Surgeons disturbed at growing number of serious knee injuries in kids
Adelaide medicos describe the number of young people suffering serious knee injuries as “disturbing” and say it’s time grassroots sports organisations and schools step up to tackle the problem.
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Each time any one of Matt Hutchinson’s four kids take to the sports field his heart in his mouth — and for good reason.
The Adelaide dad is one of the state’s leading paediatric orthopaedic surgeons and he’s seeing more children in need of knee reconstructions than ever before.
In the past three years, the number of young patients — aged between eight and 15 — he has performed surgery on has grown by 54 per cent with more than 100 patients now travelling each year from interstate to be treated at his Sportsmed clinic.
The trend at his Stepney practice is reflected globally with estimates of increases in anterior cruciate ligament (ACL) injuries in children ranging from 75 to 100 per cent in the past decade with the risk of an ACL injury up to six times as high for girls than boys.
“It does make me feel nervous when my own kids are out there playing sport … an ACL injury can be devastating both for a child and their family and can, for the short-term, put a child’s sporting dreams on hold,” he said.
Veteran knee surgeon and colleague Greg Keene describes increasing rates of ACL injuries in young people as “disturbing” and believes better ACL injury prevention programs are needed at grassroots levels, including schools and community sporting clubs.
Improved diagnosis, the professionalism of children’s sport as well as the large volume of sport being played by some kids, leading to fatigue and making them more prone to injury, are offered as explanations as to why ACL injuries in young people are on the rise.
“Australia is a sport-obsessive place, so, in some ways it is a numbers game — the more people who are playing sport, the more chance of injuries,” Dr Hutchinson said.
“With the sub-specialisation of children’s sport it is commonplace these days for children to be playing sport six or seven days a week, we are seeing kids who don’t take a day off.”
On the flip side, screens and a more sedentary way of life is meaning many kids aren’t engaging in free play as they once did, meaning they are losing some of what Dr Hutchinson refers to as “important milestone strengths”.
Some also point to the playing surfaces kids play on as being problematic.
Dr Hutchinson says treating ACL injuries in children has evolved dramatically over the past 10 to 15 years with MRI technology now allowing a definitive diagnosis and Adelaide surgeons embracing world-best practice to treat the injury, including transplanting a tendon from a parent into a child.
“ACL injuries can happen at any age, I have treated children as young as eight and nine for a ruptured ACL,” he said.
“There was a time we’d avoid doing an ACL reconstruction on a young patient, deeming it too risky for the child’s growth … so basically the child would have to wait and not do sport or anything too active for a few years until they’d stopped growing.
“(The issue with this approach is) a child is at very high risk of reinjuring their knee through incidental free play if it isn’t fixed so the focus now is on what we refer to as growth-plate friendly surgery.”
While tendons from different parts of the body can be used in the reconstruction of an adult’s ACL, options are more restricted for children with hamstring tendons favoured.
“The issue we face with very young children is that they have very small hamstrings, so if you take that child’s hamstring to make a new ACL, you are giving them a very thin graft … as much as the ACL will elongate to accommodate growth, it won’t get bigger in diameter, meaning they’ll still have a child-sized ACL as an adult, increasing their risk of further injury,” Dr Hutchinson said.
“This is where taking a hamstring from a parent — usually Dad, because males tend to have less elasticity in their collagen than females — becomes an option.”
“(But) what we do know is that at any age if you have an ACL injury, even if you have the best surgery in the world and everything goes well, later in life you are at a greater risk of arthritis,” Dr Hutchinson says.
Dr Keene agrees prevention is the best cure.
“Sport in Australia is very sophisticated and we take it pretty seriously as a nation and we always have, we need to take injury prevention just as seriously,” he said.
“ACL prevention programs have been used for a long time in parts of Europe in professional soccer and a lot of the programs and specific exercises are now used by (elite) teams here in Australia … if you can prevent one or two cruciate injuries a year, you are going to save a few careers and save your club a lot of dollars, because you lose a player for a year when you bust an ACL.
“I think progressively, (community) clubs are also starting to see the merits in those programs.
“Of course there are certain collisions that will happen in sport that it doesn’t matter how many exercises you’ve done before going out onto the ground, you’re still going to bust your cruciate.”
Sportsmed physiotherapist Rebecca Mauger agrees coaches are becoming more aware of the benefits of preventive measures and says more clubs are embracing sports training education.
“There is a lot of evidence around the benefits of neuromuscular control exercises as a way to reduce injury … a combination of these types of (landing, jumping and pivoting) drills at the beginning of each training and game as part of the warm up is really helpful in preventing injury,” she said.
Ms Maugers says free-to-access programs such as the AFL’s FootyFirst and Netball Australia’s The Knee Program are great resources for any sporting club or code.
“There is some quite good evidence to show that when neuromuscular training has been implemented for a number of years, there is a reduction in injuries such as ACL and soft tissues,” she said.
Greater awareness is something mum-of-three Brigid Piro is also pushing for, lobbying for injury prevention education programs to be rolled out across the state.
Her AFL-loving son Olly has been plagued by injury over the past four years, since first rupturing his ACL as a 12-year-old, sidelined for much of the past two years, a time she describes as both heartbreaking and an “emotional rollercoaster” for her family.
While his is an extreme case, he hopes planned new surgery — it will be the seventh in four years — will allow him to run out with his Rostrevor College school mates next season.
“I am concentrating on continuing my next stage of rehab and praying for a good run from here,” he said.
In regional SA, Mitchell Evans who turns 16 today, too, is coming to terms with being sidelined for 12 months after undergoing a right knee ACL reconstruction early this month — his beloved Cougars basketball team took out the premiership during the week.
Mum Carolyn says she is “disappointed” in herself for initially overlooking the seriousness of her son’s injury, allowing him to continue to play for months after sustaining it.
“He came down awkwardly on his ankle and later said his knee ached a bit — the pain came and went — and we just strapped it and told him to be careful … it was only after it swelled up after a game we thought, ‘something is wrong here’ and took him for a MRI,” she said.
“To be honest, I had associated ACL injuries with footy before this.”
SA Sports Minister Corey Wingard says he is “open to hearing from the local community about prevention and awareness measures”.
How to help your child
The emotional toll of a significant sporting injury on a young sportsperson can be immense, says Adelaide-based sports psychologist Geof Boylan-Marsland.
“We often see a kind of grief and loss reaction, there is a lot of emotion, a lot of anger, a lot of disappointment … for many of these young athletes it is a massive disruption to what they were looking to do, their world collapses around them, it just kind of shatters them,” he said.
“It is going to be a bit of an emotional roller coaster, it is about offering support and love. You can’t fix it.
“(But) what you can do is get them really focused around the rehab process, get them to reset their goals to be more around rehab … what we want them to do is take the same passion they have for their sport into the rehab process.”
He suggests maintaining connection with teammates, by attending training and games and taking on off-field leadership and support roles where possible. “Sport for kids is as much about the social as it is many other things … if you take away that social network, there is an added sense of loss,” he said.