Taylor Ritter

ENC1102

Long-term effects of sports injuries sustained during

adolescence
The long-term effects of sports injuries obtained before the age of eighteen is a
subject that has minimal research on it, usually with more focus on prevention
methods for the injuries, rather than what actually happens to these individuals if
they have already obtained the injury. In this annotated bibliography I will be talking
strictly about the long-term effects of sports injures obtained by adolescents, and
not how to prevent those injuries. My target audience is for those who are directly
affected by this topic, such as the actual adolescents who have the potential to
experience these injuries, or the parents of these said individuals.
My references consist almost completely of scholastic journals, due to the
fact that this topic requires extensive knowledge on the subject and the ability to
conduct studies. Scholastic journals also allow for peer review, which is a vital
process due to constant changes in ideologies because of new research. I am
allowing my references to come from relatively older sources because of the lack of
research on this topic. This shortage of research comes from a tendency to not
follow-up on patients after they have received care, which prevents us from knowing
the long-term effects of various sports-related injuries. By knowing these long-term
effects, it gives credible-caution that should be followed when participating in sports
at a young age.
Many of the journal articles have a lexis that is not easily comprehendible. A
majority of the articles talk about injures to adolescents physeal plate. This is an

individuals growth plate that is responsible for growth of the long bones (bones that
provide strength and structure to the body); it can also be called growth plate, and
usually the plate is still open while you are growing, which is why people have a
concern for injures in this area. There are also specific types of injures mentioned
such as a tear to the anterior cruciate ligament. This is a ligament of the knee that
attaches the front of the tibia to the back of the femur, and it is often shortened to
ACL. Another detriment mentioned is osteoarthritis, which is the loss of cartilage
that causes extreme pain when joints are rubbed together, also called OA. The
professions for many of the researchers of the references will be shorted to MD
(Doctor of Medicine), or PT (physical therapist).

Bowerman, E., Whatman, C., Harris, N., Bradshaw, E., & Karin, J. (2014). Are
maturation, growth and lower extremity alignment associated with overuse
injury in elite adolescent ballet dancers? Physical Therapy in Sport, 15(4),
234-241. A study was conducted by Erin Bowerman, Chris Whatman, Nigel
Harris, (all associated with AUT University, Sports Performance Research
Institute NZ), Elizabeth Bradshaw (Australian Catholic University), and Janet
Karin (Australian Ballet School). The study was conducted at the Australian
Ballet School with forty-six dancers. The study took place over six months
with the goal being to access the relationship between maturity and injury
risk. The dancers were asked to rate their maturity levels using the tanner
scale (a scale that is rated one through five in your bodily development), and
their growth was determined through change in their foot length. The study

found that age, or maturity levels can be a factor due to the increased stress
on your soft tissue. Even with this possibility however, it was found that the
dancers maturity had no real effect on the likelihood of an injury occurring.
This study was important to my research because it showed a case
study where the injuries had no correlation to the individuals ages and
skeletal maturity levels. It shows that there are some cases, where maturity
and injury do not connect. This article provides a counterargument towards
the topic of age-related sports injuries.
Brucker, J., Sahu, N., & Sandella, B. (2015). Olecranon Stress Injury in an Adolescent
Overhand Pitcher: A Case Report and Analysis of the Literature. Sports
Health: A Multidisciplinary Approach, 308-311. A case study was performed
by Jason Brucker, Novneet Sahu, and Bradley Sandella (all associated with
the Christiana Care Health System in Wilmington, Delaware). In this article
they are focusing on olecranon stress injuries (olecranon is the bony part of
the elbow), specifically a case dealing with a seventeen year old baseball
pitcher. The seventeen year old pitcher complained of a severe pain I his left
olecranon (bony part of the elbow). An MRI showed that along the olecranon
there was an area of edema (collection of excess fluid in your bodily cavities);
it was then diagnosed as an olecranon stress fracture. He was promptly asked
to cease all physical activity. He was prevented from throwing for a period of
six weeks, and then went through physical therapy. They go into the different
factors that affect the likelihood of an olecranon stress fracture occurring,
including the age of an individual being a primary factor.

