By Jim Monaghan
Baseball Health Network
Youth sports specialization is on the rise. As a result, the prevalence of pediatric ACL injuries is also increasing. Join Columbia University Sports Medicine on November 13th for Pediatric Sports Injuries: Treating our youth from head to toe to learn about the latest techniques for prevention and treatment of these injuries in our young athletes.
Children are playing sports in record numbers across the United States, and with this increase in participation there has been an alarming rise in the number of sports injuries. Taking optimal care of these injured kids requires extensive knowledge and comfort in techniques that have previously been thought of as only pediatric, or only adult. This webinar reviews and discusses treatment strategies to maximize outcomes and get these developing athletes off the sidelines and back onto the field. Understanding the etiology, diagnosis, surgical, and non-surgical modalities are the key elements of a successful treatment plan. This course will be of interest to Team Physicians, Certified Athletic Trainers, Physical Therapists, Primary Care Sports Medicine Physicians and coaches of all youth levels.
At the conclusion of this activity, participants will be better able to:
- Interpret and differentiate the physiology of pediatric sports injuries to formulate a treatment plan
- Classify and identify different graft options to reconstruct a pediatric ACL injury in order to generate an appropriate recovery plan
- Analyze and recognize the role of Orthobiologics such as PRP in the Developing Athlete
- Understand and implement treatment options for patellar instability in the growing athlete
- Produce a workup and plan for the developing athlete with lower back pain
FACULTY/AGENDA –
Charles A. Popkin, MD
Pediatric ACL Reconstruction: What you need to know in 2018
Elan L. Goldwaser, DO
Concussion in the Developing Mind: Pearls for concussion management in kids under 12
Lauren H. Redler, MD
Patellar Instability in the Developing Athlete
Benjamin D. Roye, MD, MPH
Back Pain in the Developing Athlete: When should you be concerned?
Christopher S. Ahmad, MD
The Tommy John Epidemic in Youth Throwers: How can we stop it?
This course is free to all participants.
Most players and parents are aware of the term “Little Leaguer’s Elbow,” but may not fully understand what it truly is. Little Leaguer’s Elbow was first coined in 1960 to describe an injury caused by the repetitive throwing motions in children. Technically, it’s an inflammation of the growth plate in the part of the bone called the medial epicondyle. The medial epicondyle is the palpable bump or knob on the inside of our elbow. Little Leaguer’s Shoulder is an inflammation of the growth plate of the shoulder called the proximal humeral physis which is in the bone called the humerus. Inflammation causes a widening of the growth plate which causes the pain players feel while throwing. In most cases, only an x-ray is needed to diagnosis Little Leaguer’s Elbow or Shoulder.
To reverse these epidemic trends our goal is to start changing the culture at the youth levels before bad habits develop, similar to how we educate children on the dangers of smoking. In our office, we’re seeing younger and younger players walk through the door at an alarming rate. We hope that by educating younger athletes, they won’t wind up in our office when they’re older.
It was first reported in 1903 by Mayo Robson that the ACL could be surgically repaired and patients could remain hopeful that they’d have a good outcome. Over a century later, surgeons are able to perform 3 different types of surgery to help a patient with an injured ACL: primary repair, repair with augmentation, and reconstruction. Typically, after a reconstruction, athletes return to sport-specific activity around 6 months post-operatively with full participation on the horizon. Complete, unrestricted return to play may take up to a year. After a repair, return-to-play is nearly half that of a reconstruction!
Exercises to avoid include: dips, chest flyes, lat pull-downs behind the neck, heavy-weight overhead shoulder presses and wide-grip bench presses. Patients should also avoid allowing the shoulders to be stretched to the extreme end range of motions. While these exercises are discouraged, there are variations and other exercises that can be substituted. Variations include: lat pull-downs with the hands in front of the body, using a medium grip for chest press and lat pull-downs, and using dumbbells for bench pressing. Substitutions include: the Thrower’s Ten exercises (internal/external rotation with TheraBands) and lying light dumbbell exercises such as Y’s, T’s, and A’s. 
While some exercises should be avoided, many should be done regularly. The 
of motion and needs to be decreased. If swelling is not diminished before surgery, the outcome will not be favorable for the patient. By doing prehab exercises, icing, and taking anti-inflammatory medications, swelling can be decreased. Many athletes have heard of the GameReady unit. This unit combines both ice and compression through a sleeve that surrounds the knee. Another unit similar to the GameReady is the CryoCuff which operates in a similar manner. These units are highly recommended in both the prehab and rehab phases. They can be discussed with our staff in the office. 
Once improvements are made, the patient is ready for surgery. The prehab process varies for each patient with the ideal time from injury to surgery being 2 weeks. Timelines are not set in stone so while some patients are in the average, some may be quicker and others may be longer. Another factor is severity of injury. Many ACL tears happen in addition to other injuries within the knee such as medial collateral ligament (MCL) tears and meniscus tears. These other injuries need to be taken into account for timing of surgery as well. The more effort put into prehab, the quicker surgery can be scheduled. For many athletes, timing is of the essence and getting ready for the upcoming season will take a lot of work. The hard work doesn’t stop on the day of surgery, athletes will need to keep their work ethic for the months following surgery to ensure staying healthy once they return to the athletic fields.