Jan 29, 2015Quick Hits: ACL Surgery Studies
In Young Athletes
More and more children are participating and getting hurt playing sports each year. A new study presented at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in Keystone, Colo., July 9-12, details the benefits and risks of repairing a torn anterior cruciate ligament (ACL) in young athletes under the age of 14.
“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. Our study measured the independent risk factors for and relative risk of meniscal and chondral injuries in pediatric ACL patients,” said author Theodore J. Ganley, MD, Director of the Sports Medicine and Performance Center for The Children’s Hospital of Pennsylvania and the University of Pennsylvania School of Medicine.
Researchers analyzed the records of 69 patients, 14 years of age and younger who had undergone ACL reconstruction between 1991 and 2005. 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. All patients who underwent the surgery utilized a soft tissue graft with anatomically placed tunnels and fixation devices that did not cross the growth plate. Patients were also followed for a minimum of one-year post-operatively with no growth disturbances being noted.
“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. 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,” said Ganley.
NFL Career Length
Knee injuries are a common problem in collegiate and professional football, often hindering an individual’s career length and future. A secondy study presented at the AOSSM conference suggests that anterior cruciate ligament (ACL) reconstruction versus a simple meniscus repair may predict a longer professional career in those that have suffered knee injuries.
“ACL reconstruction is a reliable surgical technique that enables professional football players to have similar length careers as their counterparts without ACL injuries. Although meniscectomy has a shorter recovery time than ACL reconstruction, these surgeries appear to lead to a significantly shorter career with fewer games played in the long term,” said lead author Robert H. Brophy, MD, Assistant Professor in the Department of Orthopaedic Surgery at the Washington University School of Medicine and Assistant Team Physician for the St. Louis Rams.
The study utilized a database containing the injury history and career NFL statistics of athletes from 1987-2000. Athletes who had a history of meniscectomy and/or ACL surgery and no other surgery or major injury were matched to a control group of athletes without previous surgeries. Athletes were also matched by position, year drafted, round drafted and additional history. Fifty-four athletes with a history of meniscectomies, 29 with a history of ACL reconstruction and 11 with a history of both were identified and matched to controls.
The results illustrated that those individuals with meniscectomy on average reduced the length of their careers by approximately 1.5 years and their games played by 23. Isolated ACL surgery did not significantly reduce the length of years or games played. In those athletes with both surgeries, careers were shortened on average by nearly two years and 32 games.
“A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete’s durability than either surgery alone. With further research, we will be able to better understand how these injuries and surgeries impact an athlete’s career and what can be done to improve long-term outcomes,” said Brophy.