Australian ACL reconstructions in the young at “epidemic” levels
Why are more young Australians having ACL reconstructions?
Not so long ago, Christopher Vertullo, associate professor and director of Knee Research Australia rarely had to treat patients aged under 15. Visits to paediatric wards were thankfully scarce. “Now every week I have to go there,” he told The Sydney Morning Herald recently.
His experiences prompted him to launch a study into ACL reconstructions, the results of which were published recently in the Medical Journal of Australia. What he discovered led him to declare an “epidemic” among Australia’s young people. In the 15 years to 2015, almost 200,000 ACL reconstructions were performed in Australia. During that period, reconstructions in under 25s leapt 74 percent. Within that group, the largest increase was in 5-14 year olds.
So what’s happening?
Not everything about these statistics is alarming. One likely contributor to the increase is raised recognition. As GPs, emergency departments and orthopaedic surgeons become better at spotting the symptoms of ACL rupture, so diagnosis rates increase. That has to be a good thing, although it doesn’t come close to fully explaining Australia’s increase in ACL injuries.
The lack of ‘free play’
Every passing year, children’s participation in sport becomes more regimented and specialised. Where once children would try a range of sports and supplement organised sport with ad hoc games, today most of their activity is centred on one or two sports at most. Free play, as Associate Professor Vertullo noted, is an endangered species.
As children specialise, so their bodies become accustomed to the same exertions involving the same muscle patterns. Reliable data is difficult to get, but in the US there has been research into the effect of limiting these ‘movement pathways’. The results suggest keeping children doing multiple sports for longer can be advantageous in reducing injuries.
At the Yorkshire Knee Clinic, we’ve not seen an increase in ACL reconstructions in the young at anything like the rates seen in Australia. If we want to keep it that way, a continued generalist approach to PE in schools would seem to be the right way to go.