee joint, by twisting or some kind of impact. Sometimes it will go back to its normal position by itself, but usually needs to be put back in place by a doctor. Symptoms include swelling and pain in the front of the knee, an abnormal bulge on the side of the knee, and inability to walk on the leg with the affected knee.
 

Articular Cartilage Injuries in Children

Sometimes a small piece of bone or articular cartilage softens and/or breaks off from the end of a bone, causing long-term knee pain. This is called osteochondritis dissecans (OCD). Symptoms include pain; swelling; an inability to move the joint; and stiffness, catching ("locked knee"), or popping sensations with knee movement.
 

How to Cope with a Pediatric ACL Injury
 

It can be very difficult for our youngsters to cope with a serious injury to the knee.  Many kids dedicate their heart and soul when it comes to their chosen sport, and some even feel strongly that their futures are dictated by their performance on the pitch, court, field, or slopes.  This can result in feelings of anger, sadness, and sometimes even depression when it feels like their dream is being taken away, albeit briefly. Nobody wants to be on the bench while you friends are out there "kicking butt and taking names".

That said, our aim is to get our youth back onto the field playing at an even higher level than they started at. We'll do our job as physicians- so your job as a parent, supporter, or even if you are the athlete in question, is to do your best to keep a can-do and positive attitude.  

Stay involved with your team however you can.  Maybe even try picking up a new hobby for the short term. And most of all, don't hesitate to share your feeling if your injury and recovery is getting you down.
 

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