Parents who encourage their child’s high-level, year-round participation in a specific sport – perhaps with dreams of a professional career or college scholarship – need to consider the potential long-term harm. Studies have shown that childhood sports injuries can place the child on the road to future osteoarthritis, or OA.

ACL and Meniscus Tears on the Rise

Physicians at one Philadelphia hospital found a significant increase in certain knee injuries in young athletes in the past decade. They looked at tears of the anterior cruciate ligament, or ACL, and the meniscus from 1999 to 2011 in athletes younger than 18. The increase in ACL and meniscus tears was more than four times higher in the last three years of the study compared to the first three years, says lead author J. Todd Lawrence, MD, PhD, an orthopaedic surgeon and pediatric sports medicine specialist at Children’s Hospital of Philadelphia. He presented the results of the study in October at the annual conference of the American Academy of Pediatrics.  

Although the exact cause of this growth in sports-related injuries is unclear, he says, “The high-level, year-round, young-age specialized sports competition has been cited as one cause for the increase.”

Other research also has linked youth sports to OA.

In a recent issue of the British Journal of Sports Medicine, for example, researchers noted that approximately 27 million children and adolescents in the United States participate regularly in team sports, with millions more involved in individual sports. The study authors reported that the trend is increased participation, increased duration and intensity of training, earlier specialization and year-round training. These sports are linked to OA, the authors wrote.

A Swedish study, published in the American Journal of Sports Medicine in 2007, found that 10 to 20 years after an ACL or meniscus tear, 50 percent of patients have OA with attendant disability and pain.

Dr. Lawrence believes his study and others suggest that parents, players and their coaches need to discuss options. For example, neuromuscular training would help players learn techniques like a safe way to land from a jump. With practice, athletes can automatically position their bodies to land properly.

William Levine, MD, director of sports medicine in the New York Presbyterian/Columbia University Medical Center Department of Orthopaedic Surgery and chair of the steering committee for STOP Sports Injuries, a national campaign urging awareness of sports overuse and traumatic injuries in children, also sees childhood sports injuries as a problem. “When I was a kid, there were seasons for sports,” he says. “You were very intense during that time, but then you went on to your next sport and your body parts got a chance to recover [from the previous sport],” he says.

“I think we live in a culture where there is super specialization. It filters down to the youth sports level and parents. This is especially true with the elite kids. They get on a school team, then all-star and traveling teams. They aren’t letting their shoulders, elbows, hips, knees and ankles recover enough.”

Some parents encourage this year-round competition, Dr. Levine adds, due to their “misconception that their child is going to make it to the professional level, or perhaps get an athletic scholarship for college.”

Struan Coleman, MD, PhD, a sports medicine orthopaedic surgeon at the Hospital for Special Surgery in New York, sees hip injuries in young athletes that set the stage for OA. He said these can present as strains and sprains of the soft tissues around the hip and pelvis.  

“As hip specialists, we are becoming increasingly aware of developmental abnormalities of the hip, which can lead to more serious injuries, especially for those children who are participating in sports at a high level and year-round – specifically, femoroacetabular impingement, or FAI, which is defined as an incompatibility of the ball and socket of the hip, resulting in a loss of internal rotation of the joint. There is increasing evidence that this loss of motion makes an athlete more susceptible to injuries of the hip and of the surrounding soft tissues in the short term, and to cartilage damage and arthritis in the long term,” he notes.

Give it a Rest

Dr. Lawrence recommends at least three months of down time after an intense season, and Dr. Levine says year-round athletes should give a body part at least three weeks of rest. He tells parents that even Yankees pitcher Mariano Rivera has an off-season. “That helps, sometimes, to frame the topic – but not always,” he says.

“Strengthening is a real issue because a lot of these kids are young and they just don’t have muscular development yet,” Dr. Levine says. “One of the reasons the ACL can tear so easily is because of muscular imbalance and weakness. During down time, the young athlete could try cross training to give the main body part some rest.”