It is estimated that more than 30 million children in the United States participate in organized sports. Multiple research studies have shown that rates of injuries in children and adolescents, knee injuries in particular, have increased over recent years.
There is no single reason to explain the increased rate of significant knee injuries seen in children and adolescents, but it is likely a combination of factors:
- More children being involved in sports
- Children playing more hours per week and playing harder per hour of participation
- Higher percentage of female sports participants
- Doctors’ improved ability to detect injuries
Overall, boys are more likely to have major sports injuries than girls because they are more likely to participate in sports with the highest injury rates, such as football and wrestling. However, when comparing within a sport, such as injury rate of boys versus girls playing basketball, girls are more likely to have a significant sports injury.
Some injuries, such as ACL tears, occur more frequently in girls than in boys, per hour of sport played. The alignment of bones, the size and strength of the tendons and ligaments, as well as patterns of movement differ between boys and girls, putting girls at higher risk of injury.
Studies have shown that significant injuries are more likely to occur during more intense play, as injuries happen more frequently in games than in practices.
Certain sports are considered riskier for knee injuries than others. Although football and wrestling are highest risk for significant sports injury in general, ACL injuries have been most frequently associated with football, basketball, soccer and skiing.
Part of the reason that knee injury rates appear to be increasing may be related to better methods of examination and diagnosis (such as MRI), and more sophisticated systems to keep track of injuries, such as local, state and national injury registries.
Being aware of the increasing rate of knee injuries in children and adolescents, and understanding what makes them vulnerable is the first step to avoiding future injury.
Steps that may help prevent future injury:
- Pre-seasonal physical exam: Ensure your child is healthy to participate.
- Limit hours of play per week, take some rest: Technique may falter when a player is fatigued. Avoid playing when tired/exhausted as this may place the player at increased risk of injury.
- Stretching: Incorporate a warm-up and cool-down.
- Safe environment: Weather and turf conditions may play a role in injury. Avoiding play when the environment is not right.
- Safe coaching and instruction: Ensure proper technique, and rotate players during practice and games.
- Variety: Participation in different sports and activities gives children the opportunity to cross-train to prevent constant stress to specific muscle groups and ligaments.
- Start prevention programs early: Knee injuries such as ACL tears can happen well before puberty. Programs typically include exercises for stretching, strengthening, balance, and specific drills to encourage landing with hips and knees bent, and avoiding landing in a valgus (knock kneed) position. Children often demonstrate decreased flexibility and core and hip strength during growth spurts resulting in altered body mechanics with sports-specific movements including sprinting, cutting, and jumping, which can lead to an increased risk of injury.
Treatment is dependent on the severity of the knee injury. More severe injuries, such as an ACL tear, may require surgical intervention to ensure a child’s mobility in the future. In addition, there are many knee injuries that may be treated conservatively. Physical therapy may be prescribed by a physician and typically includes:
RICE: Since most injuries are secondary to overuse, immediate rehabilitation usually follows the RICE Principle – Rest, Ice, Compression (if needed) and Elevation. Children are usually taken out of the sport for a period of time to allow the body to heal.
Exercise and Training: Physical therapy focuses on reducing inflammation; improving strength, flexibility and balance; and improving neuromuscular patterning for daily living and sports-specific movements. Exercises may include emphasis on abdominal and gluteal strengthening to improve leg alignment with activities including stepping down from a step, squatting and landing a jump. Children are progressed to higher level balance, proprioception and agility activities to ensure a safe and pain-free return to sport.
Home Exercise Program: This is incorporated throughout therapy and is of prime importance to allow the child to achieve their highest potential of recovery and assist in prevention of future injury.
Dr. Emily Dodwell is a pediatric orthopedic surgeon at Hospital for Special Surgery’s Lerner Children’s Pavilion.