Encouraging our youth to participate in athletics instills a sense of self-confidence, comradery, and communication at a young age, however, many are concerned about injuries that can accompany playing sports. Unfortunately, injuries are sometimes unavoidable, however, there are steps that can be taken to prevent injury occurrence and properly evaluate and manage once an injury has occurred.

Overuse injuries occur in athletes of all ages, however, they are most common in youth just getting into athletics. Factors that typically contribute to overuse injuries are sudden increase in intensity, duration, and volume of physical activity, poor sport-specific training/conditioning, and improper training techniques.

Build intensity, duration, and volume gradually. Whether participating in team or individual workouts, it is crucial to follow a proper progression that is tailored to the athlete. Strength and conditioning coaches or athletic trainers are an excellent resource when determining a plan of progression. If you do not have access to either of these, a good rule of thumb is to first increase repetitions, followed by sets, and finally weight over the course of several weeks. The knees face wear and tear from everyday activities; following these steps allows the body to adjust to a higher demand without risking overuse.

Ensure training is sport-specific. Both conditioning and practice should mirror the sport itself. For example, a football player running agility drills conditions the body for quick maneuvers that stress ligaments and musculature within the knee that are necessary in a game-situation. All drills, training, and practices should be used to physically prepare the athlete for competition. 

Utilize proper techniques. It is important to perform exercises that are sport-specific, but performing them correctly is even more crucial. A large portion of athlete injuries occur in the weight room or at practice due to improper form or inadequate warm-up. Whether a coach or athletic trainer, an experienced individual should always be present during workouts and practice to correct improper form. Warm-ups are commonly overlooked, however, they are a major component in knee injury prevention. Stretching and doing light cardio, such as jogging or biking, helps acclimate the body for more intense physical activity. 

If an injury has occurred, there are several steps that need to be taken based on the severity of the event. 

Overuse injuries can often be treated at home with rest, ice, compression, and elevation. Taking time off from the sport allows the body a chance to heal itself; the amount of time needed is dependent on the injury and symptoms. Ice will help reduce any pain and swelling; you may ice for 20 minutes, 3-4 times per day. Be sure to monitor the skin for any irritation the ice may cause. Compression also helps combat swelling; use a bandage to apply pressure to the knee. To ensure the bandage is not too tight, check capillary refill by squeezing the nail bed of the toes and ensuring blood flow returns to the area. Finally, elevate the leg while resting to reduce inflammation. 

If a sudden, acute injury such as a fracture, dislocation, or ligament tear has occurred, the athlete should be seen by a physician immediately. After acute care is provided, a referral to an orthopaedic surgeon may be necessary.

An orthopaedic surgeon is the best resource to help plan a course of action after a knee injury. Whether or not surgery is necessary, an orthopaedic surgeon can offer alternative options, manage pain, and provide referrals to physical therapy if needed. Don’t be afraid to utilize resources! On our webpage, we have made rehab exercises, eBooks, appointment requests, and much more available. 

Dr. Christopher O'Grady of North Florida Bone & Joint Specialists is specialized in performing knee and shoulder surgeries. As an Arthroscopy Association of North America instructor, he focuses on cutting-edge, advanced surgical techniques, ensuring he's up to date on the latest techniques. Every patient is offered the highest level of care, whether surgical or non-surgical. Dr. O'Grady and his entire staff work to treat every patient with compassion and concern. Set up a consultation with Dr. O'Grady today to discuss your options.

Patel, Dilip R.,Villalobos, Ana. “Evaluation and Management of Knee Pain in Young Athletes: Overuse Injuries of the Knee.” Translational Pediatrics 6.3 (2017): 190–198. PMC. 

Knee Pain in Young Athletes

Knee Pain in Young Athletes: How to Prevent, Evaluate, and Manage

Estimations indicate that each year in the United States 200,000 ACL tears occur, with a majority of those tears requiring reconstructive surgery. Furthermore, about half of those ACL tears are accompanied by a torn meniscus, which is the cartilage that acts as the shock absorber between the tibia (shin bone) and the femur (thigh bone), and/or injuries to other ligaments. Common symptoms of a torn ACL include knee instability, swelling, and pain.

The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL) are located inside the knee joint. The ACL and PCL form an ‘X’ behind the kneecap (patella), with the ACL resting in front of the PCL. Both of these ligaments are responsible for controlling the back and forth motion of the knee joint; however, the Anterior Cruciate Ligament is responsible for stabilizing the knee. In addition, the ACL is responsible for preventing the tibia from sliding forward on the femur. The ACL provides the knee with stability while an individual pivots or twists. This ligament is critical because without it, performing any kind of rotational activity is extremely difficult, particularly when it comes to playing sports like soccer and basketball.

What Does It Mean When Someone Has a Torn ACL?

An ACL tear is among the most common knee injury reported. This injury involves tearing of the fibers making up the ACL. Sometimes, the entire Anterior Cruciate Ligament is torn; whereas, other times it is just partially torn.

What Causes the Anterior Cruciate Ligament to Tear?

