Delayed ACL surgery in children may lead to more severe meniscus tears

For patients 14 years old or younger, a delay in ACL reconstruction surgery may raise their risk of further chondral injury, with surgical delays greater than 12 weeks possibly leading to irreparable damage, according to a study recently published in the American Journal of Sports Medicine.

“Treating ACL injuries in these children is controversial, because they are still growing and the surgery has a small risk of causing a growth disturbance,” study author J. Todd Lawrence, MD, PhD, stated in a Children’s Hospital of Philadelphia press release. “However, we found that the risk of additional injury outweighs the risk of growth disturbance in most children.”

The researchers reviewed the records of 70 consecutive patients aged 14 years and younger who underwent ACL reconstruction between 1991 and 2005. The reviews included patient demographics, intraoperative findings and MRI results, and grading of meniscal and articular cartilage injuries, according to the study abstract. In their abstract, the researchers identified factors independently associated with intra-articular lesions and assessed differences in intra-articular injuries based on time from injury to surgery.

In the study, 29 patients (41%) underwent reconstruction 12 weeks or more after the initial injury. The analysis revealed that a history of subjective knee instability and time to ACL surgical reconstruction were both independently associated with medial meniscal tears. The researchers also found time to surgical reconstruction was independently associated with medial and lateral compartment chondral injuries, according to the abstract.

In patients who waited more than 12 weeks for surgery, delayed treatment was associated with increased medial meniscal tear severity and higher grades of lateral and patellotrochlear chondral injuries, the investigators noted.

“More research is needed to continue to give us information that is crucial for making informed decisions on care for children and young adults with ACL injuries, but seeing these irreparable injuries that we know can lead to arthritis down the road helped tip the balance in favor of early surgery for most children with an ACL tear,” senior author Ted Ganley, MD, stated in the release.

For more information:

Lawrence JTR, Argawal N, Ganley TJ. Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: Is there harm in delay of treatment? Am J Sports Med. 2011. doi: 10.1177/0363546511420818.


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