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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3738–3753 | Cite as

Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis

  • Jeffrey Kay
  • Muzammil Memon
  • Ajay Shah
  • Yi-Meng Yen
  • Kristian Samuelsson
  • Devin Peterson
  • Nicole Simunovic
  • Helene Flageole
  • Olufemi R. AyeniEmail author
Knee

Abstract

Purpose

To evaluate the association between surgical timing and the incidence of secondary meniscal or chondral damage in children and adolescents with anterior cruciate ligament (ACL) ruptures.

Methods

Three electronic databases, PubMed, MEDLINE, and EMBASE, were systematically searched from database inception until October 16, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported the incidence of meniscal and articular cartilage damage in children or adolescent athletes with ACL injuries as well as the timing of their ACL reconstruction (ACLR). Risk ratios were combined in a meta-analysis using a random effects model.

Results

A total of nine studies including 1353 children and adolescents met the inclusion criteria. The mean age of patients included was 14.2 years (range 6–19), and 45% were female. There was a significantly decreased risk of concomitant medial meniscal injury in those reconstructed early (26%) compared to those with delayed reconstruction (47%) [pooled risk ratio (RR) = 0.49, 95% CI 0.36–0.65, p < 0.00001]. There was also a significantly reduced risk of medial femoral chondral (RR = 0.48, 95% CI 0.31–0.75, p = 0.001), lateral femoral chondral (RR = 0.38, 95% CI 0.20–0.75, p = 0.005), tibial chondral (RR = 0.45, 95% CI 0.27–0.75, p = 0.002), and patellofemoral chondral (RR = 0.41, 95% CI 0.20–0.82, p = 0.01) damage in the early reconstruction group in comparison to the delayed group.

Conclusion

Pooled results from observational studies suggest that early ACLR results in a significantly decreased risk of secondary medial meniscal injury, as well as secondary medial, lateral, and patellofemoral compartment chondral damage in children and adolescents. This study provides clinicians with valuable information regarding the benefits of early ACL reconstruction in children and adolescents, and can be used in the decision making for athletes in this population.

Level of evidence

IV.

Keywords

Pediatric ACL Timing Early Meniscal damage Chondral damage 

Notes

Funding

There are no sources of funding to be declared.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethical approval

This is a systematic review of the literature and no ethical approval is required.

Supplementary material

167_2018_5012_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 KB)

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Jeffrey Kay
    • 1
  • Muzammil Memon
    • 1
  • Ajay Shah
    • 2
  • Yi-Meng Yen
    • 3
  • Kristian Samuelsson
    • 4
  • Devin Peterson
    • 1
  • Nicole Simunovic
    • 5
  • Helene Flageole
    • 6
  • Olufemi R. Ayeni
    • 1
    Email author
  1. 1.Division of Orthopaedic Surgery, Department of SurgeryMcMaster University Medical CentreHamiltonCanada
  2. 2.Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonCanada
  3. 3.Department of Orthopaedic SurgeryBoston Children’s Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Department of OrthopaedicsThe Sahlgrenska Academy, University of GothenburgGothenburgSweden
  5. 5.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  6. 6.Department of Pediatric SurgeryMcMaster Children’s HospitalHamiltonCanada

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