Timing of ACL Reconstruction in Pediatric Patients
Timing of ACL Reconstruction in Pediatric Patients
Abstract & Commentary
Synopsis: Delays in ACL reconstruction in patients younger than 14 years old results in more unrepairable meniscus injuries.
Source: Millett PJ, Willis AA, Warren RF. Associated injuries in pediatric and adolescent anterior cruciate ligament tears: Does a delay in treatment increase the risk of meniscal tear? Arthroscopy. 2002;18(9):955-959.
The effect of delaying acl surgery on the occurrence of meniscus injury in pediatric patients is not well studied. Therefore, the purpose of this article was to evaluate the effect of a delay of ACL surgery on the occurrence of meniscus injuries in children. This paper is a retrospective review of 39 patients (30 girls, 9 boys) with an average age of 13.6 years (range, 10-14 years) who underwent ACL surgery. The mean duration from injury until ACL surgery was 101 days (range, 7-696 days). The surgical procedures varied, including ACL repairs (3), ACL repairs plus hamstring augmentation (8), and ACL reconstructions (hamstrings [7], bone patella tendon bone [21]). Two groups were compared—acute (17), if surgery was performed within 6 weeks of injury and chronic (22), if surgery was performed after 6 weeks from injury. The associations between medial and lateral meniscus injuries, the time from injury to ACL surgery, and the pattern of meniscus injury were compared.
The results identified 25 meniscus injuries (10 medial tears, 15 lateral tears). The association between the time from injury to ACL surgery and number of medial meniscus tears was highly statistically significant (P = .02). However, no significance between the incidence of lateral meniscus tears and surgery time was made. Medial meniscus tears were more common in the chronic group and required surgical repair or removal more often than in the acute group.
Comment by James R. Slauterbeck, MD
ACL injury is more prevalent in children than sports physicians would like. The reconstructions in this age group, when the growth plates are open, carry some risk. Permanent growth abnormalities may alter knee mechanics for life and may counter all our efforts to return these younger athletes to sports. On the other hand, meniscus injuries resulting from a delay in ACL reconstruction also carry some risk. Since loss of significant amounts of the meniscus is associated with arthritis, delaying treatment may also poorly affect outcome.
This study identified that in those athletes treated with delayed ACL surgery, a greater number of meniscus injuries were identified. Additionally, the greater number of medial meniscus injuries resulted in meniscectomy instead of repair.
This study gives us some new information but has some limitations because the study is retrospective, missing some documentation (MRI) or exam findings at initial visit that would identify meniscus pathology, not consistent at using specific criteria to determine the surgical treatment of the torn meniscus, and lacking standardization of ACL surgical treatment. Although the limitations of this study are real, this is probably the best study to date defining potential consequences of delaying ACL injury. All treatment of ACL injury in young children carries risk. We as sports physicians need to identify in a prospective long-term study which treatments, operative or nonoperative, carry the least risk and then advocate appropriate treatment.
Dr. Slauterbeck is Associate Professor, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock, TX.
Synopsis: Delays in ACL reconstruction in patients younger than 14 years old results in more unrepairable meniscus injuries.Subscribe Now for Access
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