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Recovery from season-ending knee injury

​​​A staggering 35 million kids, ages 5 to 18, play in organized sports each year. 

Lindsay Gotz, Auburndale Lindsay Gotz, Auburndale

​In addition to the tremendous benefits sports participation offers, including improved fitness and character building, the high participation brings increased risk for youth knee injuries. 

Some knee injuries can be season-ending. Successful recovery takes hard work and support from parents and coaches. Strengthening and conditioning programs can help with prevention.

In medical terms, the names of common youth knee injuries can be a mouthful:

  • Anterior cruciate ligament (ACL) injury
  • Medial collateral ligament (MCL) injury
  • Meniscus tear
  • Osteochondritis dissecans (OCD) lesion

Because such injuries to pro athletes are highly publicized, acronyms of the injury names are likely more familiar.

ACL and MCL injuries each affect one of the four ligaments largely responsible for stabilizing the knee joint. Meniscal injury affects the knee's stabilizing cartilage, and an OCD injury can affect the joint's bones and cartilage. ACL injuries have been deemed season-ending injuries and the most difficult from which to recover.

"In most children, their ligaments tend to be stronger than their bones," said Sports Medicine Physician Laurel Rudolph, M.D., Marshfield Clinic. "This results in more bone-related problems than ligament injuries. Overuse and the increasing intensity of youth competition and participation in year-round sports programs tend to increase the likelihood of knee injuries."

Girls seem more susceptible to serious knee injuries than boys do.

"We see more girls, particularly when you look at sports that both girls and boys play, such as basketball, soccer and volleyball," said Orthopedic Surgeon Albert Cecchini, D.O., Marshfield Clinic Merrill, Wausau and Weston Centers. "Much speculation surrounds why. It might be because of how girls jump and land, the way they're built, slight differences in how their knee joint is formed, or it could be hormonal. The research isn't there yet to know for sure."

Sidelined by a knee injury

Surgery is usually recommended in combination with intensive physical therapy for meniscal tears and ACL injury. Such was the case for Lindsay Gotz, 19, of Auburndale. Gotz suffered an ACL tear at the height of her high school sports career in 2010. She was a standout volleyball and basketball player at the time. The injury was devastating.

"I was playing in a summer basketball tourney before my senior year," Gotz said. "I was on defense and jumped up to steal the ball, and my left leg slipped outward. My teammates later told me my leg looked like a wet noodle at that moment."

Gotz doesn't recall much pain. "It was kind of achy," she said. "An ACL injury was the last thing on my mind. I iced it and went to urgent care that evening. I could sort of walk on it, but not comfortably. I thought it was just a sprain. A week later, when it was still swollen and hurt, I knew I needed to go back and get an appointment."

Clinical and magnetic resonance imaging (MRI) exams confirmed Gotz's ACL injury.

"Lindsay had an ACL tear that required surgery," Dr. Rudolph said. "This meant she wouldn't play volleyball her senior year and would possibly miss most of her last season of high school basketball."

That's a tough conversation to have with any young athlete, Dr. Rudolph said.

"It's a conversation that even affects me emotionally as a provider. I know when I see this type of injury the athlete possibly has just lost five to six months of their high school sports career," Dr. Rudolph said. "For many students that can mean one to two sports seasons, depending on when the injury occurs."

Health concerns for young athletes with knee injuries are two-fold: part psychological and part physical. To be told you can't play and need to undergo extensive rehabilitation to return to the game can devastate a young athlete. Additionally, the injury may affect growing bones and joints.

"Injury to where bone and joint growth is still occurring presents a challenge," Dr. Cecchini said. "Reconstruction is more difficult and outcomes aren't as predictable. When a child has a serious knee injury at a young age, it's harder to gauge how they'll respond after surgery. We used to have children sit out until they were further along in their growth process before performing a repair. More reconstructive approaches are available now, but the recovery requires effort, time and support."

Moving forward with rehab and support

Gotz felt she was faced with a choice when her ACL was torn. Seeing her brand new, never worn volleyball shoes was when the reality hit home.

"I had to make a decision," she said, "Did I want to lie around and mope or turn this into something positive? I suited up for every volleyball game, went to every practice and tried to be a positive influence to the girls on my team. They, in turn, showed their support for me during my recovery."

Therapy plays a huge part in the success of knee injury treatment and recovery, Dr. Cecchini said. "Athletes need to be dedicated to following through with it. If the rehab isn't adequate or the knee isn't fully rehabilitated, the risk increases for re-injury to the knee."

"We make sure parents are part of the conversation about therapy, so the student-athlete has the support needed to follow through with it," Dr. Rudolph said. "I also remind the students there is a role for them with their team, even if they can't play. Staying connected with their team, like Lindsay did, can help injured athletes come to accept what has happened and move on."

Strengthening and conditioning beneficial

Preconditioning can help with knee injury prevention. "We can't prevent when a player is hit in a way that causes a knee injury," Dr. Cecchini said, "But we can train and strengthen certain muscle groups, teach the proper way to land after jumping, and provide core strengthening and endurance exercises to keep young athletes strong and flexible."

Gotz fully rebounded from her knee injury in time for her senior year of basketball. Two years later, she's applying what she gained from that experience to her role as an assistant girls' basketball coach for her alma mater.

"As a coach, I stress to my players not to take anything for granted. Things can change that can affect the rest of your high school sports career," she said. "If a set-back like this occurs, as soon as you can, try to turn it into something positive." ​​