title: Factors predictive of concomitant injuries among children and adolescents undergoing anterior cruciate ligament surgery.
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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA The Steadman Philippon Research Institute, Vail, Colorado, USA Justin.Tyler.Newman@gmail.com.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Newman
authors.affiliation: The Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Carry
authors.affiliation: The Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: E Bailey
authors.initials: EB
authors.lastname: Terhune
authors.affiliation: Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA.
authors.forename: Murray D
authors.initials: MD
authors.lastname: Spruiell
authors.affiliation: Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA.
authors.forename: Austin
authors.initials: A
authors.lastname: Heare
authors.affiliation: Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Mayo
authors.affiliation: Department of Orthopaedic Surgery, University of Colorado-Denver, Denver, Colorado, USA.
authors.forename: Armando F
authors.initials: AF
authors.lastname: Vidal
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002358:Cartilage, Articular / Q000293:injuries*; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007718:Knee Injuries / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D000070600:Tibial Meniscus Injuries; D055815:Young Adult
keywords: concomitant knee injuries; delay in surgery; meniscus and chondral injuries; pediatric ACL