IMAGING STRATEGIES

Given the wide age range and skill level of children involved in both recreational and competitive soccer, it is impossible to prescribe an imaging algorithm that would be appropriate in all scenarios, and each case must be assessed on its individual merits. Suffice to say, a child who is injured playing soccer should first be examined at the site of play by a responsible adult.

Minor injuries such as cuts and bruises can be dealt with at the scene, and the child can return to the game. More severe injuries will require examination by a medically qualified person, often within the setting of an emergency department. If a fracture needs to be confirmed or refuted, then plain radiographs will be requested and may be all that is necessary. Orthopedic advice will dictate the need for follow-up examinations.

Ultrasound can be helpful to assess soft-tissue injuries such as muscle hematomas and tendon tears. However, such injuries may require further evaluation with MRI. This is particularly the case when children (usually adolescents) are playing to a high skill level and intensity and when the injured player's team needs rapid and accurate medical advice regarding injury management and time to be spent in rehabilitation before training can resume. MR is the modality of choice in the assessment of suspected knee ligament or meniscal tears. Ankle sprains are common and may be managed conservatively, once a fracture has been radiologically excluded; MR is generally reserved for elite players.

CT is not often requested for acute extremity trauma, but it is helpful when plain radiographs show growth plate involvement or in specific fracture types, such as tibial spine avulsion. Multiplanar reformatted and 3D images can be invaluable to assist the orthopedic team in operative planning. CT may also be required for children with blunt abdominal trauma and in the rare instances when a spinal fracture is suspected. The decision to perform a CT brain scan in a concussed child will depend upon the neurological symptoms and signs present. A period of clinical observation is often preferred to emergency imaging in these circumstances. Suspected facial fractures in children are better evaluated with CT than plain radiographs.

INJURY PREVENTION

The majority of suggestions for improving the safety of soccer for children rely on common sense. If statistics show that children are more likely to be hurt during match play than when training, then increasing the training to match ratio should lessen the number of injuries that occur. Tired players sustain more injuries, so the length and number of games children play in a season should be limited.

Shin guards are compulsory in professional soccer. They should be recommended for all soccer players, regardless of the standard of play. A well-constructed and correctly fitted mouth guard can protect the teeth and help prevent jaw fractures.

Referees should be trained appropriately, to limit aggression on the pitch and reduce the risk of injury due to foul play. The referee must also be responsible for checking the condition of the playing surface and pitch perimeter. The use of an appropriately sized ball is imperative for younger children. Coaches should be taught the signs and symptoms of concussion so that concussed children do not return to the field of play, at the risk of receiving a more severe head injury. The most important factor in preventing serious injury to recreational footballers is to ensure that goalposts are made of a suitably strong material and are securely fixed to the ground.

In summary, while it is not uncommon for children to hurt themselves when playing soccer, most injuries incurred are minor and do not require hospital treatment. ACL tears suffered by adolescent females are among the more frequently encountered severe injuries.