By Boyd W. Haynes III, MD
I think I’m qualified to speak for the entire human race when I say, “Hallelujah! It seems things are slowly returning to normal after COVID-19!”
With all the excitement and celebrations going on, I want to remind everyone involved in youth sports to stop, take a breath, and remember a few of the basics that have kept our kids safe in sports throughout the years. Top of mind on that list are ACL Safety Protocols for Youth and Adolescent Athletes, which include prevention (first and foremost), then treatment and rehabilitation when injuries do occur.
ACL injury prevention should always be our number one goal. A program with a multimodal approach that includes rigorous stretching, a variety of exercises, neuromuscular training, verbal feedback from coaches and memory cues to keep the knee aligned – knee over the toe, and the knee from caving inward, are most effective in preventing injuries. Of course, debate exists over which ages are appropriate for which protocols and how much neuromuscular training should be performed at each age. However, I think it should be emphasized that early childhood training establishes good safety hygiene, which paves the way for success throughout an athlete’s life.
Historically, when an ACL injury did occur in a youth, treatment, aka surgical repair/reconstruction, was delayed until skeletal maturity was reached. However, we learned that young athletes whose knees were braced until mature and ready for surgery also experienced meniscal, chondral and degenerative changes to the knee, which wasn’t an acceptable outcome. That predicated the development of surgical techniques, which allowed us to spare or “respect” the growth plates using soft tissue grafts for pre-pubescents and adolescents with growth remaining (Tanner scale 1-3). For an adolescent with closed or closing physes (Tanner scale 4-5), we perform an adult transphyseal ACL reconstruction.
Rehabilitation after ACL reconstruction is key to having the young athlete return to the sport that he or she loves in great condition and ready to play. However, there isn’t a great deal of good quality data on rehabbing children and adolescents from ACL reconstruction. Supervision and a planned regimen of activities designed to prevent boredom are a must. If the physical therapist is experienced in working with younger patients, all the better. Functional milestones need to be achieved and should focus on building strength and stability at first. Running and plyometrics can be added at three months, with sport-specific exercises added at six months.
Before a young athlete is allowed to return to the field, a variety of tests should be performed to ascertain his or her readiness. The LSI (Limb Symmetry Index), objective measurements of strength, the ratio of quadricep to hamstring strength, hop tests, balance tests, etc., should be performed. If the athlete is deemed ready, it may be recommended they wear a brace during sports, as ACL re-injury is always a concern for these patients.
Dr. Haynes is a Sports Medicine fellowship-trained orthopaedic surgeon who has been with OSC since 1992. osc-ortho.com