Early ACL Surgery Has Benefits in Young Athletes

By Megan Brooks

July 14, 2014

NEW YORK (Reuters Health) - Young athletes who delay anterior cruciate ligament (ACL) surgery may be at increased risk for secondary knee injuries, according to research presented July 10 at the American Orthopaedic Society for Sports Medicine's (AOSSM) annual meeting in Seattle.

"In reviewing records of young patients who received ACL reconstructions, our data showed higher rates and severity of secondary meniscus injuries when surgery is delayed," lead author Dr. Allen F. Anderson, from the Tennessee Orthopaedic Alliance in Nashville, said in a conference statement.

Historically, it was thought best to delay ACL surgery in children until skeletal maturity "and not risk damage to the growth plate," Dr. Anderson said in an interview with Reuters Health. "But what I've seen over 20 years and what this study demonstrates is that delaying surgery results in recurrent instability, meniscal damage and damage to the lining of the bone or degenerative changes that end up causing young people to have arthritis at a much earlier age."

Dr. David Geier, a Charleston, South Carolina-based orthopaedic surgeon and sports medicine specialist who wasn't involved in the study, told Reuters Health, "This study confirms studies from the last couple of years that the trend probably needs to be toward earlier surgery for athletes."

Dr. Anderson and colleagues reviewed the records of 135 athletes with an average age of 14 years who had an ACL reconstruction. They divided them into three groups based on timing of surgery: 62 patients were treated less than six weeks after injury, 37 were treated 6 to 12 weeks after injury, and 36 were treated more than 12 weeks after the injury.

Compared to patients who had surgery within six weeks, those who had surgery 6 to 12 weeks after ACL injury had 1.45 greater odds of lateral meniscus injury, and those waiting more than 12 weeks increased their risk 2.82 times.

"The risk for medial meniscal tears was 4.3 times greater when delaying surgery at least 6 weeks," Dr. Anderson said.

Additional risk factors for secondary injuries included younger age, return to sport activities prior to surgery, and prior episodes of knee instability.

These data, the researchers conclude, provide evidence that initial nonoperative treatment of ACL tears in this age group "carries a high risk" of additional injury, "which may result in long-term knee impairment."

Dr. Geier told Reuters Health, "The problem with a torn ACL, especially in an active young person that plays sports, is that the knee is not stable and may give out and that runs the risk of secondary damage to the meniscus and articular cartilage and that's what this study shows; kids who waited to have surgery had higher rates of meniscus tears."

"While parents and other caregivers have obvious reasons for concern over ACL surgery in young patients, it's important to recognize when it may be beneficial," Dr. Anderson said in a statement. "If surgery now helps eliminate long-term knee problems, it's certainly a good choice."

ACL reconstruction is "pretty well accepted among skeletally mature people, like high school and college kids and obviously adults," Dr. Geier said. "In younger kids, there has been concern about ACL surgery and having to drill through growth plate but there are techniques now that minimize the risk significantly. I think the advantages of earlier surgery outweigh the risks."


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