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. 2017 Jan;25(1):215-221.
doi: 10.1007/s00167-016-4274-z. Epub 2016 Aug 13.

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

Stephen D Zoller  1 , Kristin A Toy  2 , Peter Wang  3 , Edward Ebramzadeh  4   5 , Richard E Bowen  4   6
Affiliations

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

Stephen D Zoller et al. Knee Surg Sports Traumatol Arthrosc. 2017 Jan.

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.

Keywords: Anterior cruciate ligament; Meniscal repair; Meniscal tear; Meniscectomy; Meniscus; Surgical wait time.

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Conflict of interest statement

Compliance with ethical standards

Conflict of interest The author(s) declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
Meniscus tear classification. Meniscus tear classification, as utilized by Anderson and Anderson [1] and Laible et al. [10]. Grades were given based on tear characteristics and irrespective of whether surgical action was performed. Images are anonymous patient images from this study, printed with permission
Fig. 2
Fig. 2
Meniscal tear incidence versus surgical wait time. Graphical depiction of incidence of medial and lateral meniscal tears in each surgical wait time group. % Menisci torn given as a percentage of total available menisci in that surgical wait time group
See this image and copyright information in PMC

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