Young athletes can succeed only if they can perform at their best. To best meet the current and future needs of young athletes, the Nicklaus Children’s Hospital Orthopedic, Sports Medicine and Spine Institute continues pushing forward as a leader in the sports medicine arena.

Our orthopedic surgeons and sports medicine physicians work with in-house sports rehabilitation specialists, nutritionists and mental health experts to focus on return-to-sport and re-injury prevention so children can stay active and healthy.

“In years past, “pediatric sports medicine” focused more on the younger teenage patient population,” says Craig Spurdle, MD, pediatric orthopedic surgeon, sports medicine physician and Chief of Orthopedic Surgery at Nicklaus Children’s. “We’ve recently expanded our service to give more deserved attention to adolescents and older teenagers who are in need of specialized care because of their uniquely higher rates of re-injury compared to adults and their continued stages of growth and development; not just from a skeletal perspective but from a neuromuscular control perspective.”

Teenagers may not be receiving the best care when seen as “small adults” by adult sports doctors. They require and deserve specialized care appropriate to their stage of development both physically and mentally.

Detecting and Correcting Injury Risk

Nicklaus Children’s sports medicine experts spend ample time educating and training young athletes in injury prevention.

For most young athletes, this education and training begins at school. Currently, Nicklaus Children’s provides athletic training services to more than 35 schools in the community, and the number of contracted schools continues to increase. Through these partnerships, pediatric-trained athletic trainers are embedded within the local schools. There, they serve at practices and games, identifying risks for injury, then preventing and treating injuries.

Certain athletes at risk may benefit from the Sports Medicine Program’s 3D motion analysis capabilities. This technology permits sports medicine experts to evaluate healthy athletes and develop individualized neuromuscular training programs that aim to improve technique and movement. The end goal is reducing the risk of injury, especially in children at higher risk.

“Female athletes are up to five  times more likely to experience ACL injury or reinjury,” Dr. Spurdle says. “Our injury prevention techniques have helped reduce that risk for all athletes, especially our most “at risk” group, adolescent females.

Should an athlete require rehabilitation, emergency care or orthopedic intervention following an injury, our embedded trainers act as conduits for athletes, providing streamlined access to appropriate orthopedic surgeons and other specialists.

Full Suite of Surgical Services

With the addition of two sports medicine surgeons, Nicklaus Children’s advanced surgical intervention capabilities meet all a young athlete’s sports medicine needs. Because pediatric athletes have not finished their growth and development, surgical techniques must take this into consideration, particularly when performing  ACL reconstructions.

“Unfortunately, ACL reconstruction is a common need among the pediatric patient population,” Dr. Spurdle says. “These athletes are still growing, which means that these  ACL reconstructions are technically different than adult reconstructions, taking into account the remaining growth depending on the patient’s  individual’s stage of development. For example, Soft-tissue grafts are often required in this population, as bone-tendon-bone construction may disrupt growth.”

To meet the specific needs of each patient, surgeons choose the safest reconstruction for the patient taking into account the growth remaining and skeletal maturity.For ACL reconstruction, these include the following:

Tanner 1 and 2 

• Growth sparing procedures:
  • 1) Micheli-Kocher IT band Intra/extra articular reconstruction
  • 2) all epiphyseal ACLl reconstruction (soft tissue grafts)

​Tanner 3

• Growth respecting ACL reconstruction: partial transphyseal, transphseal, or growth sparing-soft tissue grafts.

Tanner 4

• Transphyseal growth respecting procedure: soft tissue grafts.

Tanner 5

• Transphyseal standard adult techniques: soft tissue or Bone tendon Bone grafts (patellar tendon). 

For our soft tissue grafts we strongly advocate the use of autograft tissue (from the patient). This has been shown to have a much lower reinjury rate compared to donor tissue (allograft). Some studies suggest the use of allograft (donor tissue) can have up to a 25-40% increased risk of reinjury.

Of these autograft options, quadriceps grafts are gaining in popularity. Dr. Spurdle is impressed with quadriceps’ validating research, which indicates excellent outcomes and low  reinjury rates, with a low morbidity from the donor site compared to other source of autograft such as bone tendon bone patellar tendon and even hamstring grafts. In the long run, Dr. Spurdle anticipates quad grafts may prove superior in many ways to hamstring grafts.

Opting for Repair Over Reconstruction

While advances in reconstruction and physical therapy are improving recovery and reducing reinjury rates, such an invasive procedure is not always necessary or ideal for some pediatric patients. In a select subset of patients, we are now able offer ACL repair (rather than reconstruction) using bridge-enhanced anterior cruciate ligament repair (BEAR).

In March 2023, Nicklaus Children’s became the first pediatric hospital in South Florida to offer BEAR. Thus far, athletes who have undergone BEAR at Nicklaus Children’s have experienced reduced post-operative pain and regained motion and motor control faster than with ACL reconstruction, achieving excellent stability compared to standard reconstructions.

As of December 2020, the FDA has authorized the procedure for patients age 14 and older.

Pushing Sports Medicine Forward

Experts within the institute’s Pediatric Sports Medicine Program work diligently to remain at the forefront of care. To that end, we regularly review patient data to determine:

• Effectiveness of our injury program in meeting prevention goals throughout the athletic season

• How specific surgical approaches/techniques affect patient outcomes

• Whether certain graft types affect outcomes

Additionally, we recently reviewed outcomes and reinjury rates comparing medicaid derivative insurance plans vs commercial insurance plans. Through our research, it was not surprising to discover that physical therapy access does affect outcomes. To this point, we established, from a private donor, our first fully funded injury prevention program with 3D motion analysis for ACL injury prevention that provides access to all regardless of their ability to pay. We are very proud to offer this service to our community!

A Robust, Multidisciplinary Team

Our three pediatric sports medicine surgeons and 15 pediatric athletic trainers work closely with other pediatric specialists to provide holistic care. Our team collaborates with:

• Endocrinologists to address overtraining that may cause fractures, hormonal imbalances or menstrual irregularities in female athletes

• Mental health experts, who help elite athletes gain a competitive mental edge

• Neurologists to address concussions, head and spinal cord injuries, and other neurological conditions that may interfere with athletic abilities

• Nutritionists who work with families to help ensure children receive proper nutrition that fuels activities and helps them recover from injuries

• Rehabilitative care therapists specialized in Sports Medicine—who work with athletes on injury prevention techniques, rehabilitation required after a procedure and return-to-sport care to prevent re-injury.

Along with medical expertise, sports medicine team members have personal athletic experience. Many clinicians performed at high levels, including Dr. Spurdle, who is a former member of the U.S. World Cup Ski Team. As a result, Nicklaus Children’s is uniquely qualified to understand the mindset and drive of young athletes.

“We eat, breathe and live pediatric sports medicine, and we empathize with injured athletes and their families, because we’ve been there before,” Dr. Spurdle says. “Our hearts are in everything we do, and our patients feel that compassion and respond positively to it.”

Email the Nicklaus Children's physician liaison team to learn more about the Nicklaus Children’s Pediatric Sports Medicine Program.