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Gupta A, Badin D, Ortiz-Babilonia C, Davidson AJ, Lee RJ. Is Delayed Anterior Cruciate Ligament Reconstruction Associated With a Risk of New Meniscal Tears? Reevaluating a Longstanding Paradigm. Orthop J Sports Med 2023; 11:23259671231203239. [PMID: 37810743 PMCID: PMC10559715 DOI: 10.1177/23259671231203239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Delayed anterior cruciate ligament (ACL) reconstruction has been associated with an increased risk of meniscal tears. However, studies comparing early versus delayed ACL reconstruction have not clearly demonstrated that meniscal tears diagnosed arthroscopically are new injuries as opposed to concomitant injuries sustained during ACL rupture. Purpose To determine whether and how delay of ACL reconstruction is associated with risk of "new" meniscal tears (defined as those visualized arthroscopically that had not been detected on magnetic resonance imaging [MRI]) in adult and pediatric patients. Study Design Cohort study; Level of evidence, 3. Methods We retrospectively identified patients who underwent primary ACL reconstruction between 2013 and 2022 at our institution. To ensure that MRI reflected initial intra-articular pathology, we included only patients who had an MRI scan within 3 weeks after injury (173 pediatric and 369 adult patients). Multivariate Poisson regression was performed to calculate the adjusted relative risk (ARR) of new meniscal tears after delayed (≥8 weeks from injury) operative treatment. Results The mean (± SD) time from injury to MRI was 1.0 ± 0.8 weeks for pediatric patients and 1.1 ± 0.7 weeks for adults. Less than half of the meniscal tears observed arthroscopically had been absent on initial MRI. New medial meniscal tears occurred in 15% of pediatric patients and 16% of adults. New lateral meniscal tears occurred in 48% of pediatric patients and 34% of adults. Among pediatric patients, delayed ACL reconstruction was associated with higher risk of new medial tears (ARR, 3.9; 95% CI, 1.5-10) but not lateral tears (ARR, 0.8; 95% CI, 0.4-1.5). In contrast, adults had no significant increase in risk of meniscal tears associated with operative delay. Conclusion Delayed ACL reconstruction may be acceptable in adults, who may be less active and less injury-prone than children and adolescents.
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Affiliation(s)
- Arjun Gupta
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Badin
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carlos Ortiz-Babilonia
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Anthony J. Davidson
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - R. Jay Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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2
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Ellis HB, Zak TK, Jamnik A, Lind DRG, Dabis J, Losito M, Wilson P, Moatshe G. Management of Pediatric Anterior Cruciate Ligament Injuries: A Critical Analysis. JBJS Rev 2023; 11:01874474-202308000-00001. [PMID: 37535763 DOI: 10.2106/jbjs.rvw.22.00223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
» Overall evidence for the treatment of an anterior cruciate ligament (ACL) injury in a pediatric or skeletally immature patient remains lows.» An ACL reconstruction is recommended with concomitant repairable chondral and meniscus injury or with symptoms of persistent instability despite high-quality rehabilitation.» Treatment decision for pediatric ACL reconstruction should use a shared decision-making model weighing the risks and benefits of both a nonoperative vs. surgical treatment.
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Affiliation(s)
- Henry B Ellis
- Scottish Rite for Children, Dallas, Texas
- University of Texas Southwestern, Dallas, Texas
| | | | | | - Dane R G Lind
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Philip Wilson
- Scottish Rite for Children, Dallas, Texas
- University of Texas Southwestern, Dallas, Texas
| | - Gilbert Moatshe
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Orthopedics, Oslo University Hospital, Oslo, Norway
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Robot-assisted all-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:429-435. [PMID: 36169700 DOI: 10.1007/s00264-022-05592-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To review a series of adolescent patients with anterior cruciate ligament (ACL) injuries surgically treated with robot-assisted all-epiphyseal ACL reconstruction (ACLR), and to compare with the traditional freehand group. METHODS This retrospective clinical study included 16 patients with ACL injuries who underwent ACLR by robot-assisted technique or traditional freehand method from June 2018 to March 2020. All patients were divided into the robot-assisted group (6 patients) or the traditional surgery group (10 patients). The number of intra-operative fluoroscopies, operation time, accuracy of bone tunnel insertions, International Knee Documentation Committee (IKDC) subjective score and ligament laxity testing were recorded in the two groups. RESULTS All patients returned for follow-up, at a mean of 31.6 ± 4.5 months after surgery. The average age of the robot-assisted group was 12.2 ± 1.3 years. The number of intra-operative fluoroscopies was 10.9 ± 2.8 in the traditional freehand group, whereas it was only 3.0 ± 0.6 in the robot-assisted group, which was significantly lower (P < 0.05). The operative time in the robot-assisted group was shorter than that in the traditional freehand group (87 ± 10.7 min vs. 126 ± 12.1 min, P < 0.05). The distance between the center of actual insertion and the center of the idea insertion on both femoral and tibial intra-articular bone tunnel were 1.5 ± 0.3 mm and 1.6 ± 0.3 mm for the robot-assisted group and 2.7 mm ± 0.4 mm and 2.4 ± 0.4 mm for the traditional freehand group (P < 0.05). There were no significant differences between the two groups in function recovery at the last follow-up. CONCLUSIONS All-epiphyseal ACLR is a technically demanding procedure with a small margin of error. Robot-assisted treatment of ACL injuries in skeletally immature patients is more accurate than traditional freehand method, with shorter operation time and fewer intra-operative fluoroscopies.
