Sports Medicine

Osteochondritis dissecans (OCD) is a joint condition where the bone under the cartilage of a joint dies due to lack of blood flow. Sometimes in young children, this can be found incidentally while taking x-rays of the knee for an injury.  Other times, kids may have pain because the bone and cartilage can start to wobble or break loose.  OCD can happen in any joint, but is most common in the knee, elbow, and ankle.

What are the signs and symptoms of osteochondritis dissecans?

• Pain, swelling or tenderness
• Joint popping or locking
• Joint weakness, such as a “giving away” sensation

What causes osteochondritis dissecans?

Doctors don’t know exactly what causes osteochondritis dissecans. However repetitive stress on the joint, low vitamin D, and genetics are all often linked to this condition.

How is osteochondritis dissecans treated?

OCD treatment depends on several factors including the age of the patient (and how much growth they have remaining), the type of symptoms, and the stability of the bone and cartilage.  Treatments can include:

• Observation
• Rest from activities
• Arthroscopy for drilling of the lesion to help it heal
• Arthroscopic and open treatments for fixation of the lesion
• Grafting of new bone and cartilage.

Why Connecticut Children’s?

At Connecticut Children’s, we offer the latest treatment options for OCD based on research.  We are part of 2 major study groups looking at this problem in both the knee and the elbow.

ROCK Center- Research in Osteochondritis of the Knee (KneeOCD.org)

ROCKET Center– Research in Osteochondritis of the Elbow and Talus

Medial Epicondyle Apophysitis (Pitcher’s Elbow)

Medial epicondyle apophysitis is an irritation and inflammation of the growth plate on the inside of the elbow. It is commonly referred to as pitcher’s elbow or Little League elbow because it frequently affects pitchers.  It is important that throwing athletes be evaluated if they have elbow pain.  Untreated medial epicondyle apophysitis could lead to a fracture if ignored.

What are the signs and symptoms of medial epicondyle apophysitis?

• Pain in inner side of elbow when throwing
• Swelling and difficulty extending elbow

What causes medial epicondyle apophysitis?

• Overuse caused by lots of throwing, which puts stress on the growth plate

How is medial epicondyle apophysitis treated?

• Rest from throwing for a few weeks
• Ice to reduce inflammation
• Sometimes, physical therapy to improve muscle strength

Lateral epicondylitis, also referred to as tennis elbow, is when the tendons of the elbow are inflamed or in some cases have very small tears due to repetitive wrist movements.

What are the signs and symptoms of lateral epicondylitis?

• Elbow pain where the tendons of the forearm muscles attach to the bony bump on the outside of the elbow
• Pain in forearm and wrist
• Weak grip

What causes lateral epicondylitis?

• Repetitive motions in the wrist

How is lateral epicondylitis treated?

Usually, lateral epicondylitis can be treated without surgery. Possible treatments include:

• Rest
• Anti-inflammatory medications
• Physical therapy
• Brace (Tennis elbow Strap)
• Injections

If symptoms do not improve after 6-12 months of nonsurgical treatment, doctors may recommend surgery.

An ACL injury is a tear or sprain of the anterior cruciate ligament (ACL). This ligament is a strong band of tissue that connects the thigh bone (femur) to the shinbone (tibia) to provide stability of the knee. ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, pivoting, and jumping.  High school female athletes have the highest risk for ACL injuries of all athletes.

What are the signs and symptoms of an ACL injury?

• Hearing a “pop” or feeling a popping sensation at the time of injury
• Knee swelling
• Knee gives out or buckles
• Pain with weight-bearing

What causes an ACL injury?

• Sports that involve cutting, pivoting, or quick starts and stops
• Awkward landing from a jump (with knee buckling inward)
• A direct hit to the knee or a collision

How is an ACL injury treated?

Initial treatment for ACL injuries is to reduce the swelling and regain range of motion that is often lost with acute immobilization following injury. Once swelling is normalized, begin to regain range of motion, especially knee extension, focusing on maintaining quadriceps (thigh) activation and strength.

Most often, ACL injuries are treated surgically. Conservative treatment for ACL injuries for young athletes is not commonly recommended due to the likelihood of recurrent injuries, further knee damage, such as meniscus tears, as well as an early onset of arthritis.

Surgical Treatment

Surgical treatment for ACL injuries is recommended to restore the normal function of the knee joint, for those athletes who wish to return to running, cutting, pivoting and twisting maneuvers. The surgery involves reconstructing/replacing the damaged ACL because it cannot heal on its own. There are numerous surgical options regarding graft type, which is often discussed with the surgeon who is performing the surgery. 

Here at Connecticut Children’s, we offer a range of graft options because we treat the full spectrum of patients, from young growing children to college athletes.  We often use the quadriceps tendon and have active on-going research on its use.  We also offer bone-patellar tendon-bone and hamstring grafts in certain cases. 

While ACL injuries in the very young child (more than 2 years of growth remaining) are rare, they require a different technique to protect their growth plates.  At Connecticut Children’s, we offer the IT band (iliotibial band) technique, which has had excellent long term results.

After Surgery

Following ACL reconstruction, the rehab and time away from organized athletics is about 9-12 months.  There is a lot of physical therapy, strengthening, and ACL injury prevention work done in order to successfully return to sports.

