Repairing Young Knees (JOCD, ACL Tears, et al)

[Guest guest]

Repairing Young Knees

http://abclocal.go.com/wjrt/story?section=news/health & id=6902865

(WJRT) -- (07/07/09)-- With state titles and college scholarships on the

line, more kids are pushing themselves and their bodies to the limit. But

all that practice and training can take a toll on young bodies, especially

knees.

HealthFirst reporter Toldo tell us that doctors are trying new ways

to save their knees now so they can continue to play later.

green knows it takes a lot of foot work and hard work to become a top

player.

" I'm just kind of good at it, so it just kind of stuck, " knee patient

Green said.

But his dreams of college soccer were almost wiped out. tore his ACL.

Traditional surgeries would damage the growth plates. Pediatric orthopedic

surgeon Wall developed a tendon reconstruction at Cincinnati Children's

Hospital to keep in the game.

Dr. Wall used 's hamstring tendon to create a new ACL. The new

procedure avoids any contact with his growth plate.

" In an adult, the tunnel goes up this way and crosses through the growth

plate. This way, the tunnel goes horizontally across his knee and the tunnel

is drilled beneath the growth plate, so it doesn't touch the growth plate or

doesn't cross the growth plate, " Wall explained.

Sorger suffers from a less common, but just as painful, problem --

juvenile osteochondritis dissecans or JOCD, which is caused by pressure on

immature bones.

" I couldn't even walk up the steps when I got home, it was hurting that

bad, " Sorger recalled.

Dr. Wall took a bone graft from 's hip and transferred it into his

knees with this small tube. " That bone graft supplies stem cells to grow

new bone and it supplies bone cells to grow new bone. This is the one chance

we have to actually cure a problem and get the knee back to normal, " said

Wall.

BACKGROUND: More and more, kids are overexerting their bodies in competitive

sports. According to the National Safe Kids Campaign, more than 3.5 million

children ages 14 and under receive medical treatment for sports injuries

every year. Most of these injuries occur during unorganized or informal

sports activities, with 30 percent of parents reporting their child has been

injured while playing a team sport. Half of them say their child has been

injured more than once.

Most organized sports-related injuries occur during practices rather than

games. Most sports injuries in kids can be attributed to immature bones,

insufficient rest after injury, and poor training or conditioning.

During the teenage years, girls are more likely to suffer sports injuries

than boys. Experts attribute the tendency to increased estrogen -- which

adds fat rather than muscle and makes ligaments lax -- as well as the

less-flexed, more upright running position of girls. In addition, because of

wider hips, girls are more likely to be knock-kneed (Source: New York

Times).

WHAT'S JOCD: Juvenile Osteochondritis Dissecans (JOCD) occurs in young

people when their growth plates haven't closed yet. The condition causes a

piece of bone and the piece of cartilage that covers it to come loose and

float around inside a joint like the knee. JOCD usually affects active

children and young adolescents.

Although it can lead to arthritis, children with the condition normally do

very well long-term. Symptoms including joint " locking, " stiffness and

swelling. Treatment for JOCD usually involves rest and casting, but kids

with chronic JOCD or a large affected area may need surgery (Source:

Children's Memorial Hospital Institute for Sports Medicine). A recent study

in the Journal of the American Academy of Orthopedic Surgeons says with

conservative treatment alone, 50 percent of children with JOCD will heal to

form a normal knee in adulthood.

KIDS AND ACL TEARS: The anterior cruciate ligament (ACL) is one of the

knee's four main ligaments. A sudden, abrupt change in force to the knee can

cause it to tear, and unfortunately, the ligament has virtually no capacity

to heal itself once torn. Because of the ligament's inability to heal,

surgeons repair the tear by substituting a nearby tendon -- such as from the

hamstring -- for the damaged one.

Because this type of surgery involves going through the growth plates of the

leg bone and thigh bone, it can cause growth of the leg to slow. For this

reason, doctors usually recommend a patient wait until they reach near

skeletal maturity to undergo ACL reconstruction surgery.

FOR MORE INFORMATION, PLEASE CONTACT:

Jim Feuer

Cincinnati Children's Hospital Medical Center

(513) 636-4656