Early ligament reconstruction in children key to reducing future knee injuries
MedWire News: US research suggests that delaying surgery for repair of anterior cruciate ligament (ACL) injury in children may increase their risk for future knee problems, with overweight and older age also increasing their likelihood for subsequent complications.
Presenting the research at the American Orthopaedic Society for Sports Medicine Specialty Day in San Francisco, California, Guillaume Dumont (University of Texas, Dallas) explained that surgery within 150 days is important for optimizing outcomes in children with this type of knee injury.
"In our research, children who had delayed treatment of an ACL injury more than 150 days, tended to have an increased chance of also having a medial meniscus or chondral injury in their knee. These additional injuries may increase recovery time, inhibit return to play, and worsen long term functional outcomes of the knee," he elaborated in a press statement.
Another factor associated with adverse outcome following ACL injury appeared to be weight. "Our data demonstrates patient weight over 143 lbs (65 kg) to be associated with an increased rate of medial and lateral meniscal tears at the time of surgery," commented co-researcher Philip Wilson from the Children's Medical Center PLANO, Texas.
Dumont and team analyzed records of 370 pediatric patients who underwent primary arthroscopic ACL reconstruction between January 2005 and January 2011.
Outcomes included the presence of meniscal tear or chondral injury in addition to ACL tear, number of days from injury to treatment, age, weight, gender, and how the injury occurred.
ACL injury in this cohort was largely due to sporting accidents, with 29.7% of cases due to American football, 20.2% due to basketball, 17.6% due to soccer, and 4.3% due to cheerleading or gymnastics. Other causes were cited in 28.1% of cases.
Surgical repair of ACL injury occurred before 150 days in 241 children and after 150 days in 129 children.
Medial meniscal tears were significantly more common in children who had delayed rather than early surgery, at 53.5% versus 37.8% (odds ratio [OR]=1.8). This result is important, as having a medial meniscal tear significantly increased the risk for other knee problems such as medial femoral condyle articular injury and tibial chondral injuries, notes the team.
"This finding may… be relevant when counseling patients and their families regarding timing for injury treatment," said Dumont.
The investigators also found that weighing over 65 kg and being 16 years or older were significantly associated with having medial meniscal tears after ACL injury (ORs=1.7 and 1.6, respectively).
"With recent significant increases in child and adolescent obesity rates, this… may have significant public health implications," emphasized Wilson.
By Helen Albert