Delaying Knee Surgery in Kids a Bad Idea
Reported July 13, 2009
(Ivanhoe Newswire) As more and more children participate in competitive sports at an increasingly early age, the incidence of knee injury has increased accordingly. Knee injuries are especially problematic in a child under 14 whose skeleton has not reached a mature size.
A new study explores the benefits and risks of repairing a torn anterior cruciate ligament (ACL) in young athletes under the age of 14. “The risk of inducing a growth disturbance with early reconstruction of a torn ACL must be balanced against the risk of further knee damage by delaying treatment until closer to skeletal maturity, author, Theodore J. Ganley, MD, Director of the Sports Medicine and Performance Center for The Children’s Hospital of Pennsylvania and the University of Pennsylvania School of Medicine is quoted as saying. Our study measured the independent risk factors for and relative risk of meniscal and chondral injuries in pediatric ACL patients.”
Researchers analyzed the records of 69 patients, aged 14 years and younger, who had undergone ACL reconstruction between 1991 and 2005. All of the patients were counseled about the benefits and risks of delaying ACL reconstruction and were advised to avoid any at-risk activities and to participate in physical therapy prior to their reconstruction. If the decision was made to delay treatment, patients were instructed to wear a custom ACL brace.
All patients who underwent the surgery used a soft tissue graft with anatomically placed tunnels and fixation devices that did not cross the growth plate. Patients followed for a minimum of one-year post-operatively exhibited no growth disturbances.
Patients who chose to delay treatment, however, did not fare so well. “In our study . . . a delay in treatment of more than 12 weeks had about a four-fold increase in irreparable medial meniscus tears, an 11-fold increase in lateral compartment chondral injuries and a three-fold increase in patellotrochlear injuries said Ganley. Issues with instability in the knee were also increased significantly. Our results highlight and help quantify the risk associated with delaying ACL reconstruction in young athletes and the need for continued injury prevention efforts.
SOURCE: Presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in Keystone, Colorado, July 9-12