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4
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James EW, Dawkins BJ, Schachne JM, Ganley TJ, Kocher MS, Anderson CN, Busch MT, Chambers HG, Christino MA, Cordasco FA, Edmonds EW, Green DW, Heyworth BE, Lawrence JTR, Micheli LJ, Milewski MD, Matava MJ, Nepple JJ, Parikh SN, Pennock AT, Perkins CA, Saluan PM, Shea KG, Wall EJ, Willimon SC, Fabricant PD. Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:4008-4017. [PMID: 33720764 DOI: 10.1177/0363546521990817] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries. PURPOSE/HYPOTHESIS The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article. Exclusion criteria were revision ACL reconstruction, tibial spine avulsion fracture, case report or small case series (<5 patients), non-English language manuscripts, multiligamentous injuries, and nonclinical studies. RESULTS A total of 30 studies containing 50 cohorts and representing 1176 patients met our criteria. With respect to nonoperative treatment, knee instability was observed in 20% to 100%, and return to preinjury level of sports ranged from 6% to 50% at final follow-up. Regarding operative treatment, meta-analysis results favored early ACL reconstruction over delayed reconstruction (>12 weeks) for the presence of any meniscal tear (odds ratio, 0.23; P = .006) and irreparable meniscal tear (odds ratio, 0.31; P = .001). Comparison of any side-to-side differences in KT-1000 arthrometer testing did not favor early or delayed ACL reconstruction in either continuous mean differences (P = .413) or proportion with difference ≥3 mm (P = .181). Return to preinjury level of competition rates for early and delayed ACL reconstruction ranged from 57% to 100%. CONCLUSION Delaying ACL reconstruction in pediatric or adolescent patients for >12 weeks significantly increased the risk of meniscal injuries and irreparable meniscal tears; however, early and delayed operative treatment achieved satisfactory knee stability. Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports.
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Affiliation(s)
- Evan W James
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Brody J Dawkins
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Schachne
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Theodore J Ganley
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Mininder S Kocher
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
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- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Christian N Anderson
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Michael T Busch
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Henry G Chambers
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Melissa A Christino
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Frank A Cordasco
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Eric W Edmonds
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Daniel W Green
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Benton E Heyworth
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - J Todd R Lawrence
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Lyle J Micheli
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Matthew D Milewski
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Matthew J Matava
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Jeffrey J Nepple
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Shital N Parikh
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Andrew T Pennock
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Crystal A Perkins
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Paul M Saluan
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Kevin G Shea
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Eric J Wall
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Samuel C Willimon
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
| | - Peter D Fabricant
- Investigation performed at Hospital for Special Surgery, New York, New York, USA
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5
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Stinson ZS, Davelaar CMF, Kiebzak GM, Edmonds EW. Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making? Orthop J Sports Med 2021; 9:23259671211046258. [PMID: 34676272 PMCID: PMC8524719 DOI: 10.1177/23259671211046258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Personal and professional biases can affect decision-making regarding
important issues in pediatric sports medicine. Gaining insight into the
opinions of health care professionals who specialize in pediatric sports
medicine will provide information that may be useful for directing ongoing
research in this field. Hypothesis: It was hypothesized that surgeons would demonstrate bias toward early
surgical intervention versus nonsurgeons. In addition, it was hypothesized
that youth sports medicine professionals who were parents of a child with a
previous major sports injury or concussion would be less likely to allow
their child to play American tackle football or return to football after a
concussion. Study Design: Cross-sectional study. Methods: An online survey was provided to the active members of the Pediatric Research
in Sports Medicine Society. We used both professional background information
and responses to questions related to personal experiences with youth sports
injuries to determine potential factors associated with underlying biases.
