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
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