New Minimally Invasive BEAR Implant for ACL Tears

Connecticut Children’s is the first in Connecticut to use a breakthrough minimally invasive technology called the BEAR Implant for treatment of ACL tears. Unlike reconstruction, the BEAR Implant does not require a second surgical wound site to remove a healthy tendon from another part of the leg, or donor tendon. Instead, the implant acts as a bridge to help ends of the torn ACL heal together. Our Connecticut Children’s surgeon injects a small amount of your own blood into the implant and inserts it between the torn ends of your ACL. The combination of the BEAR Implant and your blood enables the body to heal the torn ends of the ACL back together while maintaining the ACL’s original attachments to the femur and tibia. As the ACL heals, the BEAR Implant is resorbed by the body, usually within eight weeks.

Iliotibial band syndrome (also called IT band syndrome) causes pain on the outside of the knee. The iliotibial band is a strong band of tissue that runs from your hip bone to the top of the shin bone. With repeated bending and extending your knee the iliotibial band may irritate nearby tissue causing pain.

What are the signs and symptoms of iliotibial band syndrome?

• An aching or burning pain on the outside of the knee
• Sometimes pain is only when exercising, worse at the end of a workout

What causes of iliotibial band syndrome?

• Repetitive bending and extending of the knee, often occurs in distance runners

How is iliotibial band syndrome treated?

• Limiting activities that make the knee pain worse
• Icing the outside of the knee
• Taking over-the-counter pain medicines
• Corticosteroid shots to decrease inflammation
• Physical therapy to strengthen the muscles around hip and knee

In each knee there are two C-shaped pieces of cartilage, or menisci, that act as a cushion between the shinbone and the thigh bone. Activities that forcefully twist or rotate the knee while putting weight on it can tear this cartilage.

What are the signs and symptoms of a meniscal tear?

• Hearing a “pop” or feeling a popping sensation at the time of injury
• Knee swelling or stiffness
• Difficulty straightening the knee fully, or feeling as if the knee is locked into place
• Pain when twisting or rotating the knee

What causes a meniscal tear?

·      Twisting injuries to the knee

• A direct hit to the knee or a collision

How is a meniscal tear treated?

In adolescent and young adult patients, meniscus tears are often treated with surgery.  Sometimes it may be possible to treat with rest and physical therapy, but it depends on the type of tear and the amount of discomfort it is causing.

Here at Connecticut Children’s, we use the latest techniques to do meniscus repair as often as we can to try to restore normal anatomy.  We typically use suture to repair meniscus tears.  Sometimes if there is a very bad tear that cannot be repaired and a young patient loses most or all of their meniscus, we also offer meniscus allograft transplants, a surgery where we replace a missing meniscus with a donated one.

Shoulder impingement syndrome, also known as swimmer’s shoulder, refers to the pinching, or rubbing of the tendon in your shoulder.  In your shoulder you have a rotator cuff that is made up of a group of four muscles and bones that share a common tendon. When the muscles and tendons don’t slide easily, the tendons and a fluid-filled sac called the bursa can become irritated and swollen and cause pain.

What are the signs and symptoms of shoulder impingement?

• Shoulder pain when raising the arm
• Decreased range of motion due to pain
• Not being able to sleep on affected side due to pain

What causes of shoulder impingement?

• Injuries to the shoulder
• Activities that cause repetitive arm movements such as swimming, baseball, football and tennis

How shoulder impingement treated?

• Rest from all activities that could aggravate your shoulder
• Physical therapy to regain motion and strength
• If pain continues or worsens after physical therapy, surgery may be recommended

The upper bone of the arm, the humerus, connects to the shoulder by muscles and tendons. Four of the muscle/tendon groups form the rotator cuff. Rotator cuff tendonitis is an inflammation of this group of muscles in the shoulder and an inflammation of the bursa with is a soft sack that contains fluid and cushions the joint.

What are the signs and symptoms of rotator cuff tendonitis?

• Swelling
• Shoulder weakness or limited range of motion
• Pain in front and top of shoulder
• Some may experience pain when sleeping
• Some may experience a clicking in the shoulder when raising arm above head

What causes of rotator cuff tendonitis?

• Repetitive overhead activities such as throwing, raking, washing cars or windows
• Result of an injury to the rotator cuff

How is rotator cuff tendonitis treated?

• Decrease shoulder activities
• Apply ice and take anti-inflammatory medication
• Begin an exercise program to maintain flexibility
• Avoid carrying anything on affected side
• Sometimes cortisone injections can be used along with an exercise program

Hip impingement – also known as femoroacetabular impingement, or FAI – is a condition in which the ball of the hip, the femoral head, pinches up against the cup of the hip, the acetabulum. This damages the cartilage that surrounds the cup of the hip, causing stiffness and pain and possibly leading to arthritis.

What are the signs and symptoms of hip impingement?

• Hip or groin pain after prolonged sitting or walking
• Hip or groin pain after exercise
• Popping or clicking in the front of the hip

What causes hip impingement?

Hip impingement occurs when the bones around the hip aren’t shaped properly. There are two types.

• The ball of the hip (femoral head) is more oval than round, creating friction when the ball hits the cup.
• The cup of the hip (acetabulum) is abnormally shaped and covers too much of the femoral head, causing friction.

How is hip impingement treated?

• Rest and limiting activities that irritate the hip
• Anti-inflammatory medicines

• Physical therapy
• If hip impingement is not improving with nonsurgical treatments, some patients may be candidates for hip arthroscopy.  This is a minimally invasive technique that can treat the cause of impingement and as well as any problems that it has caused.  This can include labral repair, cartilage treatments, and osteoplasty (smoothing down the bone that is impinging).