Monday, October 26, 2015

What It Means To Be Pediatric Sports Medicine Surgeon

By: Jeffrey J. Nepple
Washington University Orthopedics

Over 3.5 million injuries occur in youth sports every year. It takes many types of individuals to care for all aspects of the health of these injured young athletes. Pediatric sports medicine surgeons are one part of this team and are orthopedic surgeons who specialize in the treatment of musculoskeletal injuries in these young athletes. Pediatric sports medicine surgeons have overlap with other orthopedic subspecialties including pediatric orthopedics (caring for general musculoskeletal conditions in children) and sports medicine surgeons (caring for sports injuries in adolescents and adults).  Pediatric sports medicine surgeons focus on the injuries in the growing child and adolescent (skeletally immature meaning still growing). Many surgeons in this field have dedicated fellowship training in both pediatric orthopedics and sports medicine. The unique period of rapid growth and development make young athletes at risk for a variety of injuries not seen in adults, particularly injuries involving the growth plate (called physis).  Similarly, surgical treatment of injuries in these athletes may be different than adults and require adjustment due to the open growth plate. My practice includes 4 main areas:  (1)  Nonoperative care, (2) Surgical care, (3) Team coverage, and (4) Research.

As a pediatric sports medicine surgeon, I care for a variety of conditions that will never require surgery and can be successfully treated with nonoperative measures (including rest, physical therapy, bracing/casting, and medications). This is similar to nonoperative pediatric sports medicine physicians caring for these athletes. With nearly half of all youth sports injuries occurring secondary to overuse, overuse is a common source of many of these injuries. This is particularly true for athletes playing a single sport year-round. Some common conditions include Osgood-Schlatter’s disease, patellofemoral pain, and Little Leaguer’s elbow.

As a pediatric sports medicine surgeon, I specialize in performing surgery on young athletes with injuries that can’t be managed by nonoperative measures alone.  Often these injuries are the result of traumatic injury, rather than overuse. Common conditions include anterior cruciate ligament (ACL) tears, osteochondritis dissecans (OCD), and growth plate fractures.  Most sports medicine injuries are now treated minimally invasively with arthroscopy. Arthroscopy involves the use of a pencil-sized camera to see inside joints thru small incisions and lessens the amount of pain experienced after surgery.  During surgery, surgeons watch on a video screen while they perform surgery with their hands thru these small incisions. This is commonly compared to “video games” due to the required hand-eye coordination. Depending on the age and extent of surgery, surgery may be performed either in the outpatient (able to go home on day of surgery) or inpatient (spending one night in the hospital).  After surgery, I work closely with the athlete’s physical therapist and/or athletic training to improve the athlete’s recovery and return to sports.

As a pediatric sports medicine surgeon, I am also involved in the medical care of teams of young athletes. During my career, I’ve participated in the care of athletes at almost every level including elementary school, junior high, high school, college, professional, and Olympic athletes. Injuries become more common as the size and speed of athletes increase.  So physicians are most commonly involved in team coverage at the high school age and beyond, with football being the most commonly covered.  On the sidelines, the surgeon is involved in the acute assessment of injuries and decisions regarding the safety of athletes.

The final focus of my practice as a pediatric sports medicine surgeon is research. Pediatric sports medicine is a relatively new field and there is currently inadequate research to guide many of our decisions. Clinical research attempts to utilize information from the treatment of our patients to help identify the best form of treatment for future patients. For most young athletes, this means no difference in how they are treated but instead a few extra questionnaires to help us understand how they’re doing.  Research in the twentieth century now focuses on patient-reported results, rather than those measurable by the physician. I am currently involved in several national/international research groups that my patients participate in including:

-ROCK (Osteochondritis Dissecans/OCD)
-FACT (Clavicle Fractures)
-PLUTO (ACL tears)
-ANCHOR (Young Adult Hip conditions including femoral acetabular impingement/FAI and hip dysplasia).

As a pediatric sports medicine surgeon, I feel privileged to care for some the most dedicated and determined of the next generation.  Sports injuries in children and adolescents are major events in their life and helping to “heal” or “fix” them is a tremendously rewarding part of my job.