Delaying ACL Repairs in Kids Can Lead to Additonal Surgery

A delay in surgery greater than three months was found to be the only predictive factor of the need for an additional procedure after anterior cruciate ligament (ACL) reconstruction in younger patients, according to recent research.

Justin T. Newman, M.D., and colleagues from the University of Colorado conducted a retrospective chart review of 272 consecutive patients who had ACL reconstruction during a seven-year period at a large tertiary pediatric center. Overall, 66 patients were younger than 14 years. Focal points of the data were operative reports, intraoperative imaging, chronology, return to activity, episodes of instability, meniscal and chondral injury, severity and treatment.

Patients who were more than three months out from time of surgery were 4.75 times more likely to require another procedure, a figure that jumped to nearly eight times more likely for another procedure at more than five months from surgery.

The younger patients had an average time to surgery of 2.6 months as opposed to 1.7 months for patients older than 14 years. Overall, 57 percent of patients had additional injuries that required surgery beyond ACL reconstruction. The older patient cohort had a significantly increased percentage of meniscal tears and were significantly more likely to need another procedure following ACL reconstruction. There also was a significant correlation between severity of chondral injury and time to surgery in younger patients that was not present in the older group.

“In those patients under the age of 14 alone, their sports-related injuries cost the U.S. public $49 billion each year,” Newman said. “This [study] has prognostic as well as economic implications.”