Survey responses among subgroups were compared using the Fisher exact test.
The Pearson correlation coefficient was used to evaluate years in practice
versus opioid use. Results: Of the survey participants, 62.5% were pediatric surgeons, and 37.5%
represented different nonsurgical youth sports medicine professions.
Surgeons were less likely than nonsurgeons to agree to allow their child to
return to football after sustaining a concussion and completing a concussion
protocol (48% vs 76%, P = .013). Surgeons were more likely
than nonsurgeons to agree to both elective shoulder stabilization after a
first-time dislocation and elective drilling of a stable knee
osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%,
P = .003 and 52% vs 23%, P = .013,
respectively). Those who reported having a child with a concussion history
were more likely to support him or her returning to football after a
concussion (65% vs 33%, P = .026). Conclusion: Surgeons were more likely to favor elective shoulder-stabilization surgery
after a first-time dislocation and drilling of a stable knee OCD instead of
nonoperative management. Personal experience of having a child who sustained
a major sports injury or concussion did not demonstrate a bias against
participation in football or return to football after a concussion.
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6
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Cruz AI, Beck JJ, Ellington MD, Mayer SW, Pennock AT, Stinson ZS, VandenBerg CD, Barrow B, Gao B, Ellis HB. Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis. JB JS Open Access 2020; 5:e20.00106. [PMID: 34322650 PMCID: PMC8312832 DOI: 10.2106/jbjs.oa.20.00106] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population. METHODS PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration). RESULTS The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69). CONCLUSIONS Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aristides I. Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Hasbro Children’s Hospital, Providence, Rhode Island
| | - Jennifer J. Beck
- Orthopaedic Institute for Children, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Matthew D. Ellington
- Dell Medical School, The University of Texas at Austin, and Central Texas Pediatric Orthopedics, Austin, Texas
| | - Stephanie W. Mayer
- Sports Medicine Center, Department of Orthopaedic Surgery, Children’s Hospital Colorado, University of Colorado, Denver, Colorado
| | - Andrew T. Pennock
- Rady Children’s Hospital, University of California San Diego, San Diego, California
| | - Zachary S. Stinson
- Nemours Children’s Hospital, University of Central Florida, Orlando, Florida
| | - Curtis D. VandenBerg
- Children’s Hospital of Los Angeles, Keck School of Medicine of USC, Los Angeles, California
| | - Brooke Barrow
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Burke Gao
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Henry B. Ellis
- Texas Scottish Rite Hospital for Children, University of Texas Southwestern, Dallas, Texas
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7
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Hoshikawa A, Hiraoka H, Monobe Y, Shiraki K, Sasaki Y, Nakamura H, Saita K, Sakai H. Midterm Clinical Results After All-Epiphyseal Double-Bundle Reconstruction of the Anterior Cruciate Ligament in Children With Open Physes. Orthop J Sports Med 2020; 8:2325967120910083. [PMID: 32270014 PMCID: PMC7093688 DOI: 10.1177/2325967120910083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/17/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Atsuto Hoshikawa
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama
Medical University, Saitama, Japan
- Atsuto Hoshikawa, MD, Department of Orthopaedic Surgery, Saitama
Medical Center, Saitama Medical University, Kamoda 1981, Kawagoe-shi, Saitama
350-8550, Japan ()
| | - Hisatada Hiraoka
- Department of Orthopaedic Surgery, Tokyo Teishin Hospital, Tokyo,
Japan
| | - Yoshirou Monobe
- Department of Orthopaedic Surgery, Yokohama Rosai Hospital,
Yokohama, Kanagawa, Japan
| | - Katsuhiko Shiraki
- Department of Orthopaedic Surgery, Wakaba Hospital, Sakado-shi,
Saitama, Japan
| | - Yuuki Sasaki
- Department of Orthopaedic Surgery, Misu Clinic, Kasukabe-shi,
Saitama, Japan
| | - Haruhiko Nakamura
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama
Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama
Medical University, Saitama, Japan
| | - Hiroya Sakai
- Center for University-wide Education, Saitama Prefectural
University, Koshigaya-shi, Saitama, Japan
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8
