Age, Sex, and BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients

Abstract

Background: The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options. Purpose: To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort. Results: There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears ( P = .001). Higher BMI was associated with “complex” and “radial” tear repairs of the lateral meniscus ( P < .001) but was variable with regard to medial tear repairs. Conclusion: In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.

Tough gel adhesive is an effective method for meniscal repair in a bovine cadaveric study

“…This is the rationale behind studies that encourage early postoperative weight-bearing in longitudinal tears, such as bucket-handles, but not in radial tears [47]. These findings suggest that complex lesions, usually treated with a meniscectomy and representing up to 18% of meniscal injuries in pediatrics, could be treated with the adhesive patch using the meniscus wrapping method [48]. Adhesive hydrogels could represent a treatment method for tears in the red-red zone because of their mechanical edge-holding effect, but we believe that tears in the white-white zone could also be treated with the biological augmentation of the patch.…”

Causal relationship between obesity and meniscal injuries: Two-sample Mendelian randomization

“…Rohde [ 9 ] found that meniscal injuries usually occur in a higher population of obese patients by retrospectively analyzing 1185 cases of meniscal injuries in a population of children and adolescents.…”

“…[ 7 , 8 ] Some studies have suggested that obese subjects may be more prone to meniscal injuries than normal weight subjects, but conclusions have been mixed. [ 9 , 10 ] Therefore, the causal relationship between obesity and meniscal injuries still needs further investigation.…”

That Awkward Age

“…These and other recent AJSM publications that focused on adolescents demonstrate the current keen research interest in this age group, in which intense athletic activity combines with rapid musculoskeletal development and labile psychosocial dynamics to create a challenging treatment environment. 8,9,12,15,17,19,20 Continuing clinical research will help surgeons and other sports medicine practitioners provide more knowledgeable guidance and greater treatment success for patients as they navigate this exciting yet intimidating stage of life.…”