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 LongTerm 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).
The Research Gap
Research done on the long-term effects of athletic injuries is lacking in
abundance, and because of this we have not found a conclusive answer on
whether or not there is in fact a correlation between these injuries that
happen at a young age. 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.

Project Proposal
A way to allow for a more conclusive answer to come to the forefront is
to perform a test study with several different groups. I believe the best way
to do this would be by gathering several sports teams, that are comprised of
individuals no more than seventeen years old. Once the participants are
obtained, a baseline test of their physical abilities and maturity levels would
need to be performed. The baseline test should consist of physical tests,
such as tests of flexibility, strength, height, weight, and maturity (using the
Tanner Scale which is a scale of development, which the participants would
place themselves in). Mental tests should also be administered to measure
things such as memory, and visual recognition time. The tests should be
done by the participants family health care facility. The participant can then
give a copy of the results to the establishment running the study.

Once these baseline tests are performed, I would retest the

participants approximately once every three years until they are in their late
twenties. During these check-ups it should be asked if any new injuries have
been sustained, and if the injury feels like it is affecting their everyday life,
because the whole point of knowing the long-term effects of these injuries, is
to show the difficulties that they can implement on you later in life. These
periodic check-ups will show the changes in the participants development
levels, in terms of their physicality, mentality, and maturation. Once the last
test is administered, it should be clearly asked whether or not the
participants believe they are experiencing any long-term effects of the
injuries that they sustained during adolescence.
Once all of the results have been gathered, patterns of injures and
long-term effects need to be looked for in order to clearly figure out if these
injures can cause serious consequences later in life. If no correlation is found
then nothing can really be done to change anything. However, if there is
found to be a clear relationship between these injures, and these long-term
effects, then certain actions can be taken. For example, better protective
equipment made with more regulated material, as well as new requirements
for safety gear. For many sports, safety equipment such as faceguards are
optional, but by making such equipment mandatory, I believe it would cut
down on some the serious injuries that happen to adolescents that could
cause them consequences in the future. This experiment would allow for a
more concrete answer on the subject of injuries on adolescents, and by

finding this answer we can make the activity of sports more safely regulated
for the sake of the youths future.

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).