SEATTLE—It was previously believed that children and adolescents with anterior cruciate ligament (ACL) injuries should wait until skeletal maturity to have their knee injuries surgically corrected; however, this is no longer the case, according to a study presented at the 2014 Annual Meeting of the American Orthopaedic Society for Sports Medicine.
“In reviewing records of young patients who received ACL reconstructions, our data showed higher rates and severity of secondary meniscus injuries when surgery is delayed,” said study author Allen F. Anderson, MD, from the Tennessee Orthopaedic Alliance in Nashville, Tennessee.
Dr. Anderson’s findings suggest that early reconstruction is preferable to nonoperative treatment because increased time from injury to surgery may be associated with a higher rate of meniscal and articular cartilage injury.
In the study 135 consecutive patients, ages 8 to 16 years, (mean age, 13.8) with ACL tears were evaluated from 2000 and 2012. The time from surgery was divided into three groups based on timing—acute (< 6 weeks), subacute (6 weeks to 3 months), and chronic (> 3 months). The type and grade of lateral and medial meniscus tears was documented according to the ISAKOS Meniscal Documentation Criteria and chondral injury location and grade was documented according to ICRS Criteria.
A total of 112 meniscal tears (70 lateral, 42 medial) were found in the study cohort. Sixty two patients were treated acutely, 37 subacute, and 36 chronic. Eighty percent of the patients ages 8 to 12 years had a meniscal tear and 84% of patients ages 13 to 16 years had a meniscal tear. Multivariant logistic regression revealed the risk factors for lateral meniscus tears were younger age (P = .007) and increased time to surgery (P = .008).
Study findings also conclude:
• The odds ratio of lateral meniscus tears for patients who had a single episode of instability was 3.1.
• For time to surgery, the odds ratio was 1 for acute reconstruction, 2.6 for subacute, and 2.59 for reconstruction of chronic injuries.
• The odds ratio for increased grade of tear was 3.3 for a giving-way episode and 6.5 for increased time to surgery.
• For medial meniscus tears, the risk factors were: older age (P = .001), increasing time to surgery (P =.007), return to sports (P = .044), and instability episodes (P = .001).
• Risk factors for increasing grade of medial meniscus tears were: time to surgery, return to sports, and any instability episode (P = < .001 for all).
“These data provide evidence that initial nonoperative treatment of ACL tears in this age group carries a high risk of additional meniscal and chondral injury, which may result in long-term knee injury,” Dr. Anderson concluded.