This is relevant to my research discussion because they discuss how an

athletes age can affect the severity of an olecranon injury. They state that an
athletes skeletal maturity, and the state of their epiphyseal plate. The
epiphyseal plate is only found in still growing individuals, once you have
matured it is turned into an epiphyseal line. If the plate has not completely
closed when this type of pressure and injury is enforced it can cause
patterned damage as well as a physeal-type stress injury that can have
dramatic consequences for throwing athletes.
Caine, D., DiFiori, J., & Maffuli, N. (2006). Physeal injuries in childrens and youth
sports: Reasons for concern? British Journal of Sports Medicine, 40(9), 749760. This is a scholarly research article conducted by D. Caine (Department
of Physical Education, Health and Recreation, Western Washington University,
Bellingham, WA), J. DiFiori (Division of Sports Medicine, Department of Family
Medicine, University of California, Los Angeles, CA), and N. Maffuli
(Department of Trauma and Orthopedic Surgery, Keele University School of
Medicine, Stoke on Trent ST4 7QB, UK). They discuss how injuries to the
physeal plate can damage your growing cells, which can in turn growth issues
in general. They state that a physeal injury is much more likely to occur
during rapid periods of growth because of muscle-tendon tightness around
the weak cartilage areas. They do mention however that this is a
controversial topic because some question the fact of whether or not you
have enough of a reduced flexibility during your youth to make that much an
impact.

This article gives a new reasoning as to why adolescents who take part in
sports are more likely to experience a physeal injury; but they give a warning
that this reasoning is not widely accepted, and seen more of a proposal.
Caine, D. J., & Golightly, Y. M. (2011). Osteoarthritis as an outcome of paediatric
sport: An epidemiological perspective. British Journal of Sports Medicine,
45(4), 298-303. Research was done by Dennis J. Caine (Department of
Physical Education, Exercise Science and Wellness, University of North
Dakota, Grand Forks, North Dakota, USA), and Yvonne M. Golightly (Thurston
Arthritis Research Center, The University of North Carolina, Chapel Hill, North
Carolina, USA) on some of the long term effects of different injuries in young
athletes. For example some athletes are required to have an operation where
they have to remove all, or partially remove their meniscus (cartilage formed
between two joints in the knee area). They state that this meniscus removal
causes an increased risk factor for earlier onset of OA. They also discuss the
link between ankle OA and its long-term consequences. They state that ankle
OA is less common than knee OA, but with more proven long-term effects.
They share that among professional football players obtaining at least one
ankle injury in their career makes them two point three times more likely to
be diagnosed with OA.
This article gives the long-term effects of injuries to the knee, and ankle,
which are two of the most commonly injured body parts among young
athletes.
Halstead, M. E., & Walter, K. D. (2010). Sport-Related Concussion in Children and
Adolescents. American Academy of Pediatrics, 126(3), 597-615. A research

study conducted by Mark E. Halstead (MD), Kevin D. Walter (MD) who are
both on The Council on Sports Medicine and Fitness, where they discussed
the long-term effects of concussions on adolescent athletes. They state that
athletes with a history of three or more concussions are likely to experience
loss of consciousness, or amnesia. Another effect of concussions was said to
be difficulty with processing complex visual stimuli.
Most of the scholarly articles I have cited deal with injuries to the athletes
growth plates, so this journal article gives insight to a different type of injury.
It shows that the long-term effects can more psychological, and not just
physical.
Hazle, C., & Duby, C. (2012). Anterior Cruciate Ligament Injury Diagnosis and
Management in a Pediatric Patient: A Case Report. International Journal of
Sports Physical Therapy, 7(6), 678-690. This case report was analyzed by
Charles Hazle and Cherie Duby, both Physical Therapists. They wanted to
discuss the effects of damage to the ACL. They presented a case of an eight
year old football player who sustained an injury during game play, which
turned out to be an ACL injury. He obtained surgery on the right knee and had
a successful return after rehabilitation.
The information discussed in this article is relevant to the discussion of the
effects of injuries in skeletally immature athletes because it provides the
differences between what happens with adolescents who sustain this injury
versus older individuals. For example in the article they talk about how
performing reconstruction on a person without a closed growth plate (usually
these are adolescents) is much more difficult because disruption can cause a

