Course

The Younger Athlete

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14 Lessons

Children and adolescents are not simply small adults. There are important anatomical differences in the structure of growing bone when compared with adult bone. This difference is responsible for most of the differences in injury characteristics seen between these groups.

The most significant differences between musculoskeletal injuries in children and adults are due to the stresses loaded on the epiphyses (separately ossifying ends of the long bones) and the epiphyseal cartilage. Tendons and muscle injuries also differ. Tendons attach to bone via apophyses (which are separate ossification nuclei). Epiphyseal and apophyseal cartilages are potentially weaker than the rest of the skeleton, and the tendons, muscles and ligaments. As a result they are more susceptible to injury. As a result, isolated ligament injuries are unlikely in the paediatric population.

While some of the characteristics of the developing skeleton are more prone to injury there are some things which are relatively protective. For example the articular cartilage layer in children is thicker and has a greater propensity to heal while the metaphysis (long bone) is better able to deform and absorb loads resulting in fewer fractures here.

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Learning outcomes

By the end of this topic, you should:

  • be aware of the major injuries affecting the ‘younger’ footballer
  • be able to diagnose paediatric injuries by taking an appropriate history, examination and order appropriate investigation (where needed);
  • be able to identify, and refer, more significant conditions that might mimic football injuries;
  • understand and be able to implement an appropriate rehabilitation programme to treat injuries in young football players.

Tasks

  • Review the provided text and media content
  • Read the provided articles
  • Complete the case-based assessment task

Required reading

F-MARC Football Medicine Manual, 2nd Edition

Chapter 2.4.1 (pages 112-118).

Suggested reading

Brukner and Khan’s

Clinical Sports Medicine 4th Edition

Chapter 42 (pages 888-909)

References

  1. Faude, O., Rossler, R., Junge, A. Football injuries in children and adolescent players: Are there clues for prevention? Sports Med. 2013; 43(9):819-837.
  2. Dipaola, J.D., Nelson, D.W., Colville, M.R. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991; 7(1):101-104.
  3. Edmonds, E.W., Polousky, J. A review of knowledge in osteochondritis dissecans: 123 years of minimal evolution from konig to the ROCK study group. Clin Orthop Relat Res. 2013; 471(4):1118-1126.
  4. Kocher, M.S., Tucker, R., Ganley, T.J., Flynn, J.M. Management of osteochondritis dissecans of the knee: Current concepts review. Am J Sports Med. 2006; 34(7):1181-1191.
  5. Wall, E.J., Vourazeris, J., Myer, G.D., et al. The healing potential of stable juvenile osteochondritis dissecans knee lesions. J Bone Joint Surg Am. 2008; 90(12):2655-2664.
  6. Sundar, M., Carty, H. Avulsion fractures of the pelvis in children: A report of 32 fractures and their outcome. Skeletal Radiol. 1994; 23(2):85-90.
  7. Bittersohl, B., Hosalkar, H.S., Zilkens, C., Krauspe, R. Current concepts in management of slipped capital femoral epiphysis. Hip Int. 2015; 25(2):104-114.
  8. Wiig, O., Terjesen, T., Svenningsen, S. Prognostic factors and outcome of treatment in perthes’ disease: A prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008; 90(10):1364-1371.
  9. Clohisy, J.C., St John, L.C., Nunley, R.M., Schutz, A.L., Schoenecker, P.L. Combined periacetabular and femoral osteotomies for severe hip deformities. Clin Orthop Relat Res. 2009; 467(9):2221-2227.