Adolescents undergoing an ACL reconstruction frequently have small hamstring tendon autograft size. The augmentation of these small grafts with allograft does not reduce graft failure rates and may in fact lead to higher retear rates, with earlier graft failure.

Level III--diagnostic study.

Level IV-case series.

Background Meniscus tear patterns in the pediatric population have not been well described. Hypothesis/Purpose The purpose of this study was to delineate the pattern of meniscus tears and the likelihood of repair at the time of surgery in both children and adolescents. Study Design Case series; Level of evidence, 4. Methods Retrospective review was performed on all patients between the age of 10 and 19 years who underwent arthroscopic surgery for meniscus pathology. Patients were classified into two groups: those with open growth plates were classified as children while those with closed growth plates were classified as adolescents. Demographic data was documented, including: age, sex, BMI, mechanism of injury, and duration from injury to surgery. Operative reports and intraoperative photographs were used to assess tear pattern: type, location, zone, as well as all concomitant procedures and pathology. Tears were classified as discoid, vertical, bucket-handle, radial, oblique, horizontal, fray, root detachment, or complex. ANOVA and chi-squared tests were then performed. Results Of the 293 patients reviewed, 197 (67%) had lateral meniscus tears, 65 (22%) had medial meniscus tears, and 31 (11%) had tears to both menisci. The cohort was separated into groups: 119 (41%) children (open growth plates) and 174 (59%) adolescents (closed growth plates). The mean age between groups was 13.5 years compared to 16.4 years (p < 0.001), respectively. Children were more likely to have discoid meniscus tears, lower BMI, and meniscus pathology not associated with ligamentous injuries (p<0.05). The rate of associated ligament injuries in children was 29% compared to 51% in adolescents. Overall, the most frequent tear pattern was complex (28%) followed by vertical (16%), discoid (14%), bucket-handle (14%), radial (10%), horizontal (8%), oblique (5%), fray (3%), and root detachment (2%). Complex tears were associated with boys (32% vs. 20% girls, p < 0.03) and greater mean BMI (27.4 vs. 25.1 kg/m2, p < 0.002), even when taking sex into account. Surgical repair was performed in 46% of all cases (56% in those treated within 3 months of injury compared to 42% in those treated after 6 months (p<0.03) and there was no difference in repair rate based on patient age (46% vs 48%; p>0.05)). Conclusions Adolescents and children sustain more complex meniscus injuries that are often less repairable than previously reported in the literature. Factors that are associated with greater tear complexity include: male sex and obesity. Our findings also suggest that earlier treatment of meniscus tears may increase the likelihood of repair in younger patients.

Regardless of patient age, sports participation, and final clavicle shortening, no differences in pain, strength, shoulder range of motion, or subjective outcome scores were found between the injured and uninjured limbs of adolescents treated nonoperatively for a displaced, shortened, midshaft clavicle fracture.