reduction in bone length. They must take precautions in the type of treatment
a patient undergoes just because of the factor of age. After surgery is
completed however the post-op procedures are almost identical to that of
adults.
Iverson, G. L., Gaetz, M., Lovell, M. R., & Collins, M. W. (2004). Cumulative effects of
concussion in amateur athletes. Brain Injury, 18(5), 433-443. A study was
conducted by Grant L. Iverson, Michael Gaetz (both associated with the
University of British Columbia Vancouver BC Canada), Mark R. Lovell, and
Michael W. Collins (both associated with the University of Pittsburgh Medical
Center Pittsburgh PA USA). The study chose amateur athletes who had a
history of three or more concussions from a database of athletes who had a
completed base-line record (testing done during the pre-season to use as a
base for comparison of the athletes memories), and a one to two day followup. The final sample came out to be thirty-eight player, nineteen with the
three or more concussions, and nineteen with no prior history of concussions.
These athletes were then asked to retake the base-line test they were
administered during the pre-season to see if there were any significant
changes. The testing found that athletes who had sustained three or more
concussions had lower memory scores compared to those that had never had
a concussion.
This study provides a non-physical long-term effect of a youth sports injury.
It showed that starting sports at a younger age can give you a higher risk of
obtaining multiple concussions, which in turn can give you less memory
proficiency.

Jayanthi, N. A., LaBella, C. R, Fischer, D., Pasulka, J., & Dugus, L. R. (2015). SportsSpecialized Intensive Training and the Risk of Injury in Young Athletes: A
Clinical Case-Control Study. The American Journal of Sports Medicine, 43(4),
794-801. This was a study performed by Neeru A. Jayanthi, Daniel Fischer,
Lara R. Dugus (all associated with the Stritch School of Medicine at Loyola
University in Chicago), Cynthia R. Labella (Institute for Sports Medicine, Ann &
Robert H. Lurie Childrens Hospital of Chicago, Department of Pediatrics,
Northwestern Universitys Feinberg School of Medicine), and Jacqueline
Pasulka (Institute for Sports Medicine, Ann & Robert H. Lurie Childrens
Hospital of Chicago). They studied the data of 1190 athletes who met the
criteria of being between seven and eighteen years old, and had sustained
some type of sports injury that needed referral. Their goal was to find if a
correlation between a variety of factors, including injury and growth. They
found that the relationship between injury and growth were not heavily
related.
The findings of this experiment gave my research another instance of where
injury endured by young athletes had no serious effects towards their overall
growth. With this however, they did admit that their study had several
limitations such as their research not being population based, and also the
fact that they had a wide age group that could have skewed the growth rated
downwards depending on how old the athlete was.
Lawrence, J. T. R, Argawal, N., & Ganley, T. J. (2011). Degeneration of the Knee Joint
in Skeletally Immature Patients With a Diagnosis of an Anterior Cruciate
Ligament Tear: Is There Harm in Delay of Treatment? The American Journal of
Sports Medicine, 39(12), 2582-2587. A study was conducted by J. Todd R.

