Meniscal and nonosseous ACL injuries in children and adolescents

Meniscal and nonosseous anterior cruciate ligament (ACL) injuries are being recognized in children and adolescents more frequently. This increase appears to be the result of better diagnostic skills, newer imaging techniques, and the ever-increasing physical demands of organized youth sports. We retrospectively reviewed all cases of knee arthroscopy performed at Brown University School of Medicine from August 1991 to April 1994 in patients < or = 15 years. Of the 24 patients with suspected meniscal or nonosseous ACL injuries based on history and physical examination, 18 (75%) were confirmed at arthroscopy. Fifty-six percent of the patients with nonosseous ACL tears had coexistent meniscal lesions. Twenty-one percent of the meniscal tears were peripheral and showed evidence of spontaneous healing at time of arthroscopy. Seventeen of these patients underwent preoperative magnetic resonance imaging (MRI). Four of the five patients with lateral meniscal tears, all three of the patients with medial meniscal tears, and both of the patients with ACL tears were identified correctly by MRI. This study suggests that a history and physical examination consistent with a meniscal or nonosseous ACL injury will be confirmed by arthroscopy in up to three quarters of adolescent patients. Therefore, the use of MRI should be reserved for those patients in whom the clinical findings are still in question after a careful history and physical examination has been completed.