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In a pivotal study by the Johns Hopkins Children’s Center, the delayed surgical treatment of anterior cruciate ligament (ACL) injuries in children has been linked to a heightened risk of new meniscus and cartilage tears.
This risk, however, is not significantly increased in adults facing similar injuries.
This study, recently published in the Orthopaedic Journal of Sports Medicine, underscores the contrasting outcomes that can emerge due to differing levels of physical activity and adherence to medical advice between adults and children.
ACL injuries, characterized by a distinct “popping” sensation in the knee, are predominantly sustained during sports activities involving abrupt directional changes, such as football, soccer, lacrosse, and basketball.
The annual ACL tear rate in the United States is estimated to be between 100,000 and 200,000 cases.
Traditionally, medical practitioners have advised delaying ACL reconstruction in younger patients until they have fully grown. However, these injuries inherently render the knee unstable, thereby increasing vulnerability to further injury across all age groups.
In this comprehensive study, Lee and his research team analyzed electronic medical records of 542 patients who underwent ACL reconstruction at Johns Hopkins Medicine from 2013 to 2022.
The study revealed that 66% of the patients, encompassing both children and adults, exhibited a meniscal tear observed arthroscopically, with 32% of these tears being newly developed injuries not identified in the initial MRI.
Adults are generally more compliant with activity restrictions and medical advice following ACL injuries.
In contrast, children often continue engaging in strenuous sports and play, increasing the likelihood of additional knee damage.
Consequently, the findings emphasize the necessity of prompt surgical treatment in pediatric patients to mitigate ongoing knee damage.
For older patients, however, delaying surgical treatment does not correlate with increased risk.
A closer examination of the data revealed new medial meniscal tears in 15% of pediatric patients and 16% of adults who previously showed no such injuries in initial MRI scans.
Remarkably, 48% of pediatric patients developed new lateral meniscus tears, in contrast to the 34% incidence rate among adults.
Despite these illuminating findings, the study acknowledges potential limitations, such as “selection bias,” wherein surgeons may exhibit a propensity to operate promptly post-injury in cases presenting more severe knee injuries.
Furthermore, the quantification of a patient’s physical activity level post-ACL injury, a pivotal factor in the progression of knee damage, poses a considerable challenge.
Nevertheless, these findings are instrumental in informing surgical decisions for adults and children’s caregivers facing ACL injuries.
Lee and his colleagues, including Anthony Davidson, Carlos Ortiz-Babilonia, Daniel Badin, and Arjun Gupta, are committed to continuing their investigative journey, particularly focusing on the impact of mobility restrictions on the emergence of new meniscal tears.
In an era where medical advancements and innovative research continue to redefine our understanding of sports-related injuries, this study underscores the intricate, multifaceted nature of ACL injuries and the paramount importance of tailored, age-specific treatment approaches.