Lawrence, Theodore J. Ganley (both associated with the division of

Orthopaedic Surgery, Childrens Hospital of Philadelphia, Department of
Orthopaedic Surgery, University of Pennsylvania), and Nina Argawal (Division
of Orthopaedic Surgery, Childrens Hospital of Philadelphia). They researched
sixty-nine patients with ACL tears, who were all under the age of fifteen. The
main goal of this article was finding out the appropriate time to undergo
surgery after an ACL injury. They do also talk about the benefits of
performing ACL surgery immediately, and waiting for the patient to become
more skeletally mature.
This article explains the dilemma of treating children with sports injuries. It
shows that going through surgery to fix the ACL injury will create better
stability, but could also cause growth damage. However they also explain
that waiting for skeletal maturity can cause too much instability to the knee,
and therefore cause even greater damage in the long run.
Lohmander, L. S., Englund, M., Dahl, L. L., & Roos, E. M. (2007). The Long-term
Consequence of Anterior Cruciate Ligament and Meniscus Injuries
Osteoarthritis. The American Journal of Sports Medicine, 35(10), 1756-1769.
This study was conducted by L. Stefan Lohmander, Ludvig L. Dahl, Ewa M.
Roos (all associated with the Department of Orthopaedics at Lund University
in Sweden), and Martin Englund (associated with the Department of
Orthopaedics at Lund University in Sweden, and Boston Universitys School of
Medicine). They wanted to study the long-term effects of an ACL tear. They
discuss how ACL tears are most common in athletes, and that the likelihood
of you getting osteoarthritis (the loss of cartilage in your joints causing pain)
once you have sustained an ACL injury is much greater.

This study gives evidence that the injuries you sustain during your youth as
an athlete can come back years later with hefty consequences on your
everyday life. It gives insight on a very common injury among many athletes
that usually happens before the time they are thirty.
Maffulli, N., Longo, U. G., Gougoulias, N., Loppini, M., & Denaro, V. (2009). Long-term
Health Outcomes of Youth Sports Injuries. British Journal of Sports Medicine,
44(1), 21-25. This was research done by N. Maffuli (Centre for Sports and
Exercise Medicine, Barts and The London School of Medicine and Dentistry,
Mile End Hospital, London, UK), U. G. Longo, M. Loppini, V. Denaro (all of the
Department of Orthopaedic and Trauma Surgery, Campus Biomedico
University, Trigoria, Rome, Italy), and N. Gougoulias (Frimley Park Hospital,
Frimley, Surrey, UK). In their article they discuss the long-term effects that
certain sports injuries can push upon athletes if sustained at a young age.
They talk about the physics, and the damages that can be done to it due to
certain athletic activities, for example with gymnasts; there have been cases
where their physeal plates have closed to early because of the stress that
their bodies must endure. This premature closing causes a disruption in
skeletal maturity levels.
This article shows some of the devastating effects that athletic injuries
sustained as a youth can have on your livelihood as an adult. Their various
examples of bodily defects that occur through sports provide a good amount
of information on the possible long-term effects of sports injuries.
Maffulli, N., Longo, U. G., Spiezia, F., & Denaro, V. (2010). Sports Injuries in Young
Athletes: Long-Term Outcome and Prevention Strategies. The Physician and

Sportsmedicine, 38(2), 29-34. This a research article done by Nicola Maffulli

(Centre for Sports and Exercise Medicine, Barts and The London School of
Medicine and Dentistry, London, England), Umile Giuseppe Longo, Filippo
Spiezia, and Vincenzo Denaro (all associated with the Department of
Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy).
In this article they discuss the various long-term effects of injuring different
parts of your body at a young age. They begin with the effects of the
disturbance of your physeal plate, which can cause length discrepancy,
angular deformity, or altered joint mechanics. They then move onto
apophyseal Injuries (injury of the apophyseal, which is a growth cartilage site
where the major tendon is inserted). With this specific injury they discuss the
risks of obtaining angular malalignment (mostly of the valgus or knee area, in
which the joint is facing outwards.) They also discuss spinal injuries in sports
such as gymnastics where the young athletes are subjected to repetitive
micro damage to their spines. They state that this repeated damage can
cause spinal deformities, and back problems into the young athletes futures.
They lastly discuss injuries of the lower extremities, such as the knee or
ankle, and how damage to these spots are risk factors for osteoarthritis as an
adult.
This article takes the research topic of long term effects of sports injuries on
youths, and separates it into various body parts, allowing for a more
extensive look into the athletes injuries.
Manzione, M., Puzzutillo, P. D., Peoples, A. B., & Schweizer, P. A. (1983).
Meniscectomy in children: A long-term follow-up study. The American Journal
of Sports Medicine, 11(3), 111-115. A study was done my Marc Manzione

