According to a study that appears in the February issue of the Journal of the American Academy of Orthopaedic Surgeons, youngsters who injure the anterior cruciate ligament (ACL) of the knee require special treatment and care to prevent future knee injuries and complications such as osteoarthritis.

The ACL is the main, stabilizing ligament of the knee joint. ACL injuries were once rare in children and young teens but are on the rise due to factors such as year-round training, less free play, and a focus on only one type of sport, say the researchers

They analyzed published studies to identify the best ways to treat ACL knee injuries in children and adolescents whose bones have not yet fully matured, which typically occurs in girls by age 14 and in boys by age 16.

Researchers found that youngsters with an ACL injury should be treated by an orthopedic surgeon who has expertise in surgical treatment of this type of injury. Their other recommendations included:

• Nonsurgical treatment — including limits on physical activity and bracing and/or physical therapy — should be considered for patients with partial ACL tears that involve less than 50 percent of the diameter of the ligament
• Management after surgery may include weight-bearing and physical activity restrictions, physical therapy, knee strength-training exercises and a gradual, careful return to sports.

The study author, Dr. Jeremy Frank, a pediatric orthopedic surgeon at the Joe DiMaggio Children’s Hospital in Hollywood, Fla., stated in a news release that complications from ACL knee surgery are rare in youngsters when the appropriate operation is performed on the right patient.

A recent national study of ER visits raises a red flag on the rates of cuts and bruises for infants and toddlers and what is causing them…pacifiers, bottles and sippy cups.

Previous research on injuries related to bottle, pacifier, and sippy cup use has largely focused on case reports of infant injuries or fatalities attributed to pacifiers or pacifier parts causing asphyxiation or to bottle warming causing burns.

This study, published online May 14 and appearing in the June issue of Pediatrics. is the first to use a nationally representative sample to investigate the range of injuries requiring emergency department visits associated with bottles, pacifiers, and sippy cups among children aged 0-3 years.

Using a nationwide survey, researchers estimated that more than 45,000 visits to the emergency room between 1991 and 2010 in children under 3 years old were because of injuries related to using bottles, pacifiers and sippy cups.

Most injuries involved children aged between 1 and 2 years who had a bottle and fell and cut their mouth.

“A lot of parents baby-proof their house but don’t ever think about the possibility of an injury related to these products,” said Sarah Keim, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, and lead author of the study.

The American Academy of Pediatrics recommends that parents transition their children from a bottle to a cup between 12 and 15 months of age to avoid problems such as tooth decay. The AAP also recommends weaning babies off pacifiers between 6 and 12 months.

For the study, Keim and her colleagues collected data from the U.S. National Electronic Injury Surveillance System, a network of about 100 hospitals nationwide that record injuries in their emergency departments related to consumer products.

Two-thirds of the injuries were in children between 1 and 2 years. “This is right around the time that kids start to walk and run and aren’t very good at it yet,” Keim said.

About 66 percent of the injuries were related to a bottle, and 86 percent involved a fall.

It is not clear why more injuries were associated with bottles than the other products, Keim said. “There could be something about the products themselves that are potentially more dangerous or that children are using them more.”

Injuries related to pacifiers made up about 20 percent of cases. They occurred most often in children under 1 year old and led to bruising and dental damage. Sippy-cup injuries, which were most common in children older than 2 years, were more likely to affect the head, neck and face.

Keim said it was reassuring to see that choking injuries made up a small portion of overall injuries.

Having children stay seated while drinking may help protect them, the authors said.

To learn more about child product safety, visit Keeping Babies Safe.

(SOURCES: Sarah Keim, Ph.D., principal investigator, Center for Biobehavioral Health, Research Institute at Nationwide Children’s Hospital, Columbus, Ohio; Mark Zonfrillo, M.D., pediatric emergency medicine physician, injury epidemiologist, Children’s Hospital of Philadelphia Center for Injury Research and Prevention, and assistant professor, pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; May 14, 2012, Pediatrics