In pediatric patients, delayed ACL reconstruction increased the risks of secondary meniscal and chondral injuries, according to study results.
Researchers reviewed the medical records for 130 patients younger than 17 years who had 135 ACL reconstructions. Patients were assigned to either acute, subacute or chronic surgical groups. The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine meniscal classification criteria was used to document the type and grade of meniscal injuries, whereas the location and grade of chondral injuries were documented with the International Cartilage Repair Society criteria.
Overall, the treatment of 62 ACL injuries was classified as acute, whereas 37 were classified as subacute and 36 were classified as chronic. Additionally, meniscal injuries comprised 70 lateral tears and 42 medial tears.
Results showed lateral and medial meniscal tears had a bivariate association with time to surgery. The researchers found younger age and return to sports activities before surgery were independent risk factors for incidence of lateral meniscal tears, whereas female sex, older age and any episode of instability were independent risk factors for incidence of medial meniscal tears.
A three-fold higher odds of higher grade lateral meniscal tear was observed among patients with one episode of instability, according to the researchers. Patients who underwent subacute reconstruction had 1.45-times higher odds, and chronic reconstruction patients had 2.82-times higher odds of lateral meniscal tear severity vs. acute reconstruction.
The researchers found an adjusted odd ratio of 4.7 for an instability episode for medial meniscal tear. Increased severity of medial meniscal tears had an adjusted odds ratio of 5.6 for any instability episode, 15.2 for playing sports before reconstruction and 4.3 for time to surgery greater than 3 months, according to the researchers.
Results showed 17 patients had 23 chondral injuries, and the risk factors for chondral injury included increased time to surgery and any instability episode. According to study results, risk factors for increased grade of chondral injury included time to surgery and any instability episodes. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.