Lyle J. Micheli Introduction (04:55)
Mary Lloyd Ireland provides an overview of Dr. Lyle J. Micheli's career achievements and contributions to the field of sports medicine, including researching evidence based injury prevention and treating young athletes.
Recalling Dr. Sutton (02:20)
Dr. Micheli tells a story of John R. Sutton injecting Methylene blue into an inebriated friend as an experiment. While lecturing at a sports medicine program, Dr. Micheli encountered Dr. Sutton visiting the Statue of Liberty before his talk.
ACL Story (02:34)
Dr. Micheli provides an overview of ACL surgical repair developments from the 1950s to today. Pediatric orthopedists believed knee injuries were rare in children; they were likely not recognizing them.
Young Athlete's Knee (01:41)
Knee injuries can involve collateral or cruciate ligaments; intrasubstance tears seem to be increasing. Growth plates are a concern in pre-pubescent reconstruction and ACL tears affect both genders equally.
Diagnosing ACL Injury in Children and Adolescents (00:58)
Hemarthrosis and a Lachman test are good indicators of ACL injury. An MRI is conclusive.
Treating ACL Injury in Children and Adolescents (02:07)
Dr. Micheli discusses the operative management controversy; non-operative management has not been very effective. Treatment factors include biologic age, injury type, and severity; a bone age assessment should be taken from the left wrist. Heavy training delays maturation.
Child ACL Controversy: Operative vs. Non-Operative (01:58)
Dr. Micheli cites studies showing treating child ACL injuries with a brace and exercise is insufficient. Delaying surgery increases medial meniscus injury risk, and deficient ACLs damage other knee parts.
Child ACL Controversy: Which Operation? (02:23)
Options include extra-articular, physeal sparing, partial transphyseal, and complete transphyseal options. Dr. Micheli treated a three year old boy with a congenitally absent ACL with a modified McIintosh procedure. View examples of drilling through the tibia to avoid growth plates.
Child ACL Controversy: Operation Safety (03:50)
Decision parameters include safety, efficacy, biomechanics, and long term outcome. Surgical complications are under-reported. Studies show drilling holes in animal growth plates disturbs growth.
Femoral Physeal Injury (03:01)
The femoral physis growth plate is highly susceptible to injury. Dr. Micheli discusses percutaneous pinning and femoral intra epiphyseal tunnel options. In an anonymous survey, pediatric orthopedic surgeons reported growth disturbances from child ACL reconstructions.
Child ACL Controversy: Biomechanics (01:47)
A study found ITB pediatric ACL constructs best restored knee stability, over epiphyseal and trans-tibial constructs. Dr. Micheli discusses considerations in drilling holes through the physis.
ITB Extra/Intra Repair Evolution (01:49)
Dr. Micheli explains his modified McIntosh procedure for child ACL injuries. He began with congenitally absent ACLs, and then operated on meniscus tears.
Child ACL Controversy: Long Term Outcomes (02:07)
Dr. Micheli looks at follow up studies on ACL reconstructions; many do not report bone age and few follow up beyond five years.
"Anatomic" Reconstruction? (02:00)
Pediatric orthopedic surgeons try to reproduce the anatomy in child ACL operations. There is little consensus about which procedure to use, and for what age. A meta-analysis identifies the need for prospective studies, large N, and defined rehabilitation post-operation protocols.
Future Biological ACL Repair (01:56)
Dr. Micheli discusses Dr. Martha Murray's work on direct ACL repair, as opposed to reconstruction. It will require designing a scaffold to deliver growth factors encouraging ACL healing.
Boston Marathon Bombing (03:48)
Dr. Micheli quotes "Death of Dangerous Dan McGrew" in remembrance of Dr. Sutton. Dr. Micheli's team has attended the finish line since 1975. He describes providing emergency medicine and saving lives after the terrorist attack.
Credits: ACL Injuries in the Child Athlete: Where Are We? (00:27)
Credits: ACL Injuries in the Child Athlete: Where Are We?
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