Delay in repairing a torn anterior cruciate ligament (ACL) in athletes, as young as 14, is likely to elevate the risk of physical disability, reveals a new study.
"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," said study author Dr. Theodore J. Ganley, Director of the Sports Medicine and Performance Center for The Children's Hospital of Pennsylvania and the University of Pennsylvania School of Medicine.
"Our study measured the independent risk factors for and relative risk of meniscal and chondral injuries in pediatric ACL patients," he added.
The researchers analyzed the records of 69 patients, 14 years of age and younger, who had undergone ACL reconstruction between 1991 and 2005.
The data collected included demographics, relevant history (mechanism and side of injury, time from injury to surgery, one or more episodes of instability with activity, use of brace and return to sports), earliest MRI findings and physical exam findings.
Operative reports and intra-operative images were also used to classify meniscal and articular cartilage pathology.
All of the patients were counseled as to the benefits and risks of delaying ACL reconstruction, and advised to avoid any at-risk activities along with participating in physical therapy prior to their reconstruction.
If the decision was made to delay treatment, patients were instructed to wear a custom ACL brace.
"In our study, the largest of skeletally immature patients to evaluate independent risk factors, 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," he added.
The study was presented at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting in Keystone, Colorado.