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growth

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Competitive and elite sport often challenges the balance between health and performance, especially when it involves youth athletes. As Lausanne was getting ready to host the 2020 winter Youth Olympic Games, we had the opportunity to reflect on these challenges and on what they mean for sports medicine practitioners. Elite sport pushes athletes to the limit, be it through their own intrinsic drive to achieve ever more, or through the pressures of the multiple stakeholders around sport.
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The growing spine is – particularly in performance oriented young athletes – prone to overload: under pubertal hormonal influence the 48 cartilaginous growth zones beneath the vertebral endplates are mechanical as fragil as never before during growth whereas on the other side the impacting forces are becoming higher due to the longer trunk lever arm, the often apparent relative muscular insufficiency, the increasing training hours and intensity as well as the willingness and pressure to perform. The subsequent biomechanical imbalance usually results in simple functional complaints but may also entail structural changes, for example (thoraco-) lumbar Scheuermann’s disease in sports with high axial impact such as alpine skiing oder gymnastics.
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Ideally, the musculosceletal system and it’s components maintain a biologic balance during growth in order to compensate and/or adapt to intrinsic and extrinsic factors. Otherwise, the risk of acute or overuse injuries is increasing. The growth cartilage at the level of the growth plates or apophyses as well as the spine is highly vulnerable to overuse injuries, especially during the pubertal growth spurt. The diagnosis of an overuse injury is often delayed due to the undulant clinical manifestation and the treatment can be extensive and long-lasting, sometimes leading to an early cessation of sports activities.
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ACL injuries in children and adolescents have increased substantially in recent years. Nevertheless, treatment algorithms are domiated by predjudice more than by evidence, eventhough the scientific basis, summarized in this paper, is sound. The likelihood of an ACL tear in a traumatic hemarthros, even without contact, is 52%. More than half of the cases show concurrent injuries. Methods and criteria for success of conservative treatment are published in detail, however, surgical treatment produces a better clinical outcome in most cases. Various surgical techniques exist, and age appropriate treatment can elimate the risk of a growth disturbance and restore the normal function of the knee.
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