Treatment Trends in Meniscal Pathology in the Setting of Concomitant ACL Injuries in Pediatric and Young Adult Patients: An Insurance Database Study

Abstract

Background: Meniscal pathology is commonly encountered in the setting of anterior cruciate ligament (ACL) rupture and is increasingly common in the pediatric and adolescent population. Studies have shown that over half of individuals presenting with ACL rupture will have concurrent meniscal pathology. Purpose: To define trends in the utilization of meniscal procedures (ie, meniscus repair vs partial meniscectomy) and short-term complications in pediatric and young adult patients with meniscal pathology in the setting of a concurrent ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: The IBM MarketScan Commercial Database was utilized to identify ACL reconstruction procedures performed between 2006 and 2018 for individuals aged 5 to 30 years. Annual proportions of meniscectomy and meniscal repair were analyzed, and short-term complications were compared between pediatric/adolescent patients (aged 5-17 years) and young adults (aged 18-30 years). Results: An overall 40,736 records of individuals <18 years old with ACL tears were included. The pediatric/adolescent population had a significantly lower proportion of concomitant meniscal procedures (56.8%; 23,149/40,736) than the young adult population (59.7%; 33,764/56,515; P < .01). From 2006 to 2018, utilization of meniscal repair in the setting of ACL reconstruction steadily increased (20.1% to 35.1% [+15 percentage points], P < .01), while the proportion with meniscectomy decreased (34.4% to 21.3% [–13.1 percentage points], P < .01). There was no difference in rate of reoperation for repeat meniscal repair or meniscectomy in the pediatric/adolescent population for those undergoing meniscal repair versus meniscectomy within 180 days of primary surgery (1.7% [188/10,766] vs 1.5% [186/12,383]; P = .14). Conclusion: From 2006 to 2018, the proportion of patients receiving ACL reconstruction with concomitant meniscal repair increased (20.1% to 35.1%) while the proportion with meniscectomy decreased (34.4% to 21.3%) in the pediatric/adolescent population. Meniscal repair was not associated with a higher 180-day rate of reoperation for repeat meniscal repair or meniscectomy than meniscectomy in the setting of ACL reconstruction. Given no increase in 180-day rate of reoperation for repeat meniscal repair or meniscectomy, further study may seek to understand if expanded indications for meniscal repair may be beneficial and safe in the pediatric/adolescent population.

Prevalence and Predictors of Concomitant Meniscal Surgery During Pediatric and Adolescent ACL Reconstruction: Analysis of 4729 Patients Over 20 Years at a Tertiary-Care Regional Children's Hospital

“…Jackson et al reported that boys were significantly more likely to have lateral meniscal tears and girls were significantly more likely to have medial meniscal tears. Other studies have reported that male patients had higher odds of undergoing concomitant meniscal procedures 4,24 ; however, the authors of those studies did not analyze the rates of medial versus lateral meniscal procedures separately. These sex-based differences between the 2 cohorts, specific to the tibial compartment, make future investigations of pediatric and adolescent patients particularly important.…”

“…15,17 Isolated injury to the ACL is less common, 43 and associations with concomitant injury to the menisci have been well established, particularly in younger patient cohorts. 4,12,19,29,31,41 In addition to the increasing rates of pediatric ACL injury, the rates of concomitant meniscal surgeries have been likewise increasing. 4,12 Compared with adults, pediatric patients tend to have better outcomes after meniscal repair, which have been attributed to enhanced vascularity and healing potential.…”

“… 4 , 12 , 19 , 29 , 31 , 41 In addition to the increasing rates of pediatric ACL injury, the rates of concomitant meniscal surgeries have been likewise increasing. 4 , 12 Compared with adults, pediatric patients tend to have better outcomes after meniscal repair, which have been attributed to enhanced vascularity and healing potential. 10 , 20 Accordingly, a growing trend of increasing rates of pediatric meniscal repair over meniscectomy has emerged.…”

Epidemiology and distribution of cruciate ligament injuries in children and adolescents, with an analysis of risk factors for concomitant meniscal tear

“…The incidence of cruciate ligament injuries (CLI) has significantly increased in the past two decades, particularly among children and adolescents, due to increased sports participation (1-5). Additionally, there has been a recent sharp rise in anterior cruciate ligament (ACL) reconstruction among patients younger than 15 years old (4,6). While CLI epidemiological investigation in children and adolescents has been thoroughly researched in Europe and the United States (2,3,7,8), it remains under-researched in Asian countries, particularly China.…”

The Impact of Meniscal Tear Type and Surgical Treatment on Quadriceps Strength: A Study of Adolescent Patients Post Anterior Cruciate Ligament Reconstruction

“…5 At the time of ACLR, 57% of adolescents also undergo meniscal surgery, which can complicate the rehabilitation process. 2 The menisci play a critical role in knee joint loading and dispersion of forces through the knee during dynamic activities. 11,12 Unfortunately, meniscal pathology can lead to joint instability, progressive reduction in joint space, and articular cartilage pathology.…”