The role of arthroscopy in children and adolescents

Angel, Kevin R.; Hall, David J.

doi:10.1016/0749-8063(89)90170-9

Cited by 59 publications

(18 citation statements)

References 8 publications

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“…Previous studies have found that young patients typically present with longitudinal vertical (50–90%) and bucket-handle meniscal tears to the medial meniscus. 2, 11, 13, 17 However, differences in meniscus tears that occur in children who are skeletally immature and tears that occur in adolescent patients that are skeletally mature have not been previously elucidated. The purpose of this study was to describe meniscus tear patterns and to assess the incidence of repair during surgery in these two youthful groups.…”

Section: Introductionmentioning

confidence: 99%

Meniscus Tear Patterns in Relation to Skeletal Immaturity

et al. 2013

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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.

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Section: Introductionmentioning

confidence: 99%

Meniscus Tear Patterns in Relation to Skeletal Immaturity

et al. 2013

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“…Recent studies of skeletally immature patients with ACL tears have demonstrated that non-operative treatment results in poor outcomes, especially in children that return to sports [5][6][7]. Because of the poor outcomes after ACL injury in young patients, some authors have advocated physeal-sparing techniques.…”

Section: Introductionmentioning

confidence: 99%

The anatomy of the proximal tibia in pediatric and adolescent patients: implications for ACL reconstruction and prevention of physeal arrest

Shea

Apel

Pfeiffer

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Although the treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients is still controversial, several studies have advocated ACL reconstruction in selected patients to prevent secondary injury. The proximal tibial physis is a structure at risk during ACL reconstruction in young patients, and physeal growth complications have been reported after surgery in this area. The relationship between the ACL and the proximal tibial physeal/apophyseal regions is poorly understood. This study examined the MRI anatomy of the ACL and the proximal tibia apophysis and epiphysis. MRIs of 59 skeletally immature knees were reviewed (Average age = 12.75 years, range 6-15) to define the anatomy of the epiphyseal and apophyseal regions. Measurements were recorded in three parasagittal planes: (1) at the lateral border of the patellar tendon, (2) the lateral edge of the ACL insertion, and (3) the medial edge of the ACL insertion. A single three-dimensional (3D) computed tomography (CT) scan was used to evaluate the position of standard drill holes used in ACL reconstruction to assess for potential degree of injury to the epiphyseal and apophyseal growth plates. In the parasagittal planes, the average height of the epiphysis was 19.6, 20.7, and 21.5 mm at the lateral border of the patellar tendon, the lateral border of the ACL, and the medial border of the ACL, respectively. At the level of the same landmarks, the apophysis extended below the physis at an average of 20.2, 16.8, and 7.0 mm, respectively. Expressed as a percentage of epiphysis height this was an average of 104, 82, and 33%, respectively. Examination of 3D CT images revealed that variations in drill hole placement had effects on the volume of injury to the proximal tibial physis and apophysis. Drill holes that started more medial, distal, and with a steeper angle of inclination reduced the amount of physis and apophysis violated when compared with holes placed more lateral, proximal, and with a shallow angle of inclination. The proximal tibial physis and apophysis is vulnerable to injury by drill hole placement during ACL reconstruction in skeletally immature patients. This paper defines the anatomic relationship of the apophyseal and epiphyseal regions of the physis in the proximal tibia. The volume of injury to the physis can be reduced by avoiding tunnel placement that is too lateral or too proximal on the tibia. A better understanding of these relationships may guide the placement of tibial drill holes, which have a lower risk of producing significant physeal damage.

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“…A midsubstance tear of the anterior cruciate ligament (ACL) in children is no longer considered a rare injury [1][2][3] . Increasing awareness of the surgical treatment options and higher parental expectations have led to a greater number of these children undergoing ACL reconstruction.…”

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confidence: 99%