New Strategies Help Stem Rising Injuries Among Young Athletes

It was a sunny afternoon in late October, opening day of the soccer season, and Karissa Zuriarrain, a 15-year-old starting midfielder for Coral Gables High School, was racing to steal the ball. She planted her left foot in the grass and cut toward her right. And with that, her soccer season ended.

She heard the sickening sounds — pops and cracks — before she felt the searing pain. Karissa had torn her meniscus and anterior cruciate ligament, or ACL, an injury to which female athletes in high-intensity sports are especially prone.

(Pictured: John Zvijac, M.D., examines Karissa Zuriarrain’s knee before her surgery.)

It was not the first or last time a player was carted of the field that afternoon.

Before Karissa went down, a teammate sprained her ankle, and in the second half, a South Miami High player suffered the game’s second severe knee injury. By midseason, the Gables team had lost more players to injuries, including a broken collarbone, a concussion and a torn calf muscle.

The rise of organized and competitive sports among youth has led to a corresponding rise in injuries and new strategies to prevent them. “We don’t spend a shift without seeing a sports injury,” said Tony Tavarez, M.D., associate medical director of the Baptist Children’s Hospital Emergency Center.

For some youngsters, the care doesn’t end in the ER.

From football, basketball, soccer, baseball and tennis players to swimmers, crosscountry runners and cheerleaders, young athletes are being seen in record numbers by the specialists at the Center for Orthopedics and Sports Medicine at Doctors Hospital and West Kendall Baptist Hospital. At the Doctors location, specialists see youths ages 12 and up. At the West Kendall location, orthopedic surgeon Charles Jordan, M.D., who specializes in traumatic injuries, sees kids ages 5 and up, and also works in the Baptist Children’s Hospital ER.

Led by the Center’s medical director, John Uribe, M.D., the sports medicine team has cared for Olympic, professional and other elite athletes for more than two decades, as well as the high school crowd. Dr. Uribe, Keith Hechtman, M.D., and John Zvijac, M.D., serve as voluntary medical advisors for Miami-Dade Public Schools’ Athletic Program.

“It’s a cornerstone of our practice,” said Dr. Uribe, team physician for the Florida Panthers. In the late 1980s, “I felt a strong need to take care of high school kids, especially in the inner city, which was underserved.”

(Pictured Below: Directed by physical therapist Valerie Wideroff, Karissa Zuriarrain practices
her gait after knee surgery, bearing only a fraction of her weight.)

Th­e program continues today, with Center sta‑ giving free physicals at public high schools to athletes before they are cleared to compete. ­ e Center also has a representative on the sidelines at every public high school football game and runs clinics for coaches and athletic trainers on reducing risks. “­ e best way to treat an injury is to prevent it,” said Dr. Hechtman, team physician for Florida International University. He notes a rise in the injury rate even among pre-adolescents. “I just repaired a growth-plate shoulder injury on a 12-year-old lacrosse player.”

At Karissa’s first appointment, Dr. Zvijac explained why female athletes are more at risk of an ACL rupture.

Located behind the kneecap, the ACL acts like a taut rubber band that attaches at the femur, or thighbone, and the tibia, or shinbone.

The ligament stabilizes the joint when the knee twists and it prevents the tibia from sliding forward. An ACL tear often occurs when athletes land a jump or switch directions quickly.

Girls tend to run more upright than boys, Dr. Zvijac said, which may put more stress on the knee during high-intensity moves. After puberty, girls’ hips grow wider, sometimes resulting in knock-knees, which also stress the joint. Estrogen makes adolescent girls’ ligaments more lax, and that, combined with lower muscle mass and a narrower notch where the ACL attaches to the femur, also puts girls at greater risk.

Dr. Zvijac made plans to repair Karissa’s injury surgically by using a piece of her patellar tendon to reconstruct the torn ACL. But ­ first he prescribed three sessions of physical therapy. “If you get motion back before surgery, we get better results,” Dr. Zvijac said. “It will feel better and the rehab will be quicker.”

Team physician for the Tampa Bay Buccaneers, Dr. Zvijac sometimes follows his high school patients all the way to the pros.  That’s the case with­ the Tampa Bay players he treated when they were teenage football players.

Despite the rise in injuries among young female athletes, football still accounts for nearly half of all the youth sports injuries seen at the Center.

A year ago, Dr. Uribe was working the sidelines during a Central High football game against Northwestern when Central standout sophomore running back Dalvin Cook got sandwiched between two defenders. “His shoulder popped out,” said Dalvin’s mother, Betty Cook. “Dr. Uribe put it back in place on the sidelines.”

When Dalvin went to the Center for follow-up, he saw Dr. Hechtman and his team. “Dalvin became very comfortable with those guys and that made me decide that this was where he needed to be,” Ms. Cook said. “I would recommend those doctors to anyone with a sports injury.”

Dr. Hechtman performed the outpatient surgery at Doctors Hospital to repair Dalvin’s damaged shoulder. Now a junior, Dalvin was back on the ­ eld for the 2012 season, leading Central to the 6A state championship in December. Dr. Hechtman watched Dalvin play a game late in the season. “I saw him return a kicko­ff for a touchdown and run a total 155 yards,” he said with pride.

Karissa is hoping for a similarly spectacular recovery. Her rehab began at home the same day as her surgery, with a CPM (continuous passive motion) machine.

The machine moved her leg as she lay in bed. “You relax and the machine does the work,” explained Jorge Giral, Karissa’s physical therapist. “It’s a friendly way to restore movement as soon as possible.”

About a week later, she started therapy three times a week at Doctors Hospital’s new outpatient sports medicine rehabilitation center. Therapy included biofeedback and electrical stimulation to help her quadriceps muscle start “firing” again, massage on her knee to remove scar tissue, and various exercises. She also was zipped from the waist down into an anti-gravity treadmill, which fills with pressurized air, so she could practice her gait bearing a fraction of her body weight. “It helps restore a normal walking pattern,” Mr. Giral said.

Less than six weeks after surgery, Karissa was walking without a crutch. “It’s harder than I thought it was going to be, but I’m walking sooner than I thought,” she said.

Karissa’s mother, Jennifer Zuriarrain, said her family’s experience with the Center has softened the blow of Karissa’s injury. “I could not wish more from a doctor or hospital,” she said. “We’ve had excellent care. Karissa loves going to therapy.”

Karissa hopes to be cleared to resume play for her traveling soccer club when the season begins in August.

“When I come back,” Karissa said, “I’m going to be better than before.”