Childhood Knee Injuries Occurring at an Alarming Rate
Dr. Noel Peterson
With the increased intensity and demands of childhood athletics these days, orthopedists at leading medical centers are seeing soaring rates of childhood knee tears in younger and younger children. And contrary to the old belief that boys are more prone to the injury than girls, as many as eight times more girls than boys are suffering tears to their knee ligaments.
An ACL injury is extreme stretching or tearing of the anterior cruciate ligament (ACL) in the knee, while meniscus injuries involve the shock absorbing cartilage that cushions and helps the knee track smoothly. Tears to either may be partial or complete. Both injuries cause the knee to track abnormally, and can lead to further damage to the cartilage and eventual arthritis.
Doctors have also learned that contact injuries are not the most common cause of A.C.L. and meniscus tears. It turns out tears occur more often from twisting and jumping. A child can be running and step in a hole, twisting a leg. Other times, a young athlete can tear an ACL or meniscus by coming down from a rebound in basketball or when accelerating and decelerating in a game. It seems that the best athletes are constantly at risk because of the intensity of play.
With an injured meniscus or overstretched or torn ACL, even everyday activities can injure the smooth, shock-absorbing cartilage that caps the knee joint, triggering arthritis. Parents often give in to their child’s attitude of being “indestructible”, or worse, encourage their child to play through the pain, increasing the risk of further injury.
Even the standard A.C.L. repair operation, with its drilling into the growth plate to re-attach a replacement ligament, may cause permanent damage to the still-growing bones of young children. That happened recently to a 14-year-old boy who was referred to Dr. Freddie H. Fu, an orthopedic surgeon at the University of Pittsburgh. A year after the operation, Dr. Fu said, the leg with the repair was bowed 20 degrees on one side and was shorter than the other leg.
Even when everything goes right, surgery and its aftermath can be more difficult than the child or parents anticipate. Children often are in intense pain after the operation and then spend much of the next six weeks lying down with their leg in a machine that moves the knee slowly through a range of motions. This is followed by six months of physical therapy, which is often painful and physically and emotionally difficult.
What can be done? Listen to your child and do not let them play through the pain. No game or tournament is worth permanent injury and a lifetime of knee arthritis. And don’t let minor injuries go untreated.
While physical therapy can strengthen the muscles that stabilize the knee, prolotherapy is the only therapy shown to turn on the body’s repair of cartilage and ligaments. Over the years I have treated many child athletes with prolotherapy, and have found that anything short of a full thickness ACL or meniscus tear can heal. Children are especially responsive to the natural growth and repair that prolotherapy provides.