The ACL may tear due to any movement that results in a twisting action of the knee (i.e., sidestepping, pivoting or cutting/changing directions combined with deceleration). Activities that may lead to twisting of the knee include a slip and/or fall, any quick movement while playing sports or jogging/running on an uneven surface. Initially, an individual often hears or feels a ‘pop’ accompanied by a sudden onset of pain. It may be difficult to walk. Significant swelling can occur resulting in stiffness of the knee.  A torn ACL causes the knee to give out or buckle, especially with certain activities like pivoting or cutting. Left untreated, the problem may become so severe that simple activities like walking will cause episodes of instability to occur.

Are There Any Risk Factors Related to Anterior Cruciate Ligament Tears?

Yes, in particular, young women are more likely to tear their ACL than men are. This has been attributed to differences in hormones as well as differences in mechanics during sporting activity.

The main focus in preventing knee injuries is concerned with improving the mechanics of jumping, landing, and pivoting during sports.  This was initially noted to be beneficial to young women but is now accepted as preventative in both men and women who exhibit poor mechanics. Although knee braces may be protective in the post-operative patient, they have not definitively been shown to prevent ACL injuries.

What Type of Doctor Treats an ACL Injury?

Individuals should visit an experienced Orthopaedic surgeon who specializes in treating sports injuries to bones, ligaments, joints and tendons.

Over Time, will a Torn Anterior Cruciate Ligament Heal Itself?

Regrettably, the ACL is unable to heal itself. To avoid additional injury, proper medical treatment is required.

What Happens During an ACL Reconstruction Surgery?

A torn ACL cannot be reconnected; therefore, a tendon is used as a substitute for the Anterior Cruciate Ligament. Usually the patient’s hamstring or a portion of his or her patellar tendon is used as the ACL replacement; however, donor tissue may also be utilized.

ACL reconstruction surgery is an outpatient procedure at O’Grady Orthopaedics; therefore, patients will need to bring a driver with them on the day of their procedure.

During an Anterior Cruciate Ligament reconstruction surgery, the patient receives anesthesia to ensure he or she remains comfortable throughout the procedure.  This is usually this is usually performed with a regional block with a catheter which can stay in for 3-4 days and provides excellent pain relief.  Dr. O’Grady will harvest the necessary tendon or tissue from the patient.

After making a small incision, Dr. O’Grady places a tiny camera (arthroscope) into the knee. This arthroscope allows him to see inside the knee joint. Another small incision is made for instrumentation. 

He attaches the patient’s new ACL to two long sutures. Dr. O’Grady pulls the new graft into place through the small holes he created in the knee. Two screws will hold the graft in place while the bone heals. Generally, these screws consist of a material that the body will absorb.

Once Dr. O’Grady decides that the knee is stable, he closes the incisions and dresses the knee.

Often times there are additional injuries in the knee, like meniscal tears, that are addressed and fixed at the same time. 

Directly following an ACL reconstructive surgery, patients are given crutches to use. These crutches may be used up to 3 weeks. There will also be a knee brace which provides some stability while the muscles strengthen.

Does Every Patient Need Physical Therapy?

Yes, physical therapy is an integral part of treating a torn Anterior Cruciate Ligament. Within the first day or two of surgery, patients will have their first physical therapy session. Initially, patients begin physical therapy exercises designed to improve their range of motion. Once pain and inflammation decrease, strengthening exercises will be incorporated into the patient's treatment plan. Eventually, the majority of Dr. O’Grady’s patients progress back to their full activity level and can return to their normal daily activities (including sports).

By beginning physical therapy right away after surgery, the risk of post-surgical complications is decreased. Moreover, early and appropriately aggressive therapy allows individuals to regain their full range of motion, faster and have less pain. 

How Long Does It Take to Recover from ACL Reconstruction Surgery?

Generally, patients need approximately 6 months to fully recover: However, there are instances when a patient needs up to 12 months for his or her knee to return to normal. This is especially true with elite contact athletes. 

Dr. Chris O’Grady is dedicated to helping his patients regain their mobility and return to their everyday activities as soon as possible. If you have sustained an injury or are having symptoms of pain and instability contact O’Grady Orthopaedics and schedule your appointment today.

Approximately 200,000 ACL tears occur each year in the U.S., with a majority of those tears requiring reconstructive surgery.

ACL Injuries FAQ

ACL Injuries FAQs

According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States. As people are developing the loss of cartilage in their knees, the joints start seeing a lot more stress. This comes from the “bone on bone” changes that are occurring. As the bones see more stress, we often start seeing what are called “insufficiency fractures” or bone bruises on MRI scans. 

The Orthopedic literature seems to indicate that a lot of the pain from arthritis comes, not from the bone-on-bone changes, but from the developing insufficiency fracture and bone bruising. As alternatives to knee replacement surgery, the following procedures may be suitable pending a variety of factors:

Over the last couple of years when we see these bony changes on MRI, we inject a bone graft substitute into the bone to seal up the insufficiency problem. This is called a subchondroplasty.

