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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Correlation of Meniscal and Chondral Injuries to Chronicity of ACL Tears in Children and Adolescents
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Correlation of Meniscal and Chondral Injuries to Chronicity of ACL Tears in Children and Adolescents

机译：儿童和青少年半月板和软骨损伤与ACL眼泪的慢性相关性

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Objectives: The increase in ACL injuries among children and adolescents has intensified debate about the timing of ACL reconstruction in this age group. Historically, the prevailing opinion was that non-operative management until skeletal maturity was the treatment of choice. There is now some evidence to suggest that early reconstruction is preferable because increased time from injury to surgery may be associated with a higher rate of meniscal and articular cartilage injury. The purpose of this observational cohort study was to assess the risk of meniscal and chondral injury with delay of ACL reconstruction. Our hypotheses were that increased time from injury to surgery, recurrent giving-way, and return to sports participation prior to reconstruction was associated with a higher rate of meniscal and articular cartilage injuries. Methods: After obtaining IRB approval, 135 consecutive patients, ages 8-16, (mean 13.8) with ACL tears were evaluated. The time from injury to surgery was divided into three periods: acute, less than six weeks; subacute, six weeks to three months; and chronic, greater than three months. The type and grade of lateral and medial meniscus tears was documented according to the ISAKOS Meniscal Documentation Criteria and chondral injury location and grade was documented according to the ICRS Criteria. Results: There were 62 patients who were treated acutely, 37 subacute, and 36 chronic. One hundred twelve meniscal tears, 70 lateral and 42 medial, were found in this cohort. Eighty percent of the patients, ages 8 - 12 had a meniscal tear and 84% of patients ages 13 - 16 had a meniscal tear. Multi-variant logistic regression revealed the risk factors for lateral meniscus tears were younger age (P = .007) and increased time to surgery (P = .008). The odds ratio of lateral meniscus tears for patients who had a single episode of instability was 3.1. For time to surgery, the odds ratio was 1 for acute reconstruction, 2.6 for subacute, and 2.59 for reconstruction of chronic injuries. The odds ratio for increased grade of tear was 3.3 for a giving-way episode and 6.5 for increased time to surgery. For medial meniscus tears, the risk factors were: older age (P = .001), increasing time to surgery (P = .007), return to sports (P = .044), and instability episodes (P = .001). Risk factors for increasing grade of medial meniscus tears were: time to surgery, return to sports, and any instability episode (P = < .001 for all). The odds ratio for increasing frequency of medial meniscus tears was 4.7 for an instability episode, 8.08 for having played sports prior to reconstruction, and 4.49 for increased time to surgery. The odds ratio for having increased severity of meniscal tears was: any instability episode 6.61; having played sports prior to reconstruction 15.25, and time to surgery 4.28. There were 17 chondral injuries in this cohort. The risk factors for chondral injury were: increased time to surgery (P = .005) and any instability episode (P = .001). For increased grade of chondral injury, the risk factors were: time to surgery (P = less than .001) and any instability episode (P = .003). Conclusion: These data provide evidence that initial nonoperative treatment of ACL tears in this age group carries a high risk of additional meniscal and chondral injury, which may result in long-term knee impairment.
机译：目的：儿童和青少年中ACL损伤的增加，加剧了对该年龄段ACL重建时间的争论。从历史上看，普遍的看法是直到骨骼成熟之前才进行非手术治疗是一种选择。现在有一些证据表明，早期重建是更可取的，因为从受伤到手术的时间增加可能与更高的半月板和关节软骨损伤率有关。这项观察性队列研究的目的是评估ACL重建延迟引起的半月板和软骨损伤的风险。我们的假设是，从受伤到手术的时间增加，反复让步以及在重建之前重新参加运动与半月板和关节软骨损伤的发生率更高有关。方法：在获得IRB批准后，对135例8-16岁（平均13.8）ACL撕裂的连续患者进行了评估。从受伤到手术的时间分为三个时期：急性期，少于六周;亚急性，六周至三个月;和慢性，超过三个月。根据ISAKOS半月板记录标准记录外侧和内侧半月板撕裂的类型和等级，并根据ICRS标准记录软骨损伤部位和程度。结果：急性治疗62例，亚急性37例，慢性36例。在该队列中发现了112个半月板撕裂，外侧70个，内侧42个。 8-12岁的患者中有80％患有半月板撕裂，而13-16岁的患者中有84％患有半月板撕裂。多变量逻辑回归分析显示，半月板外侧撕裂的危险因素是年龄较小（P = .007）和手术时间增加（P = .008）。单发不稳定患者半月板​​外侧撕裂的比值比为3.1。对于手术时间，急性重建的优势比为1，亚急性为2.6，慢性伤害为2.59。放弃发作的几率增加为3.3，而手术时间增加为6.5。对于内侧半月板撕裂，危险因素为：年龄较大（P = .001），手术时间增加（P = .007），重返运动（P = .044）和不稳定事件（P = .001）。内侧半月板撕裂程度增加的危险因素是：手术时间，重新参加运动以及任何不稳定性发作（所有P均<.001）。对于不稳定事件，内侧半月板撕裂频率增加的比值比是4.7，在重建之前进行体育锻炼的比值比是8.08，而增加手术时间则是4.49。半月板撕裂严重程度增加的几率是：任何不稳定性事件6.61;在重建之前参加过运动15.25，而手术时间为4.28。该队列有17例软骨损伤。软骨损伤的危险因素为：手术时间增加（P = .005）和任何不稳定性发作（P = .001）。对于增加的软骨损伤等级，危险因素为：手术时间（P =小于.001）和任何不稳定事件（P = .003）。结论：这些数据提供了证据，表明该年龄组的ACL泪液的初始非手术治疗具有额外的半月板和软骨损伤的高风险，这可能导致长期的膝关节损伤。

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