Pediatric and Adolescent Sports Medicine Center of New YorkSamantha overcame her injury and went back to sports
The Center for Pediatric and Adolescent Sports Medicine at the Children's Hospital of New York Presbyterian offers comprehensive care to children and teens that have an injury or condition affecting sports performance, exercise or activity. The orthopaedic surgeons at our Center have the expertise, experience and qualifications to treat this unique population. In growing children, injuries to bones, muscles, ligaments, tendons and joints are often quite different from conditions more commonly seen with older patients. Special training and experience in pediatric sports medicine allows our specialists to appropriately treat the unique sports related medical needs of children and teens. Pediatric and Adolescent Sports Medicine Specialist
Dr. Christopher S. Ahmad is an Assistant Attending Orthopaedic Surgeon in the Sports Medicine and Shoulder Service at the New York Orthopaedic Hospital, and an Assistant Professor of Orthopaedic Surgery at the College of Physicians and Surgeons of Columbia University. His training in sports medicine at the Kerlan-Jobe Orthopaedic Clinic has included physician team coverage for many professional teams and universities. Common Pediatric Sports Injuries
Anterior Cruciate Ligament Injury What is the Anterior Cruciate Ligament? The Anterior Cruciate Ligament (ACL) is one of the most important of 4 strong ligaments in the knee connecting the lower leg bone (the tibia) to the thigh bone (the femur). The function of the ACL is to provide stability to the knee and limit its rotational movement. If the ACL is overstretched, the ligament will tear. This is usually a result of sudden stopping or twisting of the knee. An ACL can also tear if a large force is applied to the front of the knee. Patients experiencing a torn ACL will often describe a ?pop? at the time of the injury. Some patients, however, may not feel the tear at the time of the injury. Physical Examination The physical examination is extremely important in evaluating for an ACL tear. Children and teens cannot always express what is bothering them. They cannot always answer medical questions and be patient and helpful during a medical examination. The pediatric and adolescent sports medicine specialists at our Center know how to examine and treat the patients in a way that makes them relaxed and cooperative. As in almost all acute injuries, loss of motion and instability is an important finding. The Lachman test is performed with the knee bent 30 degrees. The physician gently pulls on the tibia to check the motion of the forward leg in relation to the lower leg. Under normal conditions, the patient's knee will have less than three mm of forward motion, with a firm stopping felt when no further movement is observed. However, a patient with a torn ACL will have significantly greater forward motion and a soft end feel at the end of the movement. Because the ACL is torn, the patient will experience loss of restraint of the forward movement of the tibia. The same test is performed with the knee flexed to 90 degrees; this is called the anterior drawer test . Diagnostic Imaging Magnetic Resonance Imaging (MRI) helps the physician obtain an excellent image of all parts of the knee. The MRI is not an absolute indicator for a torn ACL, however, it can document damage to the meniscus. The meniscus is composed of cartilage inside the knee, which provides cushioning and is frequently torn at the same time as an ACL tears during injury. Immediately After Injury Immediately after the injury the patient should ice the injury to prevent inflammation and compress areas around the knee to control swelling. Elevation is also key in controlling and reducing swelling . Rehabilitation knee braces are often used early after the injury as well as for postoperative care. The brace plays an important role in putting the joint at rest and protecting it while still allowing appropriate but limited motion. Rehabilitation A rehabilitation program is designed to restore the patient's range of motion and muscle strength. Weight-bearing exercises can only be pursued after the swelling around the knee decreases. Increasing the range of motion of the knees is important in preventing stiffness and muscles tightness. Surgical Treatment Surgical treatment for a torn ACL is not always necessary. Although surgical intervention often leads to complete success, not everyone needs the ligament to return to his or her pre-injury level of function. If the patient is not incredibly physically active, reconstruction is not necessary. Also, ACL reconstruction requires that the patient undergo many months of rehabilitation. This involves both time and commitment and should be strongly considered when making a decision. The ACL has little to no capacity to heal on its own. Therefore it cannot simply be sewn back together; it must be reconstructed. This involves substitution of a new ligament for the damaged one. Skeletal Immaturity Many young patients who injure their ACL are still growing; this requires special consideration. The standard technique of ACL reconstruction requires drilling tunnels in the tibia and femur bones that would cross the normal growth plate (physis) of an actively growing child. Therefore, the ACL reconstruction technique requires modifications that avoid injury to the growth plate. The specialists at our center use physis sparring and respecting techniques to avoid growth disturbances. Graft Choice Typically, a surgeon will take a tendon from somewhere else in the patient's own body. This is called an autograft . There are several choices for autografts including patellar tendon, hamstring tendon, quadriceps tendon, Achilles tendon and anterior tibilias tendon. Surgeons can also use an allograft to reconstruct the ACL. This type of graft is harvested from a cadaver and is advantageous for several reasons. First, the operation takes less time because the harvesting time is removed. Also, the patient's own tissue is not disturbed, therefore leading to a less invasive procedure and less scaring, and easier early recovery. Procedure Reconstruction of an ACL takes about 1 hour. A patient may under go general anesthesia, spinal anesthesia or local anesthetic with sedation. Once the patient is anesthetized, the surgeon will begin the arthroscopic procedure. An arthroscope is a thin microscope that is about the size and shape of a straw. At the end of the arthroscope, there is a miniature video camera and lens that can magnify the image it sees to about 25 to 30 times the original size. This image is sent up to a video screen where the surgeon and his or her team can get a clear and detailed view of the inside of the knee. With the arthroscope and small specialized instruments, the surgeon can reconstruct the ligaments, avoiding large incisions and trauma to surrounding tissues. Before the surgeon begins reconstruction, he or she uses the arthroscope to map out the area being worked on. This allows the surgeon to identify key knee structures and also view any additional damage. The procedure begins with a small tunnel drilled through the tibia and the femur. This hole is drilled in the same positions the original ACL was attached. The graft of choice is then fit into each of these tunnels. The new ACL is then secured with specialized headless screws to hold it in place. Right after Surgery Because of the minimally invasive nature of the current ACL reconstructions technique, ACL surgery is an outpatient procedure. Although crutches are given to the patient to assist in necessary mobility, it is essential that the patient rest and elevate their new, especially in the first few days. This minimizes swelling and helps the body to reestablish all pre-surgical functioning. Physical Therapy and RehabilitationRehabilitation is essential to a successful recovery and begins soon after surgery. The ultimate goal in rehabilitation is to return to a condition where the knee provides dynamic stability, while still maintaining a full range of motion. Therefore, recovery progress is judged by the patient's perception of how stable the knee feels. Often, a surgeon will prescribe a brace for the patient to be used during the rehabilitation period. The rehabilitation brace is adjustable; it can be locked in a straight position or set to allow a certain amount of motion. The brace us normally taken off while the patient is exercising. Usually, a therapy program will begin with range-of-motion and resistive exercises. Then, when the patient is able, exercise incorporating power, flexibility, endurance and coordination is added. At last, the patients will develop speed and agility through sport specific exercises. Most patients begin light activity, such as biking or rowing, about 4 weeks after surgery. Running starts at 6- 8 weeks and competitive activity is delayed until 4 to 6 months after surgery.
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Dr. Christopher S. Ahmad, head of the Center for Pediatric and Adolescent Sport Medicine of the children's Hospital of New York Presbyterian, specializes in treating youth-specific, sports-related probblems in children and teens.
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