Taylor Ritter

ENC1102
Literature Review

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. However the
research that has been done on the subject continues to be met with
conflicts, due to various studies showing no long-term effects (Bowerman,
Whatman, Harris, Bradshaw, & Karin, 2014; Jayanthi, LaBella, Fischer,
Pasulka, & Dugus, 2015; Mithfer, Minas, Peterson, Yeon, & Micheli, 2005),
while others show that there is evidence of long-term effects (Brucker, Sadu,
& Sandella, 2015; Caine, Golightly, 2011; Lohmander, Englund, Dahl, Roos,
2007; Maffulli, Longo, Gougoulias, Loppini, & Denaro 2009; Maffulli, Longo,
Spiezia, Denaro, 2010; Patel, & Nelson, 2005; (Shanley, & Thigpen, 2013;
Spector, Harris, Hart, Cicuttini, Nandra, Etherington, Wolman, & Doyle, 1996).
These studies were done on several injuries including, injury to the physeal
plate, knee, ankle, anterior cruciate ligament, and concussions. Due to these
conflicts another conversation has emerged, which is does surgery, at a
young age, on these sports-related injuries also cause long-term effects
(Caine, & Golightly, 2011; Hazle, & Duby, 2012; Lawrence, Argawal, &
Ganley, 2011; Manzione, Puzzutillo, Peoples, & Schweizer, 1983; Mithfer,
Kinas, Peterson, Yeon, Micheli 2005)? This literature review attempts to

gather the various pieces of this conversation, and ask if there is a definitive
answer for whether or not there is a correlation between the long-term
effects of sports-related injuries and age.

Injures That Have More Conclusive Evidence on Their Long-Term

Effects
Many believe that injuries to certain body parts during adolescence can
cause an increased risk for osteoarthritis (OA) in the future. It was found in
professional football players that sustaining one ankle injury during their
careers increases their likelihood of getting OA (Caine, & Golightly, 2011). A
fairly common athletic injury is damage to the anterior cruciate ligament
(ACL), which is believed to also cause an increased chance for OA due to the
stress you have caused to the knee, which is a highly jointed area
(Lohmander, Englund, Dahl, & Roos, 2007). One specific study compared exathletes to non-athletes, and found that the ex-athletes with increasing age
had greater osteophyte formation, which is a bony outgrowth associated with
the degeneration of cartilage at joints (Spector et al., 1996).
It is widely agreed upon that head injuries that occur during
adolescence have some long-term impact. It is said 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 (Halstead, & Walter, 2010).

Through studies on football players it has also shown that those individuals
who have had concussions, scored lower on an administered memory test
than those who had not sustained a concussion (Iverson, Gaetz, Lovell, &
Collins, 2004). We have also been lead to believe that concussions create
impaired visual processing skills (Moore, Broglio, & Hillman, 2014).
Injuries That Have Controversial Opinions on their Long-Term Effects
There is an increasing amount of conflicting research on the topic of
growth plate injuries sustained by adolescents. Many studies have found that
injury to this area, when an individuals growth plate is still unclosed can
cause consequences such as physeal-stress fractures (Brucker, Sadu,
Sandella, 2015), reduction in bone length (Hazle, Duby, 2012), skeletal
maturity disruption (Maffulli, Longo, Gougoulias, Loppini, & Denaro, 2009),
length discrepancy, angular deformity, or altered joint mechanics (Maffulli,
Longo, Spiezia, & Denaro, 2010), or improper bone remodeling due to
constant stress (Patel, & Nelson, 2005). Most of this research however is
more theory based, than actual test studies.
On the other side of the debate, it is said that there is no real
correlation between sports injures and age (Bowerman, Whatman, Harris,
Bradshaw, Karin, 2014; Jayanthi, LaBella, Fischer, Pasulka, & Dugus, 2015).
This conclusion was made through actual studies of adolescents who
participated in sports, and not just theories as to what could potentially
happen. Some studies have admitted however that their results may be

skewed due to a wider allowed age range (Jayanthi, LaBella, Fischer, Pasulka,
& Dugus, 2015).
Long-Term effects of Surgeries
Once the injury has occurred, there is the dilemma of deciding whether
or not surgery is necessary, and if it is what will be the long-term
consequences? It is brought up that performing a surgery during skeletal
immaturity can cause growth damage, but gives the individual better
stability; while waiting too long to become skeletally mature may cause the
adolescent greater instability in the long run (Lawrence, Argawal, & Ganley,
2011; Hazle, & Duby,2012). Some athletes must have a procedure which
requires the partial, or entire removal of the meniscus; and there has been
studies that link this surgery with an early onset of osteoarthritis (Caine, &
Golightly, 2011). In another test on young individuals who had undergone
meniscus removal, it was found that they had reduced results in their hip
redactor tests compared to those individuals who had not undergone
meniscus removal (Manzione, Puzzutillo, Peoples, & Schweizer, 1983).
Proposal
Research done on the long-term effects of athletic injuries is lacking in
abundance. Some studies have found that there is no real effect of these
injuries, even if they are sustained during adolescence, while others believe
there can be extreme consequences if these injuries happen at too young of
an age. This being said however, it seems that the type of injury correlates

with the amount of conflict there is on the subject. For example the
discussion of whether or not physeal plate injures have long-term effects is
very controversial with the findings being almost half and half. While injures
such as concussions, or ACL injures are mostly accepted as having high a
potential for long-term effects. By performing experiments that keep up with
the adolescents for a longer period of time it would allow for more conclusive
evidence that backs up one side of the argument more.

Works Cited

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.

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.

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.

Halstead, M. E., & Walter, K. D. (2010). Sport-Related Concussion in
Children and Adolescents. American Academy of Pediatrics, 126(3),

597-615.
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.

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.
Jayanthi, N. A., LaBella, C. R, Fischer, D., Pasulka, J., & Dugus, L. R.
(2015). Sports-Specialized 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.

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.

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.
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.

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.

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.

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.

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.

Patel, D., & Nelson, T. (2005). Sports Injuries in Adolescents. Medical

Clinics of North America, 84(4), 983-1007.

Shanley, E., & Thigpen, C. (2013). Throwing Injuries in the Adolescent

Athlete. International Journal of Sports Physical Therapy, 8(5), 630-640.

Spector, T. D., Harris, P. A., Hart, D. J., Cicuttini, F. M., Nandra, D.,
Etherington, J., Wolman, R., Doyle, D. V. (1996).