ACL Reconstruction Delay in Pediatric and Adolescent Patients Is Associated with a Progressive Increased Risk of Medial Meniscal Tears

Abstract

Background: We sought to investigate the relationship between the time from an anterior cruciate ligament (ACL) tear to the surgical procedure and meniscal tears in the pediatric and adolescent population.Methods: Patients who were £18 years of age and had undergone an ACL reconstruction from 2006 to 2018 were identified in a retrospective, multicenter cohort. The primary outcomes were arthroscopically confirmed medial meniscal or lateral meniscal tears specifically and, in general, if any meniscal tear was present (medial and/or lateral). A multivariable Poisson regression model was used to determine whether the time from the injury to the surgical procedure was a risk factor for subsequent meniscal injury, after controlling for sex, age, and body mass index (BMI). Multivariable Poisson regression was also used to characterize associations of age, sex, and BMI with meniscal injury.Results: In this study, 546 patients with a mean age (and standard deviation) of 15.3 ± 1.6 years were identified. For each week that the surgical procedure was delayed, there was a 2% increased risk of a medial meniscal tear (adjusted relative risk [ARR], 1.02 [95% confidence interval (CI), 1.01 to 1.03]). The weekly increase in risk of a medial meniscal injury was significant for male patients (ARR, 1.03 [95% CI, 1.01 to 1.05]), but not for female patients (ARR, 1.00 [95% CI, 0.97 to 1.04]), even though the effect modification was not significant (p = 0.24). Obese male patients had a 77.9% increased risk of medial meniscal tear for each 10-week delay (p < 0.001). The use of crutches was associated with a decreased risk of medial meniscal tears (ARR, 0.47 [95% CI, 0.34 to 0.64]).Conclusions: In pediatric and adolescent patients, the risk of meniscal injury is substantial after an ACL tear. A delay Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G568).

How Much Will My Child’s ACL Reconstruction Cost? Availability and Variability of Price Estimates for Anterior Cruciate Ligament Reconstruction in the United States

“…Given that a third of surgical patients were found to have limited health literacy, any delays and difficulties to obtain price estimates including number of calls and length of time between when calls were initiated or received, can create barriers that can lead to delays in care 28. Delayed reconstruction of a complete pediatric ACL tear is correlated with significant increase in complications such as irreparable medial meniscal tears and lateral compartment chondral injuries 14,15. Nonoperative management has been shown to lead to failure to return to high level sports performance, with many patients experiencing complications including symptomatic instability and premature degenerative arthritis 29.…”

“…Delayed surgical intervention, commonly seen in the uninsured, is associated with meniscal tears and chondral injury. 14,15 In addition, early ACL reconstruction has been shown to be more cost effective. 16 Thus, increased rates of ACL reconstruction in the pediatric population have been observed over recent decades.…”

Impediments to Meniscal Repair: Factors at Play Beyond Vascularity

“…Timing prior to the procedure is also an important biomechanical consideration. While waiting can calm inflammation to enhance repair potential, it must be balanced with the increased risk of other injuries that can occur in this timeframe ( Fok and Yau, 2013 ; Kolin et al, 2021 ; Prodromidis et al, 2021 ).…”

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

“…5 In cases with concurrent ACL tears, meniscal repair outcomes are improved with concomitant ACL reconstruction. 2,7,9,12,18 Additionally, delayed ACL reconstruction has been associated with increased rates of meniscal tears, and early intervention is preferred to reduce these risks. 3,7,9,12,13,16…”

“…2,7,9,12,18 Additionally, delayed ACL reconstruction has been associated with increased rates of meniscal tears, and early intervention is preferred to reduce these risks. 3,7,9,12,13,16…”