Experts on Camera

Dr. Matthew Tao: Youth sports injuries

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Expert on Camera:

Although some injury rates have decreased among U.S. high school athletes, serious injuries requiring surgery and time away from sports are on the rise.

On Friday, September 8, 2023, SciLine interviewed: Dr. Matthew Tao, an associate professor of orthopaedic surgery at the University of Nebraska Medical Center. He specializes in knee preservation and athletic injuries. He discussed topics including: when young athletes are most at risk for knee injuries, especially ACL tears; what steps athletes, coaches, and parents can take to prevent or minimize the severity of injuries; what treatment options are available when injuries occur; successful rehabilitation strategies; and long-term consequences of sports injuries, including the risk of arthritis following ACL injuries.

Declared interests:

Dr. Tao currently receives research grant funding from the Arthritis Foundation, University of Nebraska system, Great Plains IDeA-CTR and Nebraska Foundation of Physical Therapy. He is on the editorial board for Current Reviews in Musculoskeletal Medicine. He is a paid consultant for Vericel Corporation and Newclip Technics. He holds stock in Overture Orthopaedics.

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MATTHEW TAO: My name is Matt Tao. I’m an associate professor of sports medicine and orthopedic surgery at the University of Nebraska Medical Center in Omaha, Nebraska. And I practice mainly knee-preservation surgery—so, ACL, ligament, meniscus, cartilage, alignment issues—and serve kind of a wide variety of athletic patients from kids all the way up to active adults—and have a particular interest in ACLs. That’s kind of the focus of my research. I partner with one of our physical therapy PhDs who is here to do research on ACLs and development of arthritis long term.

Interview with SciLine

How big of a problem are knee injuries?


MATTHEW TAO: Certainly, knee injuries are something that is kind of at the forefront of people’s minds—not just us as physicians, but the general population. It just seems like every day, if you look at ESPN or some of the other media outlets or online, there’s always a high-level athlete—college, pro, etc.—that had some type of knee injuries, often an ACL. That’s the one that really comes to mind most, I think, for people. And certainly, the prevalence of ACL injuries has gone up over the last 10 years. In fact, I was just reviewing a paper the other day about that, that it’s just become much more common. And so, it’s something that we’re dealing with a lot as surgeons, and certainly, patients have to deal with it as well.

Who is most at risk for sports injuries, and when?


MATTHEW TAO: There are certain people that may have an anatomic or genetic risk factor. And fortunately, that’s probably relatively rare. Unfortunately, there’s always going to be some level of injury with sports. It’s just one of those things that’s not completely preventable. I do think one of the things that we see often is just overuse injuries. And so, I’m not trying to pick on baseball, but in terms of our young guys that throw a lot. That’s something that we see just as an example of kids that throw all the time all year round with no breaks, it just sets you up for overuse injuries. And there’s pretty good data on that in terms of just needing breaks. The body’s just not built for that at a young age. But in general, it’s something where we love sports, because it keeps people active. Whether you’re young or old, it’s part of kind of an active, healthy lifestyle. So, I wouldn’t say not to participate because of the risk of injury. But it’s certainly something to be aware of.

What steps can athletes, parents, and coaches take to minimize the risk of sports injuries?


MATTHEW TAO: One of the things that comes up—and I’ll use ACLs as an example—is there’s certainly some very good data and some good programs out there that have been well validated with research to reduce the risk of ACL injuries. But any of these kinds of things, whether it’s ACL or something else, they really do require a fair amount of effort on the part of the athlete, the family, and particularly the team as a whole. So, there has to be a level of dedication there. I think something simple with regards to overuse injuries: If it’s somebody that’s just doing a single sport all year round with no breaks, there’s very good evidence that that’s probably not the best thing. It certainly sets you up for injuries. So, taking a break for a month at a time from a given sport a couple of times a year is a really good way to try to prevent some of those overuse injuries.

What should athletes do after an injury during a game?


MATTHEW TAO: One of the things sometimes that we try to emphasize with our athletes, particularly kids—middle school, high school, and even college—is there’s oftentimes this mindset of: I don’t want to come out of the game—which I love. I love that about working with athletes that people want to just stay active. But one of the things that I would urge people to do is at least just consider the situation. If it’s something that really bothers you, or if it was an injury that’s limiting you—concussion is one that comes to mind—that’s really a hot button topic the last couple of years. It’s always safest to at least ask the question and get evaluated. Doesn’t necessarily mean you can’t go back in the game, but it’s at least worth asking and making sure it’s safe before you do.

What treatment options are available when knee injuries occur?


MATTHEW TAO: Well, I’ll start by just saying the goal really, for any of us in sports medicine, is to get people back to being healthy and active. And oftentimes it differs, depending on the injury, what course of treatment we’re going to take. Certainly, in general there’s either non-operative or surgical options. Even as a surgeon, I guess my feeling is that no surgery is always better than surgery unless we absolutely have to. And there’s certain things—maybe a fracture, ACL tear, or something like that—where most of the time, we’re probably going to head down the road of surgery. But either way, we want to try to tailor that to the athlete and their injury. And sometimes that differs really person to person and sport to sport. But again, as a surgeon, my goal is to try to set up that recovery process well. There’s a lot of other people that factor into that, but try to set people up for that recovery and ultimately get them back to the level of activity that they want to be at.

What do successful longer-term rehabilitation strategies for sports injuries look like?


MATTHEW TAO: You know, I love the rehab side of it. I don’t pretend to be a physical therapist, but I do care about it a lot because I think it matters a ton for the ultimate outcome. I mean, if our goal is to get people back to high level activity—whether we’re talking about high school kid or a weekend warrior—there’s a lot more than just what happens in the office or in the operating room with us. And I think a big part of that ends up being: strength and conditioning, athletic trainers, physical therapists—they’re a huge part of that recovery. I’ll use ACLs as an example. I try to actually tell my ACL patients preoperatively: I think what I do is important, but my hope is that I’m setting you up well, at times—that you have a stable knee. But in terms of actually getting back to something like soccer, or basketball, or football, really all of that happens in the rehab process. And so, I think that process with the ATCs, and PTs is probably just as important if not more important than the surgery itself. So, it’s kind of natural for sports, to think of it from a team perspective. But we really do look at recovery as a team sport.

What can you tell us about the long-term consequences of knee injuries, especially ACL tears?


MATTHEW TAO: One of the things that my research partner, Liz Wellsandt, and I are really passionate about is ACL injuries, which obviously disproportionately affect young people. And it’s something that as a surgeon, we’re really eager to get people back to sports. And that’s part of the fun part of this job is seeing people get back to things like football and soccer and basketball. But what’s not talked about a lot—certainly in the general public, but even in the medical community sometimes—is that there’s a really high rate of arthritis after ACL tears. And so, if you think about a kid, maybe in their sophomore year of high school, getting an injury playing soccer; hopefully they’re back that next year playing again being active. But if they end up getting arthritis, 10 or 20 years down the road, they may still be in their 20s or 30s, which is a huge problem. It’s something that people hear arthritis and think, oh, they can just get a knee replacement. But as a 20- or 30-year-old, that’s definitely not something that you want as an individual or a society that we want. So, I think our hope is to help further that field: to have a better understanding of actually what causes the arthritis and then certainly to try to reduce that risk going forward. Because if we can help to do that—certainly on an individual level, but definitely on a societal level—it really decreases the burden of pain, dysfunction, and cost long term.

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[Posted September 8, 2023 | Download video]