Of all of the body parts a young athlete can injure playing sports, a knee injury is one of the most common. That fact is worrisome because many knee injuries in young athletes are serious, often requiring surgery. Here are some of the knee injuries in young athletes orthopaedic surgeons often see.
Osteochondritis dissecans is a disorder of bone most often seen in the medial femoral condyle, or the medial aspect of the femur in the knee joint. It almost always occurs in an adolescent patient. Occasionally an OCD lesion doesn’t cause symptoms until the patient is in his late teens or early 20s.
The bone of the osteochondritis dissecans lesion in that part of the knee dies. If the articular cartilage of the lesion is intact, the athlete might only notice vague swelling or discomfort. If the fragment breaks free within the knee, locking or catching can develop.
Treatment of an OCD lesion depends on stability of the lesion. If the patient hasn’t gone through puberty, and he rests and avoids putting weight on that leg, the lesion has a good chance of healing if the articular cartilage is intact. Surgery to hold the fragment in place or to replace the area of bone and cartilage is often needed in an older adolescent.
Ask Dr. Geier: Osteochondritis dissecans
Ask Dr. Geier: Osteochondritis dissecans in a young athlete
Distal femur fracture
An adult or skeletally mature adolescent often suffers a medial collateral ligament (MCL) injury with a valgus force to the knee. Being hit on the lateral side of the knee is a common mechanism of injury.
In a child, the growth plate can be weaker than the ligament. With this same mechanism of injury, a young athlete might suffer a fracture through the growth plate of the distal femur instead of an MCL injury. A nondisplaced or minimally displaced fracture can be treated with immobilization in a brace, while a significantly displaced fracture often requires surgery.
Tibial tuberosity avulsion
The tibial tuberosity is the bony prominence at the top and front of the tibia where the patellar tendon attaches. An adolescent athlete can partially pull off this bone attachment landing awkwardly from a jump. This injury often occurs in a teenage athlete who plays a jumping sport, like basketball or volleyball.
Treatment depends on the amount of displacement of the tibial tuberosity from the main part of the tibia. If the tuberosity remains in anatomic position or is only minimally displaced, immobilization is usually appropriate to get the fracture to heal. More displaced fractures require surgical reduction and fixation.
Tibial spine avulsion
In terms of knee injuries in young athletes, a variation of an anterior cruciate ligament injury is common as well. Instead of a young athlete suffering a tear through the ligament itself, the ligament pulls its bony attachment – the tibial spine – off of the tibial plateau. If the avulsed tibial spine remains in place, immobilization might successfully heal the injury. If the bony fragment is displaced, arthroscopic surgery to reattach it is often necessary.
This is another knee injury that both adults and young patients can suffer. The meniscus is the shock-absorbing piece of cartilage between the femur and tibia.
A meniscus tear near its attachment to the capsule can occasionally heal on its own due to better blood supply of the meniscus in a child compared to an adult. Many meniscus tears need surgery, though. Fortunately, children with meniscus tears often have repairable tears, meaning that the surgeon can arthroscopically sew the meniscus back together.
Ask Dr. Geier: Meniscus tears in young athletes
Anterior cruciate ligament (ACL) tear
The anterior cruciate ligament (ACL) is a ligament in the center of the knee responsible for front-to-back and rotational stability of the knee. While ACL tears are mostly seen in adults and skeletally mature teenage athletes, the incidence of ACL tears has increased among skeletally immature athletes in recent years.
A young athlete can tear the ACL through a noncontact injury. Examples of noncontact injuries include landing from a jump with the knee extended or planting the foot to change directions. The young athlete will usually feel a pop in the knee. Swelling and inability to bear weight are common.
Treatment for adults usually involves surgery to reconstruct the ACL, and that is becoming the norm for younger patients. Concerns about surgery to reconstruct the ACL still exist due to worries over damage to the growth plates around the knee with surgery. The trend toward surgery even for young athletes has largely resulted from studies showing higher rates of secondary meniscus and articular cartilage damage with nonoperative treatment.
Questions parents often have about ACL tears in their children
These knee injuries in young athletes can all be serious, requiring surgery or at least long periods of time out of activities. An orthopedic surgeon can determine the extent of the injury. With an appropriate treatment plan, the young athlete can hopefully return to sports as soon as possible with no long-term consequences.
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