Surgical Repair of Meniscal Tears with Concomitant Anterior Cruciate Ligament Reconstruction in Patients 18 Years and Younger

Krych, Aaron J.; Pitts, Ryan T.; Dajani, Khaled A.; Stuart, Michael J.; Levy, Bruce A.; Dahm, Diane L.

doi:10.1177/0363546509354055

Cited by 119 publications

(136 citation statements)

References 37 publications

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“…As displaced meniscal tears are readily identified on MR images [4,11,13], this suggests true progression of medial meniscal tearing related to increased time after injury, probably owing to ongoing instability of the ACL-deficient joint. This is clinically relevant because bucket handle meniscal tears have a relatively poor prognosis, with successful repair in only 59% of pediatric patients with a torn ACL compared with 84% for simple tears [26]. Outcomes were even worse in our study, with only 26.2% of bucket handle meniscal tears successfully repaired based on operative reports.…”

Section: Discussionmentioning

confidence: 65%

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

Guenther

Swami

Dhillon

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Delay of as much as 5 months between ACL injury and surgery is known to be associated with increased risk of a medial meniscal tear, but the risk of additional meniscal tear progression with a longer delay to surgery is unclear. Questions/purposes We determined the (1) times of injury, MRI, and surgery in adolescents with ACL tears, and whether (2) timing of surgery, or (3) initial integrity of the meniscus seen on MR images predicted development of meniscal tears. Methods We reviewed 112 adolescents who were 15 ± 1 years old (mean ± SD) (range, 11-16 years) with a torn ACL. These patients underwent surgical repair from 2005 to 2011 in a Canadian city. We compared dates of injury, MRI, and surgery. A pediatric and musculoskeletal fellowship-trained radiologist reread the MR images, and meniscal injuries were graded according to severity. This was compared with surgical findings described in the operative report. Results Time after injury to MRI and surgery averaged 77 days (range, 1-377 days) and 342 days (range, 42-1637 days), respectively. Patients with new or worsened medial meniscal tears had waited longer for surgery (445 versus 290 days; p = 0.002). Bucket handle medial meniscal tears were more common in patients with surgery more than 1 year after injury than others (15 of 34 versus 14 of 75; p = 0.013). A medial meniscal tear observed on MR images was a significant covariate for a torn meniscus at surgery (relative risk, 5.7; 95% CI, 2.8-11.6). Medial meniscal survival continued to decline sharply greater than 1 year after injury. Conclusions Medial meniscal tears, especially bucket handle tears, increased steadily in frequency more than 1 year after ACL injury. Timely ACL reconstruction may be warranted to reduce the risk of further medial meniscal damage even in patients whose original injury occurred more than 1 year before. Level of Evidence Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 65%

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

Guenther

Swami

Dhillon

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Furthermore, outcome studies of both isolated meniscal repairs and meniscal repairs in the setting of ACL reconstruction have shown promising results with different meniscal repair techniques. 3,9,11,14,15 Given the recent literature on meniscal treatment and findings from large, high-quality research studies, it seems possible that the trends noted in this study reflect changing practice patterns dictated by evidence.…”

Section: Discussionmentioning

confidence: 92%

“…4,12 In addition, recently published reports have documented good results with meniscal repair, including tears that extend into classically irreparable avascular zones 1,19 and other atypical meniscal tear patterns. 9,11,14,15 Furthermore, new arthroscopic devices allow for meniscal repairs to be performed with less invasiveness and potentially decreased surgical time. 18 Subsequently, the indications and criteria for meniscal repair are expanding because of the improved understanding of pathophysiology, new knowledge about biomechanics, and novel surgical techniques.…”

mentioning

confidence: 99%

Surgical Trends in the Treatment of Meniscal Tears

et al. 2016

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This study provides insight into the current practice trends of recent orthopaedic training graduates in the treatment of meniscal tears. The results suggest that reported meniscal procedures have decreased overall among ABOS candidates but that meniscal repair cases have increased. The findings support the recent shift toward evidence-based medicine, with changing practice patterns that may reflect the dissemination of recent findings from large, high-quality research studies in this field.

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“…If surgical repair of the meniscus is required, alteration to the rehabilitation program is warranted; although controversy exists regarding the duration of immobilization, WB progression, and the timing for return to pivoting sports. 9 Cannon and Vittori 25 and others 90,121,128 reported an increase in meniscal healing when a concomitant ACL reconstruction was performed. For patients undergoing concomitant ACL reconstruction and meniscus repair, ROM and WB progressions are slightly slower, depending on the extent of meniscus repair or location of meniscal injury.…”

Section: Meniscal Pathologymentioning

confidence: 98%