Associated injuries in pediatric and adolescent anterior cruciate ligament tears: Does a delay in treatment increase the risk of meniscal tear?

Millett, Peter J.; Willis, Andrew A.; Warren, Russell F.

doi:10.1053/jars.2002.36114

Cited by 360 publications

(273 citation statements)

References 9 publications

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“…Similar findings have been reported, with Millett et al [32] Bucket handle tear of the medial meniscus 4 29 Bucket handle tear of the lateral meniscus 1 13…”

Section: Discussionsupporting

confidence: 87%

“…Three American studies evaluated similar populations using much shorter times. Millett et al had a mean time to surgery of 101 days [32], at which point only 4% of our patients had undergone repair. Dumont et al reported 65% of patients had surgery 150 days or less after injury [12], compared with 20% in our series.…”

Section: Discussionmentioning

confidence: 66%

“…Previous American studies of adolescent patients with ACL tears showed an association between delay from initial injury to surgical reconstruction and an increase in medial meniscus tears [12,28,32]. However, these studies looked at relatively short intervals (all less than 5 months).…”

Section: Discussionmentioning

confidence: 99%

“…With each episode of giving way, meniscal tears can become more complex and less amenable to repair [8]. Studies in adult patients [7,8,24,39] and in pediatric patients [12,28,32] have shown an increased incidence of medial meniscal tears with delayed ACL reconstruction. Although the treatment of ACL tears in skeletally immature patients remains controversial [33], the risk of physeal injury and resulting growth disturbance from ACL repair to a patient with open physes is now thought to be small [15,22], and many centers (including our institution) opt for prompt reconstruction before skeletal maturity [9,16,20,25,31,34,40].…”

Section: Introductionmentioning

confidence: 99%

“…Previous American studies showing an increased incidence of meniscal tears with delay to ACL reconstruction in adolescent patients have looked at relatively short-term tear progression (\ 5 months) [12,28,32], but the longerterm prognosis is unclear. This is important in cases of initially missed ACL tears in patients who present late and in the Canadian public healthcare system where delays for imaging and surgery are substantially longer than in the United States [14].…”

Section: Introductionmentioning

confidence: 99%

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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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“…Similar findings have been reported, with Millett et al [32] Bucket handle tear of the medial meniscus 4 29 Bucket handle tear of the lateral meniscus 1 13…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Joint loads resulting in ACL rupture: Effects of age, sex, and body mass on injury load and mode of failure in a mouse model

2016

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Anterior cruciate ligament (ACL) tears are a common knee injury with a known but poorly understood association with secondary joint injuries and post-traumatic osteoarthritis (OA). Female sex and age are known risk factors for ACL injury but these variables are rarely explored in mouse models of injury. This study aimed to further characterize a non-surgical ACL injury model to determine its clinical relevance across a wider range of mouse specifications. Cadaveric and anesthetized C57BL/6 mice (9-52 weeks of age) underwent joint loading to investigate the effects of age, sex, and body mass on ACL injury mechanisms. The ACL injury load (whole joint load required to rupture the ACL) was measured from force-displacement data, and mode of failure was assessed using micro-dissection and histology. ACL injury load was found to increase with body mass and age (p < 0.001) but age was not significant when controlling for mass. Sex had no effect. In contrast, the mode of ACL failure varied with both age and sex groups. Avulsion fractures (complete or mixed with mid-substance tears) were common in all age groups but the proportion of mixed and mid-substance failures increased with age. Females were more likely than males to have a major avulsion relative to a mid-substance tear (p < 0.01). This data compliments studies in human cadaveric knees, and provides a basis for determining the severity of joint injury relative to a major ACL tear in mice, and for selecting joint loading conditions in future experiments using this model. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1754-1763, 2017.

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Age‐ and sex‐specific differences in ACL and ACL bundle size during adolescent growth

Cone

Barnes

Howe

et al. 2021

Journal Orthopaedic Research

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Anterior cruciate ligament (ACL) injuries are increasingly common in adolescents, and injuries in this age‐group are associated with many unique challenges. Recent large animal studies suggest that the size and function of the major bundles of the ACL change differently throughout skeletal growth. To better aid clinical treatment of pediatric partial ACL tears and better predict outcomes from age‐specific treatments, there is a need to measure changes in ACL bundle size in humans during growth. As such, the objective of this study was to compare changes in the length and cross‐sectional area (CSA) of the ACL and its primary bundles in adolescent human subjects. Magnetic resonance imaging (MRI) scans were analyzed to determine the visibility and integrity of the ACL and its anteromedial and posterolateral bundles. MRI scans were considered from a retrospective database of subjects ranging from 10 to 18 years of age. The ACL and its anteromedial and posterolateral bundles were segmented and reconstructed into 3D models, and length and CSA were calculated. Total ACL length and CSA were greater in males compared with females, with a statistically significant interaction between age and sex for CSA. Sex had a significant effect on the CSA of both bundles. These sex‐dependent differences emerge with moderate to large effect sizes (range: d = 0.50 to d = 1.23) beginning around 13 years of age. Along with ACL bundle structure–function relationships previously established in preclinical animal models, these findings may point toward biomechanical changes in the adolescent human ACL.

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Associated injuries in pediatric and adolescent anterior cruciate ligament tears: Does a delay in treatment increase the risk of meniscal tear?

Cited by 360 publications

References 9 publications

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

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

Joint loads resulting in ACL rupture: Effects of age, sex, and body mass on injury load and mode of failure in a mouse model

Age‐ and sex‐specific differences in ACL and ACL bundle size during adolescent growth

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