Temporal relation of meniscal tear incidence, severity, and outcome scores in adolescents undergoing anterior cruciate ligament reconstruction

Abstract

Purpose-Anterior cruciate ligament (ACL) rupture is increasingly common in adolescents. Time between ACL rupture and surgical reconstruction, surgical wait time, is related to concurrent meniscal tear incidence and possibly tear pattern. This study defines the relationship between meniscal tear characteristics and surgical wait time in adolescents with ACL rupture.Methods-One-hundred and twenty-one consecutive adolescent (median age 16.1 years, range 9-19 years) ACL rupture patients undergoing primary ACL reconstruction were studied. All had documented surgical wait time, preoperative and 6-month post-operative outcome (Lysholm and pedi-IKDC) scores, and intraoperative meniscus tear characteristics. Meniscal tear severity was graded according to the Lawrence and Anderson system: non-surgical: grade 1; reparable: grade 2-3; irreparable: grade 4-5. Significant tears were defined as at least grade 2.Results-Average age at surgery was 16.1 years. 48.7 % had surgical wait time greater than 6 months. 42.5 % of menisci were torn. With surgical wait time <6 months, there were more lateral than medial tears (48 vs 21 %, p = 0.001). With surgical wait time >6 months, medial tear incidence increased (50 vs 21 %, p < 0.001), there were more significant tears (63 vs 42 %, OR 2.3, p = 0.02), and preoperative Lysholm and pedi-IKDC scores were lower (58 vs 74, p < 0.001; 52 vs 61, p < 0.007). Scores were lower in patients with meniscus tears (63.8 vs 69.3, n.s.; 53.9 vs Authors' contribution S.Z. carried out statistical analysis, drafted the manuscript, and edited the manuscript. K.T. carried out data accumulation, performed statistical analysis, and drafted the manuscript. P.W. carried out data accumulation. E.E. reviewed and carried out statistical analysis, and edited the manuscript. R.B. designed the study, performed the surgeries, enrolled the patients, oversaw the study, and helped to draft the manuscript. All authors read and approved the final manuscript. Compliance with ethical standardsConflict of interest The author(s) declare that they have no conflict of interests. Conclusions-This study shows a significant increase in medial meniscal tear incidence, decrease in preoperative scores, and worse tear severity with surgical wait time >6 months. Public insurance was a risk factor for longer surgical wait time and meniscus tear. HHS Public Access

Chondral Injuries and Irreparable Meniscal Tears Among Adolescents With Anterior Cruciate Ligament or Meniscal Tears Are More Common in Patients With Public Insurance

“…2,3,12 Dodwell et al 3 found that in New York State from 1990 to 2009, ACL reconstructions were 5 times more common in adolescents with private health insurance compared with those enrolled in Medicaid. Both Newman et al 12 and Zoller et al 16 found longer wait times for ACL reconstruction among adolescents with noncommercial insurance. When orthopaedic offices were surveyed, many offices only offered timely visits to patients with private insurance, not public insurance, and once seen, patients with public insurance with ACL injuries required more time and more office visits for a diagnosis to be made.…”

“…Prior studies have associated the delayed surgical treatment of ACL tears in young patients with increases in irreparable meniscal tears and chondral injuries at the time of reconstruction. 1,8,12,16 Similarly, chronic meniscal tears are less likely to be amenable to repair and are more likely to require meniscal excision than meniscal tears treated acutely. The increased risk of severe meniscal and chondral injuries seen in patients with public insurance in the present study may be related to the delays in care that they experienced.…”

Ramp lesions are frequently missed in ACL-deficient knees and should be repaired in case of instability

“…Accordingly, time to surgery correlates with the incidence of concomitant meniscus injuries [25,29]. In particular, the incidence of medial meniscus (MM) tears seems to significantly 1 3 increase with delayed surgery [26,50]. Conversely, patients with medial or lateral meniscus instabilities have a significantly increased risk of ACL failure after reconstruction [32].…”

Operative Treatment of Isolated Meniscus Injuries in Adolescent Patients: A Meta-Analysis and Review

“…4,7,27 While many studies have focused on meniscal injuries in the context of anterior cruciate ligament (ACL) reconstruction, few studies have evaluated the outcomes of isolated meniscus treatment in the adolescent population. 3,14,15,32,36…”