The importance of age-appropriate care of pediatric and adolescent athlete

The following issue of Annals of Joint is a detailed examination of the pediatric and adolescent patient in sport. We have designed the articles to address a wide range of topics related to this theme, including current epidemiological information about pediatric sport participation, acute on-field injury management, medical and metabolic issues, and in-depth reviews of injuries to specific anatomic areas.

An estimated 30 million American youths participate in organized athletics, and this number is steadily increasing, in part driven by public health initiatives that promote sports activity for physical and psychological benefit. Participation in sports has been linked to improved self-esteem, reduced childhood obesity and decreased alcohol and drug use. However, sports are also one of the leading causes of injury in adolescents. There is a wide array of injuries that can occur during play, and previous studies have linked certain sports to an increased risk of specific injuries. In addition, the frequency of surgery for these injuries has increased in a pattern commensurate with the rise in sports participation.

Injuries in youth athletes present both as acute injuries from falls or on-field trauma and chronic, over-use injuries due to excess participation, improper technique and/or the unique anatomy and biology of the physis. Shoulder and elbow injuries include those specific to the throwing athlete, including traction injuries (physeal stress fractures and apophysitis), impingement syndromes, and osteochondritis dissecans lesions. Knee injuries range from acute anterior cruciate ligament (ACL) ruptures and meniscal tears, particularly with sports involving jumping, cutting, or pivoting, to more subacute chondral lesions or pain syndromes. In the spine, young athletes can prevent with pathology of the neurologic structures (i.e., stingers, neuropraxias), ligamentous support (i.e., strains), or bony vertebral support (i.e., fractures, spondylolisthesis).

Young athletes are also victims of similar metabolic syndromes and acute illnesses that can affect adults. The female athlete triad, for example, can have significant ramifications on ability to achieve peak mass, delayed or interrupted menarche and other endocrine abnormalities. On-field management of acute injuries or other medical conditions, such as sudden cardiac death or hyperthermia, are critically important. Concussions and their long-term sequelae are receiving increasing attention in the public sphere. Proper acute diagnosis and return to play management is absolutely necessarily in the current climate.

With an ever-growing level of sport participation among pediatric and adolescent patients, there is also an increasing focus on injury prevention and rehabilitation. For example, research continues into pitch counts and limitations in the pediatric throwing athletes. Accurate diagnosis of acute concussions and stratification to return to play algorithms continues to be investigated and improved.

Awareness of injuries and knowledge of their diagnosis and treatments is paramount for the practicing orthopaedic surgeon. We hope that this issue of the journal focusing specifically on the pediatric athlete can aid in making all athletics as safe, and a beneficial, as possible for all pediatric and adolescent participants.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Joint for the series “Orthopaedic Sports Injuries in Youth”. The article did not undergo external peer review.

Conflict of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aoj.2018.05.06). The series “Orthopaedic Sports Injuries in Youth” was commissioned by the editorial office without any funding or sponsorship. DCP served as the unpaid Guest Editor of the series. ACC served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Joint from Jun 2016 to May 2018. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Alexis Chiang Colvin

Diana C. Patterson