Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear?
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.
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.
- [Show abstract] [Hide abstract]
ABSTRACT: Das Knie wird durch die Seiten- und Kreuzbänder geführt. Das vordere Kreuzband (VKB) entspringt am Condylus lateralis des Femurs, verläuft nach anterior-medial und inseriert tibial in der Area intercondylaris. Häufigste Ursache der VKB-Ruptur ist ein indirektes Trauma (Gelenktorsion im Sport). Der Betroffene hört ein Reißen, oft gefolgt von einem Hämarthros. Begleitverletzungen sind Rupturen des medialen Kollateralbands, mediale Meniskus- (,,unhappy triad“) und Knorpelläsionen. Der Altersgipfel liegt zwischen 15 und 30 Jahren. Die Inzidenz für weibliche Sportler ist erhöht. Leitsymptom der veralteten VKB-Ruptur ist das Giving-Way-Phänomen. Die Diagnose wird klinisch mit dem Lachman-, dem Pivot-Shift- und dem vorderen Schubladentest gestellt. Röntgenaufnahmen schließen Frakturen aus. Die Magnetresonanztomographie (MRT) zeigt die Kniebinnenstrukturen. Eine Rekonstruktion kann arthroskopisch als Semitendinosus- oder Patellarsehnenersatzplastik erfolgen. Die frühfunktionelle Nachbehandlung ist für ein gutes Ergebnis wesentlich.Der Orthopäde 01/2010; 39(9). · 0.51 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Delay in surgical treatment is a source of distress to patients and an important reason for poor outcome. We studied the delay before carrying out scheduled operative orthopaedic procedures and the factors responsible for it. This prospective study was carried out between March 2011 and December 2012. Temporal details of the surgical procedures at our hospital were recorded in a proforma including the patients' perception of the causes of the delay to surgery. Based on the urgency of the need for surgery, patients were classified into three groups using a modification of the method employed by Lankester et al. Data was analyzed using the Statistical Package for the Social Sciences, version 17.0. Predictors of surgical delay beyond 3 days were identified by logistic regression analysis. Two hundred and forty-nine patients with a mean age 36.2 ± 19.2 years and M:F ratio 1.3 were recruited. 34.1% were modified Lankester group A, 45.4% group B and 20.5% group C. 47 patients (18.9%) had comorbidities, hypertension being the commonest (22 patients; 8.8%). Median delay to surgery was 4 days (mean = 17.6 days). Fifty percent of emergency room admissions were operated on within 3 days, the figure was 13% for other admissions. Lack of theatre slot was the commonest cause of delay. There was full concordance between doctors and patients in only 70.7% regarding the causes of the delay. In 15.7%, there was complete discordance. Logistic regression analysis confirmed modified Lankester groups B and C (P = 0.003) and weekend admission (P = 0.016) as significant predictors of delay to surgery of >3 days. Promptness to operative surgical care falls short of the ideal. Theatre inefficiency is a major cause of delay in treating surgical patients in our environment. Theatre facilities should be expanded and made more efficient. There is a need for better communication between surgeons and patients about delays in surgical treatment.Journal of the Nigeria Medical Association 11/2013; 54(6):420-5.
- [Show abstract] [Hide abstract]
ABSTRACT: Objetivo avaliar uma série de pacientes esqueleticamente imaturos submetidos a três técnicas cirúrgicas de reconstrução do ligamento cruzado anterior (LCA) de acordo com o potencial de crescimento de cada paciente. Métodos foram avaliados prospectivamente 23 pacientes com idade de sete a 15 anos esqueleticamente imaturos submetidos à cirurgia de reconstrução do LCA. A técnica cirúrgica foi individualizada de acordo com o escore de maturação sexual de Tanner. As técnicas cirúrgicas usadas foram a reconstrução transfisária (TF), a transfisária parcial (TFP) e a extrafisária (EF). Quatro pacientes foram submetidos à EF, sete à TFP e 12 à TF. Avaliação pós-operatória foi baseada no escore de Lysholm, na análise clínica do joelho e na presença de deformidade angular ou dismetria do membro inferior. Resultados a média do escore de Lysholm foi de 96,34 (± 2,53). Nenhum paciente apresentou diferença de comprimento e/ou alteração clínica ou radiográfica de mau alinhamento dos membros inferiores. Conclusão a reconstrução do LCA com o uso de enxerto de tendões flexores em pacientes esqueleticamente imaturos proporcionou resultados funcionais satisfatórios. O uso de técnicas cirúrgicas individualizadas de acordo com o potencial de crescimento não ocasionou lesão fisária capaz de determinar discrepância de comprimento ou mau alinhamento dos membros inferiores, mesmo em pacientes com alto potencial de crescimento.Revista Brasileira de Ortopedia (English Edition). 05/2014; 49(3):252–259.