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Published on: April 30, 2014
Predictors of meniscal pathology in paediatric chronic anterior cruciate ligament tears: a case-control study
Marlena Urvater1, Nathan Johnson1, Kylie Bradford2
1University of Queensland, Ochsner Clinical School, 1514 Jefferson Hwy, New Orleans, LA, United States.
Insights
Paediatric anterior cruciate ligament (ACL) injuries frequently involve meniscal tears, especially in Māori and/or Pacific Islander (MPI) adolescents and those with higher body mass index (BMI). Early identification of these risk factors is key for preventing osteoarthritis.
Area of Science:
- Orthopaedic surgery
- Paediatric sports medicine
- Osteoarthritis research
Background:
- Long-term outcomes of paediatric anterior cruciate ligament (ACL) injuries are not well understood, particularly regarding post-traumatic osteoarthritis (PTOA).
- Meniscal pathology is a significant predictor of osteoarthritis and poorer outcomes after ACL injury.
- Concomitant meniscal pathology is common in paediatric ACL injuries.
Purpose of the Study:
- To identify risk factors for meniscal pathology in paediatric patients with ACL injuries.
- To inform targeted prevention strategies for post-traumatic osteoarthritis (PTOA) in at-risk youth.
Main Methods:
- Analysis of perioperative data from 347 paediatric ACL reconstructions with meniscal pathology.
- Inclusion of demographic, injury-related, and physical factors in the analysis.
- Use of univariate and multivariate logistic regression to determine predictors of meniscal pathology.
Main Results:
- Meniscal pathology was present in 58.5% of paediatric ACL injuries.
- Increased body mass index (BMI) and Māori and/or Pacific Islander (MPI) ethnicity were significant predictors of meniscal pathology.
- MPI adolescents had a 4.1-fold increased risk for lateral meniscus tears and a 5-fold increased risk for any meniscal tear. Higher BMI was associated with medial meniscus tears (OR 1.19) and combined tears (OR 1.31).
Conclusions:
- Meniscal pathology is highly prevalent in paediatric ACL injuries.
- Identifying at-risk populations, such as MPI adolescents with higher BMI, is crucial for PTOA prevention.
- Targeted injury-prevention strategies and counselling on modifiable risk factors are recommended for these high-risk groups.
Introduction:
Long-term outcomes following anterior cruciate ligament (ACL) injury in paediatric populations are unclear, with particular concern for post-traumatic osteoarthritis (PTOA). Meniscal pathology is a key predictor of OA and poorer outcomes, frequently occurring alongside ACL injury. This study aims to quantify the risk factors for concomitant meniscal pathology in children and adolescents ACL injury.
Methods:
Perioperative data from 347 ACL reconstructions with meniscal pathology were extracted from a paediatric ACL registry. Demographic, injury-related, and physical factors, including age, sex, ethnicity, injury characteristics, body mass index (BMI), leg dominance, Beighton's score, knee extension range of motion, anteroposterior laxity, skeletal maturity, and time to surgery, were analyzed. Univariate and multivariate binomial logistic regression evaluated for predictors of meniscal pathology.
Results:
Meniscal pathology was present in 58.5% of patients: 53.7% lateral meniscus (LM), 26.1% medial meniscus (MM), and 20.2% both. Increasing BMI and Māori and/or Pacific Islander (MPI) ethnicity were individual predictors of meniscal pathology. MPI adolescents were 4.1-fold increased risk for lateral meniscal injury and a 5-fold increased risk for any tear. Increasing BMI was associated with MM tears (OR 1.19) and combined LM/MM tears (OR 1.31).
Conclusion:
Meniscal pathology is highly prevalent in paediatric ACL injury. Identifying at-risk populations is critical for PTOA prevention and improved long-term outcomes. MPI adolescents with higher BMI may benefit from targeted injury-prevention strategies and counselling on modifiable risk factors.