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Everhart JS, Kirven JC, Abouljoud MM, DiBartola AC, Kaeding CC, Flanigan DC. Effect of Delayed Primary Anterior Cruciate Ligament Reconstruction on Medial Compartment Cartilage and Meniscal Health. Am J Sports Med 2019; 47:1816-1824. [PMID: 31125273 DOI: 10.1177/0363546519849695] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The time required to develop a secondary cartilage or meniscal injury in the medial compartment after anterior cruciate ligament (ACL) injury is not well understood. PURPOSE To determine the association between time delay until ACL reconstruction and the presence of medial compartment Outerbridge grade 3 or 4 chondral injury or medial meniscal tear requiring treatment. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 609 patients underwent primary ACL reconstruction at a single institution at a median 46 days between injury and surgery (61.4% male; mean age, 26.5 years [SD, 11.1]). Chondral status was graded according to Outerbridge criteria at the time of surgery. Multivariate regression analysis was used to assess the relationship between time delay until surgery and medial compartment chondral injury or meniscal injury requiring treatment. Adjustment was performed as needed for patient demographics, sporting activity, and prior knee injuries. Time until surgery had a nonlinear association with medial compartment health and was more effectively described in discrete intervals rather than as a continuous variable. The optimal time intervals to predict medial compartment health were determined by comparison of Bayes information criterion values between fully adjusted regression models. RESULTS After controlling for relevant confounders, delay of surgery >8 weeks had an increased likelihood of a medial meniscal tear requiring partial meniscectomy (adjusted odds ratio [aOR], 2.30; 95% CI, 1.04-5.12; P = .04) and a decreased likelihood of a meniscal tear requiring repair (aOR, 0.50; 95% CI, 0.32-0.76; P = .001). Delay of surgery >5 months had an increased likelihood of a medial Outerbridge grade ≥3 chondral defect (aOR, 3.11; 95% CI, 1.64-5.87; P = .001) or a grade 4 defect (aOR, 3.84; 95% CI, 1.75-8.45; P = .001). CONCLUSION From the time of ACL injury, risk of an irreparable medial meniscal tear found at the time of ACL reconstruction is significantly increased by 8 weeks, and risk of high-grade medial chondral damage is increased by 5 months.
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Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Caid Kirven
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Moneer M Abouljoud
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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9
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Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2018; 26:3738-3753. [PMID: 29876862 DOI: 10.1007/s00167-018-5012-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/01/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the association between surgical timing and the incidence of secondary meniscal or chondral damage in children and adolescents with anterior cruciate ligament (ACL) ruptures. METHODS Three electronic databases, PubMed, MEDLINE, and EMBASE, were systematically searched from database inception until October 16, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported the incidence of meniscal and articular cartilage damage in children or adolescent athletes with ACL injuries as well as the timing of their ACL reconstruction (ACLR). Risk ratios were combined in a meta-analysis using a random effects model. RESULTS A total of nine studies including 1353 children and adolescents met the inclusion criteria. The mean age of patients included was 14.2 years (range 6-19), and 45% were female. There was a significantly decreased risk of concomitant medial meniscal injury in those reconstructed early (26%) compared to those with delayed reconstruction (47%) [pooled risk ratio (RR) = 0.49, 95% CI 0.36-0.65, p < 0.00001]. There was also a significantly reduced risk of medial femoral chondral (RR = 0.48, 95% CI 0.31-0.75, p = 0.001), lateral femoral chondral (RR = 0.38, 95% CI 0.20-0.75, p = 0.005), tibial chondral (RR = 0.45, 95% CI 0.27-0.75, p = 0.002), and patellofemoral chondral (RR = 0.41, 95% CI 0.20-0.82, p = 0.01) damage in the early reconstruction group in comparison to the delayed group. CONCLUSION Pooled results from observational studies suggest that early ACLR results in a significantly decreased risk of secondary medial meniscal injury, as well as secondary medial, lateral, and patellofemoral compartment chondral damage in children and adolescents. This study provides clinicians with valuable information regarding the benefits of early ACL reconstruction in children and adolescents, and can be used in the decision making for athletes in this population. LEVEL OF EVIDENCE IV.
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