Associated injuries in pediatric and adolescent anterior cruciate ligament tears: Does a delay in treatment increase the risk of meniscal tear?

Department of Orthopaedic Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 11/2002; 18(9):955-9. DOI: 10.1053/jars.2002.36114
Source: PubMed

ABSTRACT To evaluate the incidence of associated injuries and meniscal tears in children and adolescents with anterior cruciate ligament (ACL) tears, we performed a retrospective review of patients, age 14 and younger, who were treated surgically at our institution.
Retrospective review.
We reviewed 39 patients (30 girls, 9 boys) with an average age of 13.6 years (range, 10 to 14 years) who underwent surgical treatment of the ACL; 24 right knees and 15 left knees were treated. Of the injuries treated, 24 occurred by a twisting mechanism, 10 were the result of contact, and 5 occurred from hyperextension. Thirty-five injuries occurred during sports activities, and 2 were sustained in motor vehicle accidents. The mean duration from injury to operative treatment was 101 days (range, 7 to 696 days). Injuries were classified as acute (n = 17) if surgery was performed within 6 weeks of injury and chronic (n = 22) if surgery was performed after 6 weeks from injury. Relationships between medial and lateral meniscal injuries and the time from injury to surgery were analyzed, and the 2 groups, acute and chronic, were compared. Finally, the patterns of meniscal injury were compared.
Twenty-six patients had associated injuries (10 medial meniscal tears, 15 lateral meniscal tears, 3 medial collateral ligament tears, and 1 fractured femur). The association between medial meniscal tears and time from injury to surgery was highly statistically significant (P =.0223). There was no statistical significance between the incidence of lateral meniscal tears and time. Medial meniscal tears were more common in the chronic group (36%) than in the acute group (11%), whereas lateral meniscal tears were found with equal frequency. Medial meniscal tears that required surgical treatment (either partial excision or repair) were more common in the chronic group, and lateral meniscal tear patterns were equally distributed.
Evidence from this study supports the contention that associated injuries are common in young individuals with ACL tears. Furthermore, the data also show that a delay in surgical treatment was associated with a higher incidence of medial meniscal tears.

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    • "A highly significant relationship was found between time to surgery and medial meniscal tears. 36% of patients in the chronic group sustained medial meniscal tears versus only 11% of acute group, which led the authors to support early operative intervention [18]. Henry et al. [19] retrospectively looked at 56 patients who sustained an ACL tear while skeletally immature and compared those who had open physes at reconstruction with those whose reconstruction was delayed until skeletal maturity. "
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    ABSTRACT: The incidence of ACL tears is rising in the pediatric and adolescent populations as these individuals succumb to traumatic and nontraumatic athletic injuries. Management of this condition in the skeletally immature patient poses a challenge and is controversial. Operative reconstruction carries the concern for damage to the physis with resultant limb length inequality and angular joint deformity but provides stability to the knee and allows return of function in most patients. On the other hand, nonoperative treatment has been shown to carry an increased risk of meniscal and articular cartilage damage and is difficult from a compliance standpoint in this demographic. For the majority of skeletally immature patients, operative treatment is recommended as it has shown good clinical and functional results with minimal risk of growth disturbance. This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies.
    International Journal of Pediatrics 01/2012; 2012:932702. DOI:10.1155/2012/932702
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    • "Pierre et al. [12], analyzing the onset of meniscal lesions secondary to ACL reconstruction with abstention from operating on the initial meniscus lesion, found secondary lesions occurring in the MM while LM lesions remained asymptomatic, in agreement with earlier reports by Beaufils et al. [13], Fitzgibbons and Shelbourne [14] and Zemanovic et al. [15]. At the same time, many studies have reported a secondary increase in the number of MM lesions in chronic anterior instability in both adults [4] [5] [16] and children [17] [18]. These findings were recently corroborated by reports to the SFA's 2008 LM congress. "
    Orthopaedics & Traumatology Surgery & Research 11/2009; 95(8 Suppl 1):S85-96. DOI:10.1016/j.otsr.2009.09.004 · 1.17 Impact Factor
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    ABSTRACT: Objective: To report our experience and conduct a literature review of the clinical series and experimental stu- dies on reconstruction of the anterior cruciate ligament (ACL) in patients with open physes. Anterior cruciate ligament ruptures in skeletally immature patients are increasingly common. The risk of altering growth has li- mited the routine application of ACL anatomical reconstruction methods, which have demonstrated their effi- cacy in adult patients. Conclusion: Reconstruction of the ACL in growing patients must be established on an early basis in order to avoid chondral and meniscal lesions.
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