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Concomitant injuries, reoperation more prevalent in older children who undergo ACL surgery
Recently published data indicated older children had a greater prevalence of concomitant knee injuries and the need for additional surgical procedures after ACL reconstruction compared with younger patients.
Researchers retrospectively reviewed data for adolescent patients who underwent primary ACL reconstruction between July 2005 and December 2012. Patients were split into two cohorts: the younger cohort included 66 patients ages 14 years and younger, and the older cohort included 165 patients between the ages of 14 years and 19 years.
Justin Newman
Demographic variables recorded included age at injury, race, sex, injury laterality, return to activity, whether the patient was given a brace before surgery, BMI and grade of Lachman test. The researchers recorded the location, severity and treatment of additional injuries and used multivariable logistic regression analysis to determine what factors were related to the presence of a concomitant injury requiring additional treatment. Additionally, the relationship between time to surgery and meniscal injury severity was explored using Kaplan-Meier analyses.
Results showed a statistically significant relationship between time to surgery and patients’ development of an irreparable meniscal injury in both groups. However, the time to surgery and the severity of chondral injury were correlated only in the younger cohort, according to the researchers.
A delay in surgery greater than 3 months was a predictor for additional operative procedures needed with the presence of concomitant knee injuries in the younger cohort, and with patients in this category being 4.75-times more likely to need additional surgery than those who underwent the surgery less than 3 months after injury.
Return to activity and obesity were predictors for additional operative procedures needed with presence of concomitant knee injuries in the older cohort, and patients were 3.86-times more likely to need additional operative procedures than those who did not return to activity before surgery, according to the researchers. – by Monica Jaramillo
Disclosure: The study was supported by the National Institutes of Health/National Center for Research Resources (NIH/NCRR) Colorado Clinical and Translational Sciences Institute(CCTS) (grant number UL1 RR025780).