title: Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  In pediatric patients, anterior cruciate ligament (ACL) reconstruction is controversial; however, delaying surgery until skeletal maturity is complete may increase the risk of secondary meniscal and articular cartilage injury.
  
  
  OBJECTIVE
  To assess the risk of meniscal and chondral injuries with delay of ACL reconstruction.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Records were reviewed in patients younger than 17 years (median age, 14 years) who had ACL reconstruction. Patients were consecutively enrolled and assigned to 1 of 3 surgical groups based on timing of surgery: acute (<6 weeks after surgery), subacute (6-12 weeks), or chronic (>3 months). The type and grade of meniscal injuries was documented according to the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) meniscal classification criteria. International Cartilage Repair Society (ICRS) criteria were used to document location and grade of chondral injuries. Associations between patient characteristics and meniscal injury were tested using rank sum and chi-square tests. Regression analyses were conducted to model incidence and severity of lateral and medial meniscal tears. There were 130 patients who had 135 ACL reconstructions between the years of 2000 and 2012.
  
  
  RESULTS
  Sixty-two ACL injuries were treated acutely, 37 were subacute, and 36 were chronic. Meniscal injuries (n = 112) included 70 lateral and 42 medial tears. Time to surgery had bivariate association with lateral and medial meniscal tears (P = .016 and .007, respectively). Independent risk factors for incidence of lateral meniscal tears were younger age (P = .028) and return to sports activities before surgery (P = .007). Patients with 1 episode of instability had 3-fold higher odds of higher grade lateral meniscal tear (95% CI, 1.30-7.60). Compared with acute reconstruction, subacute and chronic reconstruction patients had 1.45 and 2.82 times higher odds, respectively, of lateral meniscal tear severity (P = .12). Independent risk factors for incidence of medial meniscal tears were female sex (P = .03), older age (P = .01), and any episode of instability (P = .01). Adjusted odds ratio for medial meniscal tear was 4.7 for an instability episode (vs no episode; P = .01). Adjusted odds ratio for increased severity of medial meniscal tears included any instability episode, 5.6 (P < .01); playing sports before reconstruction, 15.2 (P < .01); and time to surgery greater than 3 months, 4.3 (P = .046). Seventeen patients had 23 chondral injuries. The risk factors for chondral injury included increased time to surgery (P = .005) and any instability episode (P = .001). For increased grade of chondral injury, risk factors were time to surgery (P ≤ .001) and any instability episode (P = .003).
  
  
  CONCLUSIONS
  Delayed ACL reconstruction increased the risks of secondary meniscal and chondral injuries in this population of pediatric patients.
authors.affiliation: Tennessee Orthopaedic Alliance, Nashville, Tennessee, USA andersonaf@toa.com.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Anderson
authors.affiliation: Tennessee Orthopaedic Alliance, Nashville, Tennessee, USA.
authors.forename: Christian N
authors.initials: CN
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002358:Cartilage, Articular / Q000293:injuries*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007718:Knee Injuries / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D000070600:Tibial Meniscus Injuries; D013997:Time Factors
keywords: ACL; adolescent; cartilage; children; knee; meniscus; reconstruction; skeletally immature