Teens and Sports Participation
According to the National Federation of State High Schools Association, more than 7.5 million students participate in school sports programs (4.4 million boys and roughly 3.1 million girls). Among boys, the most popular sports programs are football, basketball, track and field, baseball and soccer. For girls, the most popular sports are basketball, track and field, volleyball, softball and soccer.

The American Academy of Pediatrics recommends children be given the opportunity to take part in a variety of sports and physical activities. Participation in sports can burn off extra calories, strengthen muscles and improve flexibility and cardiovascular endurance. It also teaches teens cooperation and team-building skills and improves self-esteem.

Terrible Sports Injuries: Osteochondritis Dissecans
The American Academy of Orthopaedic Surgeons reports Americans made 19.4 million visits to physicians’ offices in 2003 for knee injuries. One kind of knee injury is osteochondritis dissecans (OCD). It occurs when an area of bone in the joint is damaged, disrupting the blood supply to the region. The affected area of bone dies. Sometimes the bone fragment remains in the place. In other cases, it can break free and “float” inside the knee joint. OCD is most commonly seen in the knee, but can occur in the elbow, hip or ankle.

In the initial stages, OCD can cause intense pain that increases with activity, swelling and a clicking or popping sensation when bending the knee. The athlete may be unable to fully straighten the knee or bend it through a full range of motion. The knee may feel stiff after rest.

OCD appears to be more common in sports using certain types of high-impact actions (like jumping, cutting or pivoting). Researchers believe repetitive minor trauma to the knee causes the damage that leads to OCD. Shannon Safier, M.D., Pediatric Orthopaedist with St. Christopher’s Hospital for Children in Philadelphia, says many students are playing sports year-round. So their joints don’t get a rest and risk for OCD may increase.

Treating OCD
Safier says if the bone injury is detected early on (before the blood supply is cut off), conservative treatment is often effective. Patients are advised to rest and immobilize the joint, take non-steroidal anti-inflammatory medications and avoid playing sports for at least six to eight weeks, to give time for the injured bone to heal. Physical therapy may also be recommended to maintain/improve range of motion in the joint.

If the blood supply is cut off, but the bone and cartilage are still intact, doctors may be able to drill holes in the lesion. The body responds to this intentional injury by growing new blood vessel, restoring the blood supply to the affected area.

If the area of bone dies, the affected area can no longer heal on its own. So the only option is surgery. In many cases the surgery can be done arthroscopically, using small incisions and tiny surgical instruments. Safier explains the piece of bone is placed back into position and then secured with bioabsorbable screws.

Total recovery time is about three to four months. Patients must keep weight off the affected leg for one month. During the second month, walking is permitted, but activities are still restricted. Physical therapy begins after the end of the second month and takes four to sex weeks. After that, most students are able to go back to playing sports and other activities.

Safier says parents should be alert for any sudden or unusual signs that may indicate a knee injury in a student athlete. Often, X-rays and MRI scans are needed to detect OCD.

AUDIENCE INQUIRY
For general information on orthopedic sports injuries:
American Academy of Orthopaedic Surgeons, http://orthoinfo.aaos.org

For information on sports and exercise guidelines:
American Council on Exercise, http://www.acefitness.org
Centers for Disease Control and Prevention, http://www.cdc.gov/physicalactivity

BIBLIOGRAPHY
Donaldson, L., and E. Wojtys, “Extraarticular Drilling for Stable Osteochondritis Dissecans in the Skeletally Immature Knee,” Journal of Pediatric Orthopaedics, December 2008, Vol. 28, No. 8, pp. 831-835.

Kijowski, Richard, M.D., et al., “Juvenile Versus Adult Osteochondritis Dissecans of the Knee,” Radiology, August 2008, Vol. 248, No. 2, pp. 571-578.

Marshall, K., et al., “Osteochondral Lesions of the Humeral Trochlea in the Young Athlete,” Skeletal Radiology, May 2009, Vol. 38, No. 5, pp. 479-491.

Michael, J., et al., “Long-term Results after Operative Treatment of Osteochondritis Dissecans of the Knee Joint,” International Orthopaedics, April 2008, Vol. 32, No. 2, pp. 217-221.

Mihara, K., et al., “Nonoperative Treatment for Osteochondritis Dissecans of the Capitellum,” American Journal of Sports Medicine, February 2009, Vol. 37, No. 2, pp. 298-304.

Wall, E., et al., “The Healing Potential of Stable Juvenile Osteochondritis Dissecans Knee Lesions,” Journal of Bone and Joint Surgery, American Volume, December 2008, Vol. 90, No. 12, pp. 2655-2664.