Think of it as injecting a type of wall grout inside the bone to help support it while it attempts to heal.

For those patients who are too young, too obese, or not interested in a total knee replacement, this minimally invasive procedure could be a pain-reducing procedure.

The results are early but are quite promising. You may be the right patient for this procedure if your pain seems greater than you would think from the amount of arthritis present, or the tenderness is actually on the bone rather than in the joint.

Please see below additional details about the SCP Procedure.

Bone Marrow Lesions (BML) are subchondral bone defects visible on an MRI. You can only see them on fat-suppressed MRI sequences (PDFS, T2FS, etc.) where they look like a hazy white spot against the darker bone background. According to pathologists, BML represents a trauma-related healing response like subchondral bone micro-trabecular fractures. They can be found in any bone that sees weight-bearing or repetitive motion stress.
In these patients, present guidelines for treatment suggest an initial course of conservative care to help heal the defect. Then, the Subchondroplasty® (SCP®) Procedure might be an option if the defect remains.

This procedure is a fluoroscopically-assisted, minimally-invasive procedure surgeons use for targeting and filling subchondral bone defects, such as BML, with AccuFill® PF Bone Substitute Material (BSM). This is a biomimetic, hard-setting bone substitute.
Unlike standard “knee replacement surgery” where the surgeon removes the damaged or diseased knee joint and replaces it with an artificial one, the Subchondroplasty Procedure is a minimally-invasive procedure surgeons use to delay or prevent knee osteoarthritis progression by treating the underlying causes of osteoarthritis knee mobility limitations and pain. The term “subchondroplasty” literally refers to “surgical repair below the cartilage.”

Allows for future treatment option slike total knee replacement

Despite physical examination and negative X-rays when BMLs are causing the pain, the Subchondroplasty Procedure could ease the pain.

The surgeon performs Subchondroplasty along with arthroscopy of the impacted knee for:

Assessing the extent of the injury to the tibial plateau

Helping in targeting the underlying defect of the plateau

Visualizing and treating other joint structures

WHO IS AN IDEAL CANDIDATE FOR THIS PROCEDURE?

You might be a candidate for Subchondroplasty if you have:

Symptomatic knee pain for over three months

Symptoms that come back after an arthroscopy

Limited benefits from bracing, NSAIDs, physical therapy or injections

Frequently, osteoarthritis is the cause of knee pain and is the most common type of arthritis. Because it’s a “wear-and-tear condition” occurring as your joints degenerate with age and use, it’s aptly named degenerative arthritis. Traditionally, doctors diagnose knee osteoarthritis by evaluating:

The affected joints’ X-rays will have a characteristic appearance where the ends of the bones look closer to one another because of joint space narrowing with the wearing away of cartilage.
Additionally, fluid-filled cavities or cysts might be noticeable in the bone as your body reacts to cartilage destruction. The doctor might observe uneven joints or increased bone density since when cartilage doesn’t cushion bones any longer, the bones rub against each other with more pressure and create pain and friction. Your body reacts to this increased pressured force by increasing bone density and laying down more bone which creates bone spurs (osteophytes) and uneven joint surfaces around the joint margins.
According to a study published by the National Institutes of Health, there’s a 45% lifetime risk of developing knee osteoarthritis. Many individuals expecting more active lifestyle years are searching for alternatives to the full knee replacement procedure which is invasive and comes with a lengthy recovery period. It also comes with certain lifetime activity limitations (no jumping/running for instance). Subchondroplasty provides them with such an option.

1. Preoperative Plan: Find the BML bone defect through a fat-suppressed MRI scan; plan trajectory and approach based on the location of the defect.
2. Target the Bone Defect: Using intraoperative fluoroscopy and arthroscopy, localize the bone defect in relation to the findings on the MRI.
3. Access the Defect: Drill the proper AccuPort® Delivery Cannula to reach the bone defect.
4. Fill the Bone Defect: Inject the subchondral bone defect with AccuFill BSM.

The Subchondroplasty Procedure will target and fill the BMLs in those not responding to conservative treatments.

Your surgeon will use AccuFill® Injectable Bone Substitute Material. This is a self-setting, osteoconductive, macroporous, calcium phosphate, injectable bone graft substitute material made for filling bony gaps or voids of the skeletal system of the spine, pelvis, and extremities that aren’t intrinsic to the bony structure’s stability.

The defects might be traumatic injury-related osseous defects or surgically created osseous defects to the bone. The AccuFill injectable resorbs and is replaced by new bone during the process of healing.

You will likely experience some discomfort and pain in the surgery area for a day or two after your procedure. The doctor may prescribe you pain medicine to manage it. They will recommend crutches for one to two weeks after your procedure to reduce weight-bearing on your operated leg. They may also recommend physical therapy to regain mobility and strength in your knee.

As alternatives to the more than 600,000 knee replacements performed each year, we offer several treatment options for patients pending a variety of factors.

Blog Posts for Knee

Knee Pain in Young Athletes: How to Prevent, Evaluate, and Manage

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ACL Injuries FAQs

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Knee Replacement Alternatives

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