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Am J Sports Med. 2015 Feb;43(2):282-8. doi: 10.1177/0363546514562168. Epub 2014 Dec 23.

Factors predictive of concomitant injuries among children and adolescents undergoing anterior cruciate ligament surgery.

Author information

1
Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA The Steadman Philippon Research Institute, Vail, Colorado, USA Justin.Tyler.Newman@gmail.com.
2
The Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA.
3
Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA.

Abstract

BACKGROUND:

The timing of treatment for pediatric anterior cruciate ligament (ACL) injuries remains controversial. The risks of delaying reconstruction and the differences between age groups are poorly defined.

PURPOSE:

To investigate factors that contribute to the prevalence and severity of concomitant chondral and meniscal injuries among patients aged 14 to 19 years versus those aged ≤14 years at the time of ACL reconstruction. The hypothesis was that concomitant injuries would be more prevalent in older versus younger subjects. Also, a delay in surgery would be predictive of the presence and severity of concomitant knee injuries requiring additional operative procedures.

STUDY METHODS:

Cohort study; Level of evidence, 3.

METHODS:

All subjects who underwent primary ACL reconstruction at a single tertiary pediatric hospital between 2005 and 2012 were retrospectively reviewed. The location, severity, and treatment of all concomitant knee injuries were recorded. Chi-square tests were used to compare the prevalence of chondral and meniscal injuries in the older (age, 14-19 years; n = 165) versus younger (age, ≤14 years; n = 66) cohorts. A multivariable logistic regression analysis was used to identify factors related to the presence of a concomitant injury that required additional treatment. Kaplan-Meier analyses were used to explore the relation between time to surgery and meniscal injury severity.

RESULTS:

There was a significant relationship between time to surgery and the development of an irreparable meniscal injury (P < .05 for all) in both the younger and older groups. Time to surgery correlated with severity of chondral injury in the younger cohort (P = .0343) but not in the older cohort (P = .8877). In the younger cohort, only a delay in surgery >3 months (odds ratio [OR] = 4.8; 95% CI, 1.7-14.4; P = .0027) was significantly predictive of the presence of an injury that required additional operative procedures. In the older patients, a return to activity before surgery (OR = 3.8; 95% CI, 1.52-11.9; P = .0034) and obesity (OR = 2.5; 95% CI, 1.1-7.4; P = .0381) were significantly predictive of an injury that required additional operative procedures.

CONCLUSION:

Compared with younger subjects, the prevalence of concomitant knee injuries as well as the need for additional operative procedures was greater among older subjects. A delay to surgery correlated with increased severity of injury among both older and younger populations. A delay in surgery >3 months was the strongest predictor of the development of a concomitant injury in the younger cohort. A return to activity and obesity were significantly related to the presence of a concomitant knee injury in the older cohort.

KEYWORDS:

concomitant knee injuries; delay in surgery; meniscus and chondral injuries; pediatric ACL

Comment in

PMID:
25537943
DOI:
10.1177/0363546514562168
[Indexed for MEDLINE]

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