Early ACL reconstruction in children leads to less meniscal and articular cartilage damage when compared with conservative or delayed treatment

Fabricant, Peter D.; Lakomkin, Nikita; Cruz, Aristides I.; Spitzer, Elad; Lawrence, J. Todd R.; Marx, Robert G.

doi:10.1136/jisakos-2015-000012

Cited by 26 publications

(23 citation statements)

References 34 publications

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“… 43 , 47 , 51 , 54 This may be explained in part by the fact that an ACL-deficient knee is at increased risk for subsequent cartilage and meniscal damage. 5 , 47 Recent systematic reviews that have investigated the relationship between time from ACL injury to ACL reconstruction (ACLR) and meniscal or cartilage damage 18 , 46 , 57 have reported that prolonged time to ACLR is associated with increased risk of meniscal and cartilage damage. However, the link between prolonged time to ACLR and knee OA is less clear, with some studies identifying a positive association 36 , 48 and others not.…”

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confidence: 99%

Recurrent Instability Episodes and Meniscal or Cartilage Damage After Anterior Cruciate Ligament Injury: A Systematic Review

Sommerfeldt

Raheem

Whittaker

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Delayed anterior cruciate ligament (ACL) reconstruction may be associated with increased risk of subsequent knee joint damage and osteoarthritis (OA). The relationship between recurrent instability episodes and meniscal or cartilage damage after first-time ACL injury is unknown.Purpose:To assess the association between recurrent knee instability episodes and prevalence of meniscal lesions, cartilage damage, and OA after first-time ACL injury.Study Design:Systematic review; Level of evidence, 4.Methods:Six electronic databases were systematically searched using keywords and Medical Subject Heading terms. Studies selected were of English language, included original data, had a prospective design, and provided an outcome of recurrent instability and meniscal lesions, cartilage damage, or OA after first-time ACL injury. Adjusted odds ratios (ORs) were extracted or unadjusted ORs (95% CI) were calculated. PRISMA guidelines were followed, and 2 independent raters assessed study quality using Downs and Black criteria.Results:Of 905 potentially relevant studies, 7 were included. Sample sizes ranged from 43 to 541, and Downs and Black scores ranged from 2 to 12. Clinical and methodological heterogeneity precluded meta-analysis. Six studies reported a positive association between recurrent instability episodes and medial meniscal damage (OR range, 3.46 [95% CI, 1.24-9.99] to 11.56 [1.37-521.06]). The association between instability episodes and lateral meniscal or cartilage damage was inconsistent. No studies examined the association between instability episodes and OA.Conclusion:This systematic review provides preliminary evidence that recurrent instability episodes after first-time ACL injury may be associated with increased odds of medial meniscal damage. This highlights the importance of early diagnosis, education, and treatment for individuals with ACL injury, all of which must include a specific focus on the prevention and management of instability episodes. High-quality, prospective cohort studies are needed that assess the effects of diagnostic and treatment delay, recurrent instability episodes on secondary meniscal and cartilage damage, and OA after an initial ACL injury.

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confidence: 99%

Recurrent Instability Episodes and Meniscal or Cartilage Damage After Anterior Cruciate Ligament Injury: A Systematic Review

Sommerfeldt

Raheem

Whittaker

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…However, subsequent reports have indicated that this treatment strategy leads to sport dropout (up to 94% of 18 children were unable to participate at the preinjury level of activity and up to 56% of 16 children were unable to participate at all) because of recurrent buckling and giving-way [73][74][75][76] . Furthermore, continued instability events can result in progressive meniscal and cartilage damage, as well as arthritic changes 5,74,77,78 , which in 1 study occurred in 61% of 18 knees 74 . This is particularly true in children and adolescents who are frequently disinterested in modifying activity levels after injury.…”

Section: Nonoperative and Delayed Operative Treatmentmentioning

confidence: 82%

“…Historically, nonoperative management until skeletal maturity followed by traditional ACL reconstruction was a popular treatment strategy. However, the recent understanding of the perils of nonoperative and delayed surgical treatment have supported a trend toward early surgery [4][5][6][7][8][9] . In light of this, surgical techniques and instrumentation have evolved in order to accommodate the unique anatomy of skeletally immature patients.…”

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Management of ACL Injuries in Children and Adolescents

Fabricant

Kocher

2017

The Journal of Bone and Joint Surgery

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ä Children and adolescent athletes constitute the largest demographic of patients who sustain anterior cruciate ligament (ACL) tears, and the frequency is increasing. ä In ACL-deficient children and adolescents, continued symptoms of instability can result in progressive meniscal and cartilage damage as well as arthritic changes. ä Growth disturbance can occur after ACL surgery in children, and includes tibial recurvatum due to tibial tubercle apophyseal arrest as well as limb-length discrepancy and/or angular deformity due to physeal arrest or overgrowth. ä Several "physeal sparing" and "physeal respecting" ACL reconstruction techniques have been developed for use in skeletally immature patients to minimize the risk of growth disturbance, with favorable clinical outcomes. ä ACL injury prevention strategies include neuromuscular conditioning and may be performed to prevent both initial ACL injury as well as reinjury and injury of the contralateral ACL after reconstruction. Disclosure: No internal or external funding was provided for this project. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/B603).

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“…It is considered the standard of care for young active patients who wish to return to sport practice after ACL injury[ 1 ]. Despite the lack of clear evidence of its ability to reduce the onset and progression of knee osteoarthritis (OA), ACL reconstruction is expected to prevent further meniscal and cartilage lesions that could occur in the ACL-deficient knee[ 2 , 3 ]. Usually, ACL reconstruction is performed arthroscopically (occasionally combined with extra-articular plasty/augmentation) using autologous graft such as Gracilis and Semitendinosus tendons (HS), bone-patellar tendon bone (BPTB), and Quadriceps Tendon (QT), or allogenic grafts such as BPTB, Achilles Tendon, and Posterior or Anterior Tibialis tendons.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide

Grassi¹,

Bailey²,

Signorelli³

et al. 2016

WJO

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Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.

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Early ACL reconstruction in children leads to less meniscal and articular cartilage damage when compared with conservative or delayed treatment

Cited by 26 publications

References 34 publications

Recurrent Instability Episodes and Meniscal or Cartilage Damage After Anterior Cruciate Ligament Injury: A Systematic Review

Recurrent Instability Episodes and Meniscal or Cartilage Damage After Anterior Cruciate Ligament Injury: A Systematic Review

Management of ACL Injuries in Children and Adolescents

Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide

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