It was the pop he’ll never forget. Devante Anderson, a running back on the Quince Orchard High School football team, had just had the ball handed to him during a state play-off game in mid-November. As he tried to cut from his left leg, a player from the opposing team hit him, not hard. But after heavy rains, the field was muddy, and Anderson’s foot stayed planted while his knee turned.
“It happened so fast. I remember hearing my knee pop, and I realized it was dislocated and I couldn’t stand up,” recalls Anderson, 18, a senior at the Gaithersburg school. As he waited for an ambulance to take him to the hospital, “I was more in shock than pain,” he says. “I was shaking all over.”
The injury tore three of the four major ligaments in Anderson’s left knee, essentially unhinging the bone in the lower leg (the tibia) from the thigh bone (the femur), an injury that required “massive reconstructive surgery to restore stability and function to the knee,” according to his orthopedic surgeon, Dr. Christopher Raffo, a sports medicine specialist with offices in Bethesda and Germantown. “The operation is arguably the most difficult sports medicine procedure performed, and it is usually career-ending,” Raffo says.
Anderson had hoped to play football in college, but “they’ve told me it’s going to take a full year for me to build my leg up again. I’ve always been very active and I like to run; I can’t even walk up the stairs right now,” he says. “But I just have to move on and keep fighting. I feel like if I can recover from this, I can recover from anything.”
Anderson isn’t the first young person to face this kind of challenging life lesson. More than 3.5 million kids 14 and younger receive emergency medical treatment for sports injuries each year, according to the Consumer Product Safety Commission (CPSC). And “another 8 million will bypass the emergency room and go to physicians’ offices and clinics,” says Dr. David Janda, an orthopedic surgeon and director of the Institute for Preventative Sports Medicine in Ann Arbor, Mich.
Furthermore, kids’ sports injuries appear to be on the rise: According to the CPSC, 132,267 kids under 18 were treated at ERs for soccer injuries in 2008, compared with 119,956 a decade earlier; 370,857 were treated for football injuries in 2008, a 41 percent increase over 1998 figures; and 13,586 were treated for lacrosse injuries in 2008, a 74 percent rise from just four years earlier. Not surprisingly, football has the highest severe injury rate among high school athletes in the United States, followed by wrestling, girls’ basketball and girls’ soccer, according to a recent study from Ohio State University.
When it comes to explaining the increase in sports injuries among kids, several factors seem to be at play. For one, more kids are participating in organized sports. And the level of training and competition has been ratcheted up as kids play coached team sports at much younger ages than previous generations. Moreover, kids often begin specializing in particular sports—playing, for example, on travel soccer, baseball or hockey teams—before age 10 (even though experts recommend not doing so before ages 12 or 13). As a result, the speed and intensity of play have increased considerably, Janda says. And many kids play year-round, day after day, season after season, in as many as five games over the course of a weekend.
“The more kids play and the higher the intensity of the play, the greater the chance of injury,” says Dr. James Gilbert, an orthopedic surgeon with Metro Orthopedics & Sports Therapy in Silver Spring and a physician with the Human Motion Institute at Bethesda’s Suburban Hospital. “We tend to see certain injuries—like ACL [anterior cruciate ligament] injuries [in the knee]—at the end of a game, when the athlete is tired, or in the third game of a weekend tournament. We need to look at that—to see if we’re playing kids in too many games in a row or in a year.”
Of course, excessively rough play also can result in injuries, as Tyler Green of Kensington found out. Green, a freshman at Bethesda’s Walter Johnson High School, tore a tendon in his left ankle and fractured his left fibula during football practice in October.
“It was a pretty dirty tackle, especially for a practice,” recalls Green, 15, who also plays travel baseball. Surgery, including the insertion of plates and screws, was required to repair his leg.
His experience is hardly a fluke. The Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, found illegal moves to be an overlooked risk factor for sports-related injuries, particularly in girls’ basketball and boys’ and girls’ soccer.
But even when kids play fairly, there’s an inherent risk of injury, especially with sports that involve contact. Nico Deandreis, 18, a soccer player who’s a senior at Walter Johnson, collided shin to shin with an opponent during a district playoff game in October and fractured his right tibia. “Thankfully, it was a clean break,” says his mother, Ana Aguirre-Deandreis, a clinical psychologist who lives in Bethesda. “But the hit was extremely hard, and Nico was in a lot more pain than he’d ever had in his life.”
Because kids’ bones, muscles, tendons and ligaments are still growing, they’re particularly at risk for certain injuries. Younger kids’ growth plates—the softer, weaker cartilage at the ends of bones where growth occurs—are still open, and these areas are particularly vulnerable to fractures from stress or impact. Kids’ broken bones heal more quickly than adult bones, but “if they’re not set right, it can affect the way the bones grow,” says Dr. Edward Bieber, an orthopedic surgeon in Bethesda.
Indeed, treating growth plate injuries is tricky. If there’s abnormal healing of a fractured growth plate, or if pins, plates or screws are put through a growth area during surgery, it can affect the way that bone will grow. As a result, a child could end up with one leg longer than the other or with a bone deformity.
“Sometimes you’re weighing competing evils when trying to decide how to treat a fractured growth plate in a child,” Bieber says. The good news is that skeletal maturity typically kicks in around age 14 for girls and 16 for boys. “The bones become more solid,” Bieber says, “and that’s when there are more options available, including surgeries that would not be appropriate in children.”
For girls, there can be another complicating factor: Teenagers training at an intense level are at risk for the “female athlete triad,” a spectrum of disordered eating habits, lack of or infrequent menstruation and bone loss, or osteoporosis. The syndrome is believed to be so prevalent that doctors and coaches are advised to be on the lookout for it.
“It has such huge health consequences down the road, including osteoporosis, fractures and orthopedic complications,” Gilbert says. Even in the short term, it can set girls up for sports injuries, especially repeated stress fractures, which are often early clues that a girl suffers from the problem.
One component of the syndrome alone can exacerbate a girl’s risk of fracture. For months, Alexis Iderman, 15, a freshman at Stone Ridge School of the Sacred Heart in Bethesda, had been playing tennis for hours each day and tournaments every weekend. In late August, she began experiencing intense pain in her right arm, later diagnosed as a stress fracture in the humerus bone.
