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Temporal relation of meniscal tear incidence, severity, and outcome scores in adolescents undergoing anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Anterior cruciate ligament (ACL) rupture is increasingly common in adolescents. Time between ACL rupture and surgical reconstruction, surgical wait time, is related to concurrent meniscal tear incidence and possibly tear pattern. This study defines the relationship between meniscal tear characteristics and surgical wait time in adolescents with ACL rupture.

Methods

One-hundred and twenty-one consecutive adolescent (median age 16.1 years, range 9–19 years) ACL rupture patients undergoing primary ACL reconstruction were studied. All had documented surgical wait time, preoperative and 6-month post-operative outcome (Lysholm and pedi-IKDC) scores, and intraoperative meniscus tear characteristics. Meniscal tear severity was graded according to the Lawrence and Anderson system: non-surgical: grade 1; reparable: grade 2–3; irreparable: grade 4–5. Significant tears were defined as at least grade 2.

Results

Average age at surgery was 16.1 years. 48.7 % had surgical wait time greater than 6 months. 42.5 % of menisci were torn. With surgical wait time <6 months, there were more lateral than medial tears (48 vs 21 %, p = 0.001). With surgical wait time >6 months, medial tear incidence increased (50 vs 21 %, p < 0.001), there were more significant tears (63 vs 42 %, OR 2.3, p = 0.02), and preoperative Lysholm and pedi-IKDC scores were lower (58 vs 74, p < 0.001; 52 vs 61, p < 0.007). Scores were lower in patients with meniscus tears (63.8 vs 69.3, n.s.; 53.9 vs 60.5, p = .04). Patients with public insurance had risks of surgical wait time greater than 3 months (OR 12.4, p < 0.001) and 6 months (OR 7.8, p < 0.001), and of a significant meniscus tear (OR 2.5, p = 0.03). Six-month post-operative pedi-IKDC scores improved more in meniscus tear patients (28.4 vs 21, p = 0.05).

Conclusions

This study shows a significant increase in medial meniscal tear incidence, decrease in preoperative scores, and worse tear severity with surgical wait time >6 months. Public insurance was a risk factor for longer surgical wait time and meniscus tear.

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Abbreviations

ACL:

Anterior cruciate ligament

PI:

Private insurance

GI:

Government insurance

PPO:

Preferred provider organization

HMO:

Health maintenance organization

ISAKOS:

International society of arthroscopy, knee surgery and orthopaedic sports medicine

pedi-IKDC:

Pediatric international knee documentation committee

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Acknowledgments

Ekta Partani aided in the enrolling of patients and accumulation of outcomes scores for all patients.

Authors’ contribution

S.Z. carried out statistical analysis, drafted the manuscript, and edited the manuscript. K.T. carried out data accumulation, performed statistical analysis, and drafted the manuscript. P.W. carried out data accumulation. E.E. reviewed and carried out statistical analysis, and edited the manuscript. R.B. designed the study, performed the surgeries, enrolled the patients, oversaw the study, and helped to draft the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California – Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA

    Stephen D. Zoller, Edward Ebramzadeh & Richard E. Bowen

  2. University of Toledo College of Medicine, Mulford Library 114, 3000 Arlington Ave, Toledo, OH, 43614, USA

    Kristin A. Toy

  3. USC Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, 90033, USA

    Peter Wang

  4. The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, 403 West Adams Blvd., Los Angeles, CA, 90007, USA

    Edward Ebramzadeh

  5. Orthopaedic Institute for Children, 403 West Adams Blvd., Los Angeles, CA, 90007, USA

    Richard E. Bowen

Authors
  1. Stephen D. Zoller
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  2. Kristin A. Toy
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  3. Peter Wang
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Correspondence to Stephen D. Zoller.

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Zoller, S.D., Toy, K.A., Wang, P. et al. Temporal relation of meniscal tear incidence, severity, and outcome scores in adolescents undergoing anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 215–221 (2017). https://doi.org/10.1007/s00167-016-4274-z

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  • DOI: https://doi.org/10.1007/s00167-016-4274-z

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