Kids, sports and injuries, according to sources

We try to keep this a (mostly) commercial-free zone. Today is an exception. The New York Times is offering a series of on-line sessions on the topic of sports, kids and injuries. The class meets weekly starting in late February and the instructors are first-rate, Times reporters Gretchen Reynolds and Alan Schwarz.

The cost is $135. I hear it's an easy A.

The whys - and why nots - of ACL reconstruction

Interesting and important piece last week on the New York Times "Phys Ed" blog on ACL injuries and whether the most aggressive treatment (surgery) is always best. Research just published in the New England Journal of Medicine raises real doubts. Patients who had ACL reconstruction- an expensive and relatively complicated operation - were followed in a study by researchers from the University of Sweden along with a second group that opted to forgo surgery and be treated with physical therapy only.

Surprising outcome. The Times reports, that “more than half the A.C.L. reconstructions” currently being conducted on injured knees “could be avoided without adversely affecting outcomes.”

The article continues, "Part of the reason for A.C.L. surgery’s popularity is that by most measures, it works. In the current study, most of the group members who had reconstructive surgery reported that their injured knees felt healthy after two years and that they had returned to activity — not, in most cases, at the same level as before their injuries, but they were active. Significantly, their knees also were notably more “stable” than the joints that hadn’t been surgically fixed. Stability is, in theory, desirable. A stable knee rarely gives way.

The article, though, goes on to explain that sports docs and researchers are split on the importance of a 'stable" knee. There seems to be agreement that it's very important for athletes in pivot, cut, change direction sports like basketball and lacrosse. In straight-ahead activities like running and biking, it appears to be less important. (There's even disagreement about that, though.)

I say the decision to have surgery on a damaged ACL is more complicated. A few years ago, I wrote an article about a spike in Tommy John surgeries being performed on high school pitchers. I interviewed James Andrews and Lewis Yocum, two prominent sports orthopedists, about the increase in the number of such patients showing up in their operating rooms. Yocum expressed his concern that sometimes he was operating on kids with limited futures in baseball. Maybe a year or two more of high school ball and that was it.

"Just because we have a hammer doesn't mean everything is a nail. Obviously, the surgery isn't designed for everybody," Yocum said.

The parallel carries only so far. And every kid deserves the best knee that modern medicine can provide. But everything isn't a nail.

Hat tip to my pal Ed Wiest.

Answering the ACL epidemic with training, coaching

Should parents invest in specialized sports fitness and skills training for their kid athletes? Usually, I'm a skeptic about such programs. The younger the kids, the more skeptical I am. (Batting lessons for 7-year-olds? Why?)

In Thursday's Washington Post, there's an article worth reading about a training regimen for kids that makes total sense. Its purpose: reducing ACL injuries in girls.

The article relates how Patricia Lake, a "determined Bethesda mom" is protecting her daughter.

The story explains:

"Lake's daughter, Corinne, ruptured her ACL the day before her 15th birthday, the day after she made the Whitman High School varsity soccer team as a freshman. Because she had not finished growing, doctors were reluctant to drill into her femur, a routine part of repairing the ligament. They held off her surgery for six months.

"The operation was followed by grueling physical therapy and personal training. As Corinne grew stronger, Lake began to wonder how she could keep her daughter's strength and flexibility regimen on track and help spare other girls the same fate. She spoke with Corinne's physical trainer, Graham King, owner of Balance Sport and Fitness, who was eager to start a program for teen girls.

"Now, once or twice a week, a dozen girls on Corinne's travel soccer team work on protecting their knees in Balance's Dupont Circle facility, a converted high school gymnasium, while their parents get in workouts of their own."

Recently, I spoke with Dr. Andrew Gregory, co-author of a just-published report on soccer injuries in kids. The conversation swung to ACL injuries. He recommends that parents choose teams and leagues that train coaches in injury prevention. He's helping to educate coaches of the soccer team his daughter, Sarah, 11, plays on. (Once again proving the axiom: When possible, get your kid on a team with the child of an orthopedic surgeon).

"There are [education] programs that teach girls how to land correctly, how to cut with their knees and hips in good position," Dr. Gregory told me. "Those can be very effective."

Why to repair a young athlete's knee asap

This sobering advice from a University of Pennsylvania study:

Young kids who injure their knees so badly that ACL surgery is needed should strongly consider having their repairs asap. This despite the fact that such operations, when performed on youth athletes, can disrupt normal bone growth.

Kids whose operations were delayed more than 12 weeks faced multiple risks, including:

- about a four-fold increase in irreparable medial meniscus tears.
- an 11-fold increase in lateral compartment chondral injuries.
- a three-fold increase in patellotrochlear injuries.

More on the study here.

ACL injuries in Albany

ACL stands for anterior cruciate ligament. It seems fewer and fewer girls complete their high school sports lives with their ACLs intact. Mike Sokolove wrote a wonderful book about the epidemic of ACL injuries, why they occur in soccer, lacrosse, basketball, field hockey players, etc., and ideas about curbing them.

The Albany Times-Union and the newspaper's youth sport blogger Joyce Bassett are telling the ACL story in an interesting way. Bassett has turned over her blog to Karly DeSimone, a striker for the Shenendehowa High School girls soccer team. In turn, Karly has been blogging about her experiences as an ACL surgery patient and about her lengthy rehab. The blog has generated feedback from lots of other ACL patients. One wrote a college paper - see November 10 entry - about the ordeal.

I'm also linking to an article written by Times-Union reporter Tom Keyser, a former colleague at the Baltimore Sun. Tom explains the spike in these injuries and the long road to recovery.