Pediatric sports medicine is one of the newest subspecialties in medicine. It addresses injuries occurring in the child athlete, the special physiology of exercise in children, and early detection and prevention of illnesses or injury in exercising children. In North America, it began as an area of special interest in the broader field of pediatric orthopedics.

The origins of pediatric orthopedics date back to the earliest perceptions of orthopedics as a field of medicine. The origin of the word orthopedics derives from the Greek words for straightening the child, first coined by Nicholas Andre(y) in the title of his book Orthopedie, published in 1746.¹ In it he described his methods of using exercises, manipulation, and splinting for the treatment of childhood deformities including clubfeet rickets and deformities of the spine (Figure 30.1).

Over the next 2 centuries, the empiric fields of the practice of bone setting, barber surgeries, and increasing use of surgical technique and musculoskeletal disorders have evolved into the present-day practice of orthopedic surgery in general and pediatric orthopedics in particular. Sports medicine is a relatively new field of medicine originating in the care of adults who had the luxury or means to participate in sports activity. The first sports medicine texts addressed physical training, nutrition of the athlete, as well as treatment and prevention of sports injuries.²

The evolution of the new field of pediatric sports medicine paralleled the growth of organized sports for children, a relatively recent phenomena dating from the post-World War II era. Little League baseball was the first organized sports for children and grew in size and scope after World War II; other organized sports for children have subsequently followed, with more than 17 different sports for children now available in the United States. Title IX certainly increased the numbers of children participating in sports. When first initiated, approximately 10% of soccer players in the United States in the childhood ranks were females; now more than 50% of soccer players United States are young female.³

We believe the first sports medicine program focusing on child athletes was founded here at the Boston Children’s Hospital in 1974. Less than 100 patients were seen in this clinic in the year. The Sports Medicine Division of Boston Children’s Hospital presently sees patients with a faculty of 24 physicians, 14 advanced practice practitioners, nutritionists, psychologists, and physical therapists. This growth in the number of professionals addressing the issues related to sports active children has occurred across the country and the world. Combined with rapid advances in the technology available to address these sports-related problems, this has presented unprecedented opportunities for this field.

Arthroscopy, magnetic resonance imaging (MRI), sophisticated endoscopic surgical equipment, and increasingly engineered “hardware” have made the treatment of musculoskeletal disorders and injuries more sophisticated and at the same time more challenging, increasing the scope of surgical intervention. This increased scope of operative technology has made treatment decision-making even more challenging. We must all be aware that the ready access to these new tools has increased the potential bias toward surgery over nonoperative management of these conditions.

In Chapter 32, Dr Mininder Kocher addresses the present approaches for surgical treatment of anterior cruciate ligament (ACL) injuries in the child. As with many of the acute or overuse injuries addressed in this text, the growing number of children with ACL injury has paralleled the growth of organized sports for children.⁴