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

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.