(MD), Peter D. Puzzutillo (MD), Alan B. Peoples (MED, PT), and Paul A.
Schweizer (PT). The study consisted of skeletally immature individuals who
had to be treated for a meniscectomy at the Alfred I. duPont Institute. They
obtained final data on twenty individuals; the data was gathered through
questionnaires, and physical tests of their strength and abilities. They stated
that on follow-up twenty-five percent of the patients had what the examiners
considered excellent results, fifteen percent had good results, fifty-five
percent had fair results, and five percent had poor results. They found the
strength of the result through comparison to individuals of similar
characteristics (age,height,weight). The greatest difference between the
individuals who received meniscectomies, and those who had not was their
results in the hip abductor test (where the patient lays on their side and tries
to raise their leg upwards while receiving downwards resistance from a
physical therapist). These results concluded to the researchers that
meniscectomies are not simple procedure, especially on skeletally immature
individuals.
This article while old provides the results of an athletic injury sustained
during youth. It gives an example of how surgery to the meniscus, which is
easily injured during adolescents, can have long-lasting effects.
Mithfer, K., Minas, T., Peterson, L., Yeon, H., & Micheli, L. J. (2005). Functional
Outcome of Knee Articular Cartilage Repair in Adolescent Athletes. The
American Journal of Sports Medicine, 33(8), 1147-1153. A study was
conducted by Kai Mithfer, Howard Yeon (both associated with Department of
Orthopedic Surgery, Childrens Hospital, Boston, Massachusetts, Department
of Orthopedic Surgery, Brigham and Womens Hospital, Boston,

Massachusetts, Harvard Medical School, Boston), Tom Minas (Department of

Orthopedic Surgery, Brigham and Womens Hospital, Boston, Massachusetts,
Harvard Medical School, Boston, Massachusetts), Lars Peterson (Gothenburg
Medical Center, Gothenburg, Sweden), and Lyle J. Micheli (Department of
Orthopedic Surgery, Childrens Hospital, Boston, Massachusetts, Harvard
Medical School, Boston, Massachusetts). A study of twenty patients with
articular cartilage lesions underwent autologous chondrocyte transplantation
(procedure to repair a damaged ACL). All patients were no older than
eighteen, and some still demonstrated open growth plates. A follow-up of the
patients activity and ability status was recorded, with a mean forty-seven
months being the follow-up time. It was found that there was no difference in
recovery or physical level in those who had closed growth plates, with those
patients who did not.
This study showed that age and plate closure, were not contributing factors
in the long-term effects of this specific sports injury. This study found that
injury when your growth plates are still open, resulted in no long-term effects.
Moore, R. D., Broglio, S. T., & Hillman, C. H. (2014). Sport-Related Concussion and
Sensory Function in Young Adults. Journal of Athletic Training, 49(1), 36-41. A
research study was conducted by Robert D. Moore, Charles H. Hillman (both
associated with the Department of Kinesiology and Community Health,
University of Illinois), and Steven T. Broglio (School of Kinesiology, University
of Michigan). In the study they took thirty-eight individuals (nineteen had
endured a concussion before the age of eighteen, and the other nineteen had
never been concussed) and performed tests on them in order to measure
their visual processing. They state that the largest peak after stimulus

