Is Early Sport Specialization a Risk Factor for Anterior Knee Pain in Female Athletes?

Is Early Sport Specialization a Risk Factor for Anterior Knee Pain in Female Athletes?

Youth sport specialization has become a hot topic in the sports medicine world recently.  Baseball seems to be getting much of the attention, with the record setting pace of Tommy John surgeries in the MLB and studies reporting pitching participation on consecutive days and in some cases multiple games per day.   Another growing youth sports trend is knee injuries in active females, most notably patellofemoral pain (PFP) and ACL tears.  A recent study links the risk factors for both conditions, and suggests that PFP can be a future predictor of possible ACL injury.  Even more common is the general diagnosis of anterior knee pain. Many kids come through our clinic with anterior knee pain, which can include; patellar tendonitis, Osgood Schlatter Disease, PFP, Plica and fat-pad inflammation.  For years now we have been preaching to parents that kids should play seasonal sports, papers have been published and books have been written that support the position.  Still all to often a young female is on the treatment table with painful knees and her reported activity level consists of 5-7 days of single sport participation in either, basketball, volleyball, or soccer.  I recently came across this study ahead of print and look forward to reading the entire text when it is published, the abstract caught my attention because its a bold statement that could make educating young female athletes and their parents about the dangers of early sport specialization much easier.
The authors conducted a retrospective cohort of 546 adolescent females, 357 played multiple sports and 189 played a single sport and found that athletes that had reported early sport specialization demonstrated a 1.5 times greater relative risk for PFP diagnosis.  Additionally, single sport specialists demonstrated a four-fold greater relative risk for Osgood Schlatter and patellar tendinopathy.  In conclusion, the authors suggest that, “early sport specialization in female adolescents is associated with increased risk of anterior knee pain disorders including PFP, Osgood Schlatter and Sinding Larsen-Johansson compared to multi-sport athletes”.
Although the specifics of the study were not readily available, and the subject size is small, this study does take a step towards linking early sport specialization to some of the most common knee disorders in adolescent females.  If, in time, there is significant undeniable evidence to support this notion as well as the reported link between PFP and ACL tears, we can then say that early sport specialization can lead to significant playing time lost and possibly early cessation of sport due to injury.  Hopefully the work by Hall et al. spurs larger, more powerful studies that can turn the idea of early sport specialization being unhealthy for youth athletes into a proven fact.