Rehabilitation of pediatric musculoskeletal sport-related injuries: a review of the literature.

AIM The recent increase in sports participation in children and adolescents has resulted in the increase of sport-related injuries and the need for rehabilitation. The purposes of this study were to review studies involving rehabilitation of pediatric musculoskeletal sport-related injuries to determine the study design (level of evidence), inclusion of a reference to skeletal immaturity, adequacy of the description of the rehabilitation program and treatment outcome. METHODS Medline(1950-June 2009), CINAHL(1982-June 2009), Cochrane and journals (sports, physical therapy, pediatric orthopedic) were searched using the terms: physical therapy or rehabilitation plus sports/athletic injuries or individual sports plus pediatrics, adolescent, children, youth and young. Inclusion criteria were: published in English peer-reviewed journal, examined rehabilitation/management, subjects <or=18 years of age, and sport-related musculoskeletal injury/diagnosis. Study design (level of evidence), injury/diagnosis, sport involved, information regarding skeletal maturity, description of rehabilitation program and treatment outcome were extracted. RESULTS Fifty-seven studies met the criteria: 75% were case reports, 21% case series, 4% retrospective comparative studies and no randomized-controlled trials. Forty-seven different diagnoses were investigated. Fifty-four percent did not address skeletal immaturity; 26% involved injuries/diagnoses unique to skeletally immature. Components and parameters of each study's rehabilitation program and outcome are reported. CONCLUSION Current literature lacks well-designed controlled studies: 1) to address issues relevant to the pediatric injured athlete and 2) to determine the optimum program for each sport-related injury/diagnosis to expedite return to sport. Programs were often inadequately detailed to permit replication.