title: The Effects of Delays in Diagnosis and Surgical Reconstruction of ACL Tears in Skeletally Immature Individuals on Subsequent Meniscal and Chondral Injury.
abstract: BACKGROUND
  Although studies have shown increased rates of chondral injury with delayed surgical treatment of pediatric anterior cruciate ligament (ACL) injuries, it is unknown if this is related to a delay in diagnosis and appropriate activity restrictions. The purpose of this study was to determine if the time from injury to diagnosis, time from diagnosis to reconstruction, and preoperative activity level correlate with the degree of cartilage injury seen intraoperatively.
  
  
  METHODS
  A retrospective review of skeletally immature patients who underwent ACL reconstruction was performed. Patients were stratified based on the time from injury to diagnosis (≤6 vs. >6 wk), diagnosis to surgery (≤6 vs. >6 wk), and injury to surgery (≤12 vs. >12 wk). Weight-bearing status, brace usage, athletic participation, and meniscus tears were characterized as binary variables. Articular cartilage injury was graded on a scale of 0 to 3. Differences between groups were analyzed using the χ test.
  
  
  RESULTS
  In total, 91 subjects with mean age of 13 years (range, 9 to 16 y) were included. In total, 71% were diagnosed within 6 weeks of injury and 40% underwent surgery within 6 weeks of diagnosis. No differences were found in the presence of medial or lateral meniscus tears or the grade of articular cartilage damage when groups were analyzed by time from injury to diagnosis, diagnosis to surgery, and injury to surgery (P>0.05 in all cases). When stratified by weight-bearing status, brace status, and athletic activity, there were no significant differences between groups for meniscal tears or cartilage injury in any compartment (P>0.05).
  
  
  CONCLUSIONS
  Diagnosis of ACL rupture within 6 weeks of injury and surgical reconstruction within 6 weeks of diagnosis or 12 weeks of injury do not appear to affect the rate of cartilage injury in skeletally immature patients. Weight-bearing status, brace use, and participation in athletic activities between the time of injury and diagnosis also did not impact the rate of intra-articular injury following ACL tear.
  
  
  METHODS
  Level IV.
authors.affiliation: Sports Medicine Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.|Bayhealth Orthopaedic Surgery, Dover, DE.
authors.forename: Eileen A
authors.initials: EA
authors.lastname: Crawford
authors.affiliation: Sports Medicine Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.|Peachtree Orthopaedic Clinic, Atlanta, GA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Young
authors.affiliation: Sports Medicine Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
authors.affiliation: Sports Medicine Service, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Wojtys
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging* / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis* / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001915:Braces; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D002648:Child; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D000070600:Tibial Meniscus Injuries / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors; D061665:Time-to-Treatment