Delay in ACL surgery may increase risk of medial meniscus injury in pediatric patients
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Pediatric and adolescent patients with ACL tears had a 2% increase in the risk of medial meniscal injury each week that a surgical procedure was delayed following the initial injury, according to published results.
David A. Kolin, BA, MSc, and colleagues retrospectively identified 546 patients 18 years of age or younger who had undergone an ACL reconstruction between 2006 and 2018. Researchers considered arthroscopically confirmed medial meniscal or lateral meniscal tears and if any meniscal tear was present in general as primary outcomes. Researchers used multivariable Poisson regression models to determine whether the time from injury to surgical procedure was a risk factor for subsequent meniscal injury after controlling for sex, age and BMI, as well as to characterize associations of age, sex and BMI with meniscal injury.
Results showed patients had a 2% increased risk of a medial meniscal tear for each week of delayed surgical procedure. Researchers found male patients had a significant weekly increase in the risk of a medial meniscal injury compared with female patients; however, researchers noted the effect modification was not significant. For each 10-week delay, male patients who were obese had a 77.9% increased risk of medial meniscal tear, according to results. Researchers noted patients who used crutches had a decreased risk of medial meniscal tears.
“Our results suggest that early surgery could prevent medial meniscal tears, which may be a consequence of activity on the ACL-deficient knee,” Kolin told Healio Orthopedics. “These findings may lead orthopedic surgeons to recommend operating earlier following ACL injury. Future research could investigate the role of limiting weight-bearing and/or using crutches between injury and surgery.”
Perspective
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In an article by David A. Kolin, BA, MSc, and colleagues, the relationship between the timing of pediatric ACL reconstruction and a meniscus tear was reported in a retrospective multicenter study. Although prior studies established that delays in pediatric ACL reconstruction led to increased rates of medial meniscus pathology, this is the first to report a 2% increase in medial meniscus tears for each additional week from injury to surgery. Whether a delay in access to care or surgical scheduling, these authors reinforce the importance of avoiding prolonged treatment for pediatric ACL reconstruction as delays of greater than 10 weeks may cause up to a 33.3% increase in the risk of a medial meniscus tear.
While this study has important clinical implications in expediting the treatment of pediatric ACL injuries, limitations due to the retrospective nature should not be overlooked. Are delays associated with access to care? Do these medial meniscus tears occur at the time of the ACL injury or are these due to persistent instability? Are all pediatric ACL injuries similar (pre-pubescent vs. skeletally mature adolescent)? Lastly, the ideal timing of a pediatric ACL reconstruction remains unclear as the surgeon must still balance the risk of early reconstruction and arthrofibrosis with a delay in reconstruction and the risk of a medial meniscus injury.
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