A Look at Recent Pediatric Research
In honor of Child Health Day, we’re taking a look at recent pediatric research done at Hospital for Special Surgery’s Lerner Children’s Pavilion. Dr. Daniel Green, Pediatric Orthopedic Surgeon, shares some of his recent work in the pediatric research field:
Two alarming spikes in child and adolescent injuries have created the need for new research in the pediatrics space: increases in pediatric ACL tears and sports-related injuries to the spine.
Here at Hospital for Special Surgery, we’ve seen a mini-epidemic of pediatric knee injuries. We’re seeing children and adolescents patients weekly – some even as young as 6-years-old. While these injuries used to only be present in adults, they are becoming more common in children due to increased physical activity (particularly specializing in one sport at a young age). In the U.S., 35 million children between the ages of 5 and 18 are participating in organized sports. Girls are at higher risks for a variety of reasons including difference in anatomy, hormones and other factors. There appears to be increased incidents and increased diagnosis, which prompted the need for us to pioneer new procedures for treatment. Along with Dr. Frank Cordasco, Orthopedic Surgeon, we have modified and developed procedures to surgically reconstruct a new ACL while minimizing any potential injury to the adjacent growth plates. Previous procedures allowed for the ACL to be repaired in a way that was not anatomically correct – it was a temporary fix, which did not always guarantee stability.
Sports-related injuries to the spine are also increasing in children and adolescents who participate in organized sports. Back pain in the young athlete can be very significant and may even be secondary to an overuse fracture of the lumbar spine, called spondylolysis.
In new research to be published in October, we evaluated 137 cases of symptomatic spondylolysis and found the top sports in the New York Metropolitan area associated with teenage athletes with this type of stress fracture are: soccer (19.3%), basketball (17.2%), lacrosse (9.4%) followed by baseball, tennis and football. Most Doctors and previous textbooks have thought that gymnastics and football put an athlete at high risk for spondylolysis – but rarely associate lacrosse and baseball with the stress fractures. Our results found that spondylolysis may not be unique to any one sport or movement pattern, but can occur in adolescents who participate in a variety of sports. What’s interesting with our sample group was that a lot of athletes played both lacrosse and baseball. As stress fractures usually do not come from an isolated event, it is difficult to pinpoint exactly where the injury originates; it is normally due to stress reaction and/or repetitive use injury to the lumbar spine. 95% of fractured lumbar spine cases can be treated conservatively with a brace, rest, and physical therapy.
We emphasize consideration of spondylolysis in young athletes if they complain of low back pain. Parents, young athletes, coaches and school nurses should be counseled about the possibility of stress fractures as a cause of lumbar back pain.
To read more about research at HSS, including pediatrics, check out the latest issue of Discovery to Recovery!
Dr. Daniel Green is a pediatric orthopedic surgeon at Hospital for Special Surgery and director of the Pediatric Sports Program for the Division of Pediatric Orthopaedic Surgery. He specializes in pediatric knee surgery, scoliosis and trauma.