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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >THE RATE OF MENISCUS TEARS IN ASSOCIATION WITH ANTERIOR CRUCIATE LIGAMENT INJURIES INCREASES WITH AGE
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THE RATE OF MENISCUS TEARS IN ASSOCIATION WITH ANTERIOR CRUCIATE LIGAMENT INJURIES INCREASES WITH AGE

机译：伴有前交叉韧带损伤的半月板撕裂率随着年龄的增长而增加

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Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal injury. Numerous authors have described associations between the presence of a meniscal tear at the time of ACL reconstruction and time to surgery and number of instability episodes1-3. The purpose of this study was to evaluate the relationship between age and the presence of a meniscal tear at the time of ACL reconstruction in children and adolescents. Methods: A single-institution retrospective review was performed of consecutive pediatric and adolescent patients who underwent ACL reconstruction over a 3.5-year period at a single institution. Inclusion criteria were age less than 20 years and an ACL injury treated with knee arthroscopy and ACL reconstruction. Patients with multiligament knee injuries were excluded. A chart review was performed to obtain demographic information and intra-operative findings. Meniscus tears were defined as tears documented during diagnostic arthroscopy. Results: Four hundred sixty-one patients met inclusion criteria, including 226 males (49%) and 235 females (51%) with a mean age of 15 years (range 7 – 20 years). The right and left knees were affected equally. Two hundred seventy patients (80%) had intra-operative evidence of a meniscal tear, including 215 lateral meniscus tears (56%) and 119 medial meniscus tears (44%). Sixty-four patients (14%) had both medial and lateral meniscus tears. Age at surgery was found to be a statistically significant independent predictor of the presence of a meniscus tear, odds ratio=1.14, 95% CI (1.05 – 1.25), p=0.003. For every 1-year increase in age, there is a 14% increase in the odds of having a meniscus tear and this is depicted in the figure below. Among patients 13 years of age and younger (n = 89), 47% had a meniscus tear. In contrast, 62% of patients 14 – 19 years of age (n = 301) had a meniscus tear, which was significantly greater (p = 0.01). Age was also a statistically significant independent predictor following subgroup analysis of medial and lateral meniscus tears. For every one year increase in age at surgery, there was a 21% increase in the odds of having a medial meniscus tear (odds ratio = 1.21, 95% CI: (1.08 – 1.35), p&0.001) and a 13% increase in the odds of having a lateral meniscus tear (odds ratio = 1.13, 95% CI: (1.04 – 1.24), p=0.01. Conclusions: Among children and adolescents with anterior cruciate ligament tears, for every 1-year increase in age, there is a 14% increase in the odds of having a meniscus tear. Adolescents over the age of 13 years had a significantly greater rate of meniscus tears than did those 13 years of age and younger. A complete arthroscopic examination with close attention to the menisci is required to diagnose and treat meniscal tears. Surgeons should be comfortable with all meniscus repair techniques, including inside-out, outside-in, all-inside, radial, and transosseous root repairs as the majority of children and adolescent patients with ACL tears also have an associated meniscus tear. Anderson AF, Anderson CN. Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 2015;43(2):275-281. Millett PJ, Willis AA, Warren RF. Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 2002;18(9):955-959. Shieh A, Bastrom T, Roocroft J, et al. Meniscus tear patterns in relation to skeletal immaturity: children versus adolescents. Am J Sports Med 2013;41(12):2779-2783.
机译：背景：前交叉韧带（ACL）眼泪经常与半月板损伤相关。许多作者已经描述了ACL重建时半月板撕裂的存在与手术时间和不稳定性发作次数1-3之间的关联。这项研究的目的是评估年龄和儿童和青少年进行ACL重建时半月板撕裂的存在之间的关系。方法：对单机构接受连续3.5年以上ACL重建的连续儿童和青少年患者进行单机构回顾性研究。纳入标准为年龄小于20岁，并通过膝关节镜和ACL重建治疗ACL损伤。排除多韧带膝关节损伤患者。进行图表检查以获取人口统计学信息和术中发现。半月板撕裂定义为诊断性关节镜检查中记录的撕裂。结果：461名患者符合入选标准，其中男性226例（49％），女性235例（51％），平均年龄15岁（范围7至20岁）。左右膝盖受到同等影响。 270名患者（80％）术中有半月板撕裂的证据，包括215个外侧半月板撕裂（56％）和119个内侧半月板撕裂（44％）。 64名患者（14％）同时患有内侧和外侧半月板撕裂。发现手术年龄是半月板撕裂存在的统计学上重要的独立预测因子，比值比= 1.14，95％CI（1.05-1.25），p = 0.003。年龄每增加1年，弯月面撕裂的几率就会增加14％，如下图所示。在13岁及以下（n = 89）的患者中，有47％的患者有半月板撕裂。相比之下，年龄在14至19岁（n = 301）的患者中有62％的半月板撕裂明显增多（p = 0.01）。在对内侧和外侧半月板撕裂进行亚组分析后，年龄也是统计学上显着的独立预测因子。手术年龄每增加1年，内侧半月板撕裂的几率就会增加21％（几率= 1.21，95％CI：（1.08-1.35），p <0.001），而增加13％半月板外侧撕裂的几率（几率= 1.13，95％CI：（1.04-1.24），p = 0.01）结论：在前交叉韧带撕裂的儿童和青少年中，年龄每增加1岁，半月板撕裂的几率增加了14％。13岁以上的青少年半月板撕裂的发生率比13岁及以下的青少年大得多。诊断和治疗半月板撕裂需要外科医生应熟悉所有半月板修复技术，包括由内而外，由内而外，全内，radial骨和透骨根修复，因为大多数儿童和青少年ACL撕裂患者也是如此伴有半月板撕裂。Anderson AF，Anderso n CN。儿童和青少年半月板和关节软骨损伤与前交叉韧带重建时间的相关性。美国运动医学杂志2015年; 43（2）：275-281。 Millett PJ，Willis AA和Warren RF。小儿和青少年前交叉韧带撕裂的相关伤害：治疗延迟是否会增加半月板撕裂的风险？关节镜2002; 18（9）：955-959。 Shieh A，Bastrom T，Roocroft J等。与骨骼不成熟有关的半月板撕裂模式：儿童与青少年。 Am J Sports Med 2013; 41（12）：2779-2783。

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