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: 3.21). 11/2002; 18(9):955-9. DOI: 10.1053/jars.2002.36114
Source: PubMed


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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    • "Ainsi, 65 % des enfants testés (hop test, évaluation isocinétique) sont susceptibles de bénéficier cette prise en charge d'attente (sur une période moyenne de suivi de trois ans). Parallèlement à l'instabilité secondaire persistante, il faut souligner la fréquence tout à fait inhabituelle des lésions méniscales associées, qu'elles soient primitives (touchant essentiellement le ménisque latéral) ou secondaires : • Graf et al. [11] : 75 % de lésions méniscales initiales [14] ; • Mizuta et al. [12] : 78 % de lésions méniscales initiales ; • Pour Bonnard et al. [6], 50 % de lésions méniscales initiales touchant un peu plus le ménisque latéral que le ménisque médial ; • Aronowitz et al. [15] : 46 % de lésions méniscales secon- daires ; • Woods et O'Connor [16] : 68 % de lésions méniscales "
    Journal de Traumatologie du Sport 10/2014; 32(1). DOI:10.1016/j.jts.2014.08.004
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    • "Delay in surgical treatment is a source of distress to patients, an important reason for poor outcome and a significant contributor to surgical deaths especially in hip fractures.12345 Time measurement studies have shown that delay before diagnosis and treatment is associated with increased risk of complications.6 "
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    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. DOI:10.4103/0300-1652.126301
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    • "More serious injury to the medial meniscus is significantly more common later post ACL injury [1, 21, 22]. One possible explanation is that displaced flap tears or bucket handle tears of the medial meniscus may develop due to ongoing joint instability rather than occurring directly at time of initial injury. "
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    ABSTRACT: ObjectiveMagnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) injury are well known, but most published reviews show obvious examples of associated injuries and give little focus to paediatric patients. Here, we demonstrate the spectrum of MRI appearances at common sites of associated injury in adolescents with ACL tears, emphasising age-specific issues.MethodsPictorial review using images from children with surgically confirmed ACL tears after athletic injury.ResultsACL injury usually occurs with axial rotation in the valgus near full extension. The MRI findings can be obvious and important to management (ACL rupture), subtle but clinically important (lateral meniscus posterior attachment avulsion), obvious and unimportant to management (femoral condyle impaction injury), or subtle and possibly important (medial meniscocapsular junction tear). Paediatric-specific issues of note include tibial spine avulsion, normal difficulty visualising a thin ACL and posterolateral corner structures, and differentiation between incompletely closed physis and impaction fracture.ConclusionACL tear is only the most obvious sign of a complex injury involving multiple structures. Awareness of the spectrum of secondary findings illustrated here and the features distinguishing them from normal variation can aid in accurate assessment of ACL tears and related injuries, enabling effective treatment planning and assessment of prognosis.Teaching points• The ACL in children normally appears thin or attenuated, while thickening and oedema suggest tear.• Displaced medial meniscal tears are significantly more common later post-injury than immediately.• The meniscofemoral ligaments merge with the posterior lateral meniscus, complicating tear assessment.• Tibial plateau impaction fractures can be difficult to distinguish from a partially closed physis.• Axial MR sequences are more sensitive/specific than coronal for diagnosis of medial collateral ligament (MCL) injury.
    Insights into Imaging 05/2013; 4(3). DOI:10.1007/s13244-013-0250-z
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