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.
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ABSTRACT: To verify the usefulness of and optimal timing for conducting anterior cruciate ligament (ACL) reconstruction, we evaluated and compared baseline characteristics and surgical outcomes in patients with ACL injury divided into acute and chronic groups. 101 patients after ACL reconstruction were studied. Patients who underwent surgery within 8 weeks after injury were classified as acute group (n = 40), and those having surgery after 8 weeks as chronic group (n = 61). SF-36, VAS, Lysholm score, anterior tibial translation, and pivot shift were assessed before surgery and 6, 18 and 30 months after surgery. The results of two groups were compared. In the preoperative SF-36 survey, physical and mental health scores were lower than the national standard scores in both groups. Physical health score was significantly lower in acute group, although mental health score was not significantly different between two groups. Preoperative VAS and Lysholm score were significantly poorer in acute group compared to chronic group. However, preoperative anterior tibial translation and pivot shift were not significantly different between the two groups. In postoperative evaluations, all parameters were improved significantly compared to preoperative values in both groups, and no significant differences were observed between the two groups. All evaluation methods showed significant improvements after surgery in both acute and chronic groups, confirming that ACL reconstruction is useful for both acute and chronic injuries. However, preoperative evaluations by SF-36, VAS, and Lysholm scale yielded different results in two groups, indicating the need to evaluate acute and chronic cases separately. Development of a specific evaluation method that is valid for any duration from injury to surgery is desirable.Archives of Orthopaedic and Trauma Surgery 03/2014; · 1.36 Impact Factor
Article: Knieverletzungen im Wachstumsalter[Show abstract] [Hide abstract]
ABSTRACT: Diese PDF-Datei darf ausschließlich für nicht kommerzielle Zwecke verwendet werden und ist nicht für die Einstellung in Repositorien vorgesehen – hierzu zählen auch soziale und wissen schaftliche Netzwerke und Austauschplattformen.Trauma und Berufskrankheit 05/2013;
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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.