Revista de Medicina Desportiva (English) May 2018 - Page 13

The articular cartilage of children and adolescents is less resistant to the forces of compression, tension and shear forces than that of the adult, being the increased risk in periods of faster growth. 10 There are two injury mechanisms: acute lesion (chondral or osteochondral fracture) or chronic, overload (Osteochondritis dissecting and microtraumatic). Sev- eral classifications of cartilage lesions have been described in the literature, with the most used classifications of Outerbridge 11 and the International Cartilage Research Society (ICRS). 12,13 The therapeutic recommendation for the lesions of the articular car- tilage, particularly in the paediatric population, is not consensual, and the most showed is the individualiza- tion of the treatment, which may be surgical or non-surgical. 4 A largely expanding area is tissue engineering, with the auto transplant of chondro- cytes as the first line of treatment, but still with little scientific evidence. 1 Although it is a frequent pathology, commonly present in children and adolescents, the prevention of this injury is the key to the problem. The education of the patient in relation to the pathology and the objectives of the treatment is of utmost importance, in order to estab- lish a good confidentiality relation- ship. In addition, the first approach in any musculoskeletal lesion follows the principle of PRICE (protection, rest, ice, compression and elevation), which means joint protection, relative or absolute rest, static cryotherapy, local containment (possibly with stabiliza- tion orthosis) and the elevation of the segment (with the lower limb). Clinical research in this pathology and in this population is limited and low evidence. There is no consensus supported by the evidence and in this way the authors present under- standing elements of the literature as therapeutic references. Conservative therapy. Non- pharmacological intervention The correction of biomechanics segmenting 14-16 It is known that certain structural or dynamic changes of the locomotion device may promote change in the load distribution. In the lower limb stand out the changes of its align- ment, whether static, or dynamics [genu valgus/Varus, flat feet/cavus, lateral/high patella, atrophy and decrease of Strength of Hip stabiliz- ers (dynamic valgus) among oth- ers. Some studies argue that the correction of biomechanical errors (either static or dynamic) should be stimulated to prevent future injuries. Dynamic changes can be worked through posture reeduca- tion, segmental rebalancing of agonists and antagonists, according to reeducation programs with some scientific evidence. Some stud- ies show that the correction of the alignment of the member/segment can be achieved through the use of molded insoles with different adap- tations. However, and although some observational studies show this improvement, this is not supported in studies considered low evidence. The correction of the lower limbs should also be considered when greater than 5-6mm. In the group of children and adolescents it is impor- tant to check the evolution of the www.clinicamedicadamarginal.com Saúde é connosco! A Clínica Médica da Marginal foi fundada em 1990 e dedica-se à prestação de cuidados de saúde especializados de proximidade, em regime de ambulatório, nos concelhos de Vila do Conde (sede) e Póvoa de Varzim (filial). É uma unidade poliva- lente com múltiplas especialidades e valências clínicas e terapêuticas. A expe- riência desenvolvida no decorrer de mais de 25 anos permitiu elevar o seu nome como uma referência local no setor da saúde e fortalecer a capacidade competiti- va na excelência dos serviços prestados. Tem uma forte presença na Medicina e Traumatologia Desportiva, incluindo uma sucursal do Centro Internacional de Traumatologia Desportiva do Ave. Avenida Infante Dom Henrique, 1326 - Caxinas 4480-670 Vila do Conde T · 252 623 347 · 252 299 690 T · 962 057 263 · 926 957 578 F · 252 299 697