inversion is given the name P1. After the testing they found that those who
had previously had concussions had lower P1 levels than those who had
never experienced a concussion. Because of this data they concluded that
there is a reason to correlate concussions sustained during youth with
impaired visual processing skills. They found however that there was no
correlation between number of concussions, and the time since the
concussion had been endured.
This article concluded that factors such as number of concussions, and time
since a concussion are not important in an individuals visual processing skill.
This opposes other works on concussions that state more concussions cause
greater likelihood for impairment.
Patel, D., & Nelson, T. (2005). Sports Injuries in Adolescents. Medical Clinics of North
America, 84(4), 983-1007. Research was conducted by Dilip Patel
(Departments of Pediatrics and Adolescent and Sports Medicine, Michigan
State University Kalamazoo Center for Medical Studies), and Terry Nelson
(Departments of Pediatrics and Adolescent and Sports Medicine, Michigan
State University Kalamazoo Center for Medical Studies, and Southwestern
Michigan Sports Medicine Clinic, Kalamazoo, Michigan) on the effects of
sports injuries on athletes. They discuss why adolescents are more prone to
injuries, and how these injuries can affect them in the long run. They discuss
how repetitive use of a specific body part, without any rest for proper
remodeling is what causes a stress fracture, and can in turn cause a physeal
injury. These physeal injuries can cause angular deformation due to improper
remodeling of the bones.

This article gives another reasoning as to why adolescents are so prone to

these injuries that can affect them for very long intervals of time. It gives a
new proposal which is inadequate remodeling time for the adolescents
bones.
Shanley, E., & Thigpen, C. (2013). Throwing Injuries in the Adolescent Athlete.
International Journal of Sports Physical Therapy, 8(5), 630-640. This is a
research article conducted by Ellen Shanley (Proaxis Therapy, Greenville, SC,
Hawkins Foundation Greenville, SC, and Rocky Mountain University of Health
Professions Provo, Utah), and Chuck Thigpen (Proaxis Therapy, Greenville, SC,
Hawkins Foundation Greenville, SC). The article specifically goes into the
detail of injuries sustained by young softball and baseball players, due to the
overuse of their upper extremities, such as the shoulder and elbow. They first
discuss injuries relating to the shoulder, and the different symptoms; with
throwing athletes it is very common to find that there is a widening of the
proximal humeral physis. This only happens in adolescents because their
growth plates are still not fully closed. They then go on to discuss elbow
injuries and the risk of Panners disease (developmental derangement of the
elbow).
This provides another example of the effects of injuries specific to young
athletes. Breaking down the condition between baseball and softball players
shoulders and elbows gives a more specific example of what long term
effects can occur.
Spector, T. D., Harris, P. A., Hart, D. J., Cicuttini, F. M., Nandra, D., Etherington, J.,
Wolman, R., Doyle, D. V. (1996). Risk of osteoarthritis associated with long-

term weight-bearing sports: A radiologic survey of the hips and knees in

female ex-athletes and population controls. Arthritis & Rheumatism, 39(6),
998-995. A research study was conducted by Tim D. Spector (St. Thomas'
Hospital, London, UK, Department of Rheumatology, St. Thomas' Hospital,
Lambeth Palace Road, London), Pat A. Harris, Deborah J. Hart, Flavia M.
Cicuttini, Dabir Nandra, John Etherington (all associated with St. Thomas'
Hospital, London, UK), Roger L. Wolman (Royal National Orthopaedic Hospital,
Stanmore, UK), and David V. Doyle (Whipps Cross Hospital, London, UK). In
this study eighty-one female ex-athletes participated in order to find out the
correlation between playing sports as a youth and OA; the athletes were
compared to a control group. The most prominent difference between the
control group and the ex-athletes was found in the hips, where ex-athletes
showed much greater osteophyte formation (bony outgrowth associated with
the degeneration of cartilage at joints).
This article found a clear correlation between sports intensity in your
younger years affecting your body in your later years. OA appears from
increased stress to your joints, which in athletes is caused by their constant
pressure to them, this article shows the follow-up to that applied stress in
your later years.