NEW YORK (Reuters Health) – Young patients who undergo surgical reconstruction of an acute anterior cruciate ligament (ACL) tear more than 3 months after the injury, appear to be at greater risk of having sustained irreparable medial meniscal tears and lateral compartment chondral injuries, Pennsylvania-based researchers report in a September 14th on-line paper in the American Journal of Sports Medicine.
Dr. J. Todd R. Lawrence and colleagues at Children’s Hospital of Philadelphia note that in skeletally immature patients with significant growth remaining, the risk of inducing a growth disturbance with early reconstruction must be balanced against the risk of further intra-articular damage by delaying treatment until closer to skeletal maturity.
“The real implications of this research,” he told Reuters Health by email, “are that physicians and parents can now have a more informed discussion regarding the risks of delaying ACL reconstruction in young patients.”
To investigate, the team retrospectively reviewed data on 70 patients 14 years of age and younger who underwent ACL reconstruction between 1991 and 2005. Of these, 29 (41%) had reconstruction more than 12 weeks from the time of injury.
In this group, the odds of an associated medial meniscal tear were 4 times that of patients who underwent reconstruction less than 12 weeks from injury. The odds were 11-fold higher if a subjective sense of instability was noted before reconstruction, irrespective of the time from surgery.
Time to surgical reconstruction was also independently associated with medial (odds ratio, 5.6) and lateral (odds ratio, 11.3) compartment chondral injuries.
“Perhaps more importantly,” the investigators add, “more medial meniscal tears in patients who were reconstructed more than 12 weeks after their injury were deemed to be irreparable compared with those noted in the patients reconstructed earlier.”
In light of these findings and “despite there being no data to support the notion that ACL reconstruction can prevent the development of arthritis,” the investigators conclude that “given that both ACL injury and meniscal damage are associated with the development of osteoarthritis, these data may influence many to favor early ACL reconstruction in this population.”
In fact, added Dr. Lawrence, “Combined with newer research noting a relatively low rate of growth disturbance following early ACL reconstruction in children with significant growth remaining, the data presented in our paper, highlighting the significant risk to the joint if surgery is delayed, have led many to recommend early ACL reconstruction.”
Reference:
Am J Sports Med 2011.
