Duke orthopaedic surgeon Dr. Jonathan Riboh, MD, treats sports injuries in children and adolescents. In this Q&A he offers helpful information for parents looking for an orthopaedic surgeon for their child.
How Is a Sports Surgeon Who Treats Children Different from a Pediatric Orthopaedic Surgeon?
A general pediatric orthopaedic surgeon typically treats children with birth conditions like hip dysplasia, scoliosis, cerebral palsy, and limb deformities.
As a sports surgeon, I specialize in treating sports injuries in children and adolescents -- injuries like shoulder dislocations, ACL tears, kneecap dislocations, cartilage tears, or meniscus tears -- injuries where people might say, ‘Let’s see the local sports surgeon.’ These injuries often have to be treated differently in children. That’s what makes our program at Duke unique.
About 90 to 95 percent of my practice involves injuries of the knee, shoulder, and elbow. I have partners who are experts in ankle and hip surgery and are experienced in treating children. You can get comprehensive pediatric and adolescent sports care for any joint in the body at Duke.
Why Is It Important for Parents to Find a Sports Surgeon with Experience Treating Kids?
To start, there are different operations for kids than there are for adults with the exact same injury. One example would be ACL reconstruction. The surgery we do in adults can’t be done in children because of their growth plates. These are areas of growing tissue that enable their bones to reach adult length and shape. I am trained in a unique set of operations that can fix the ACL without affecting a child’s growth.
Another example would be a torn meniscus -- the cartilage pad in the knee. Most meniscal tears are treated by cutting out the torn portion. But you only get one meniscus for your whole life. So in kids, one has to be comfortable with advanced repair techniques to try to save the meniscus as often as possible, even if that means a meniscus transplant.
But that’s just part of it. Obviously, parents should look for a surgeon with the technical ability to do child-specific surgeries. But above all, they should look for a physician with the passion and bedside manner to effectively communicate with children and their families.
What Else Should Parents Look for in Sports Medicine Care for Their Child?
First and foremost, look for doctors and physical therapists who enjoy working with children and are used to dealing with parent-child dynamics. Reconciling what the kid wants, what the parent wants, what the coach wants, and what the physician believes is best is an acquired skill.
What Other Child-Specific Sports Medicine Services Does Duke Offer?
We have physical therapists who enjoy working with children, are great with children and parents, and have received additional training in pediatric physical therapy. Most of my local patients are treated by one of our pediatric sports physical therapists.
Since pediatric sports injuries are a little bit rarer, I also perform surgery on a lot of kids who come from far away. By necessity, we send them back to a physical therapist in their town who may never have seen, for example, an 8-year-old with an ACL tear. So my physical therapy team members will regularly email or call the local physical therapist who is treating our kids, to make sure they know what the restrictions and protocols are, make sure that the kids are on track, and keep me updated on how they’re doing. So even if you don’t live near Duke, you can get customized pediatric care even after you go back home.
We also have child life services through Duke Children’s Hospital. They meet with the child a week or so before surgery. They put together an individualized document with lots of pictures and bold fonts. It explains, ‘This is what the surgery center looks like. This will be your pre-op nurse. This is what your pre-op bed is going to look like. It’s OK for you to bring a stuffed animal. Mom and Dad are still going to be with you.’ It addresses all the different steps, from walking into the surgery center, to getting your surgery, to going home. It makes it much easier for the children on the day of surgery.
What Advantages Does Duke Sports Medicine Offer for Families with Child Athletes?
My colleagues and I also take care of elite Division I collegiate teams: Duke basketball, football, lacrosse, etc. So we’re really team physicians. We understand the dynamics of talking to coaches. We understand what parents’ desires are in terms of scholarships or achievements in the sports realm. We also have an understanding of when an athlete can push through something and when they have to go slow. When you combine our pediatric focus with our experience treating high-level athletes, I think it really helps us get people back into the game as quickly as possible but in a safe fashion.
Has Your Personal Experience Shaped the Way You Treat Children with Sports Injuries?
I was a competitive tennis and volleyball player growing up. I injured my shoulder playing those overhead sports, and I put off treating it until I was an orthopaedic resident and had an operation. Recovery was not easy but I’ve done very well in the long run. I think it’s given me an understanding and compassion for what people go through. It gives me the ability to look people in the eye and say, ‘I’ve been where you are. I’ve struggled with this, too. It’s going to be OK.’