Growing Pains
Trends converge to create a whole generation of people who require orthopedic care at a young age
by Bill Donahue


With Americans living longer and staying active well into their so-called twilight years, it’s no surprise that orthopedic surgeons are treating a greater number of older patients with bone- and joint-related ailments each year. But local surgeons such as Richard Zamarin, M.D., F.A.C.S., are also seeing the reverse.


“Absolutely,” says Dr. Zamarin, when asked if he has noticed a spike in the number of teenaged patients who need treatment for bone or joint troubles. Dr. Zamarin does approximately 350 surgeries per year, with his practice focusing mostly on knee-and-hip replacements and sports rehabilitation. He has a rather simple explanation for the rise: overuse, combined with a lack of recovery time.


“With young kids playing sports, lots of parents don’t give their kids time to rest,” says Dr. Zamarin, an orthopedic surgeon with RSZ Orthopaedics, which has locations in Bala Cynwyd, Limerick, Paoli and Phoenixville. “They’re playing sports year round—football, soccer, basketball—and that has a high impact on the joints. Kids wind up paying for it in their 30s and 40s; a lot of them will end up with bad arthritis and other problems.


“As the population continues to grow and age,” he adds, “this will only become more prevalent.”


Although some sports-related injuries are the result of genetic predisposition, research suggests an increasing number of orthopedic issues are linked to excessive sports play at a young age. Some of the most common orthopedic injuries associated with this trend include sprains and other overuse injuries, stress fractures and sprains, shoulder problems and tears of the anterior cruciate ligament (ACL), according to the American Orthopaedic Society for Sports Medicine, Rosemont, Ill.


Overuse injuries: Examples of overuse injuries, which stem from repetitive “micro-trauma” to the tendons, bones and joints, include wrist fractures, ankle sprains and shoulder dislocations. Nearly 50 percent of all injuries sustained by middle school and high school athletes are the result of overuse, with approximately 3.5 million children receiving treatment for overuse injuries each year. Ankle sprains are perhaps the most common sports injury among young athletes, with 25,000 occurring in the United States daily.


Stress fractures: Depending on the sport and other risk factors, the annual incidence of stress fractures among athletes ranges from 5 percent to 30 percent. Children may be at greater risk because their bones have yet to reach full density and strength.


ACL injuries: The ACL, which connects the front top part of the shin bone to the back bottom part of the thigh bone, is one of the most commonly injured ligaments, often the result of a direct blow to the knee. (Tears of the meniscus, which is a wedge of cartilage that cushions the knee, are often associated with ACL injuries.) Approximately 150,000 ACL injuries are treated in the United States each year, accounting for an estimated half-billion dollars in health-care costs each year. Female athletes who participate in basketball and soccer are two to eight times more likely to suffer an ACL injury.  


Shoulder dislocations: As the most mobile joint in the body, the shoulder is also prone to injury because it has less stability than other joints. More than 70,000 shoulder dislocations—in which the ball of the upper arm comes out of the socket, either partially or completely—occur in the United States each year. Chronic shoulder instability is often treated with nonsurgical means, though surgery may be needed for problem cases.


A Heavy Price

Local physicians suggest another reason for the increase in the number of young people in need of orthopedic treatment: obesity. Obese children who do not lose the excess weight before adulthood face a host of complex and potentially life-changing musculoskeletal disorders, such as osteoarthritis due to stress on the joints, which in turn could require premature surgery in the form of knee and hip replacements for young adults.


In addition, obesity has been linked to an increased risk of orthopedic “wear and tear” syndromes. These syndromes, including Blount’s disease (which causes the leg bones to bow and thicken from the constant stress of weight those bones were not meant to bear) and conditions involving the growth plate of the hip bone, could require corrective surgery.


The obesity epidemic will likely worsen as the prevalence of obesity in the United States increases in adults and children alike. More than 66 percent of U.S. men and women ages 20 years and older are overweight, and almost 32 percent are obese, according to data from the National Health and Nutrition Examination Survey.


As with most medical issues, experts suggest moderation and a commitment to healthy behaviors. For teens and young adults struggling with their weight and eating habits, commit to regular exercise and adjust the size, quality and frequency of meals. For teenaged aspiring athletes, take a cue from professional athletes by indulging in an offseason.


“Going from playing football to playing basketball to playing soccer then on to something else isn’t healthy for your body,” says Dr. Zamarin. “Parents wonder why their kids’ knees hurt. That’s why. … You’ve got to give kids time to rest.”