O0811 Oct.3: 3:30pm - Are Delays to Operative Management Associated with Increased Risk of Meniscal Injury in Pediatric and Adolescent ACL Reconstructions?

Purpose: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears – which occur after the initial ACL injury – were associated with greater delays from injury to ACL reconstruction (ACLR). We investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population.

Methods: We performed a retrospective review of all patients <18 years who underwent an ACLR between 2014 and 2018 at two tertiary academic hospitals. Patients were excluded from analyses if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index.

Results: 546 patients were included in the analyses. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients tore any meniscus, 169 (30.9%) patients tore their medial meniscus, and 257 (47.1%) tore their lateral meniscus. Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.45; 95% CI, 1.12-1.90) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.73-1.39). When considering any meniscal tear, consisting of either medial or lateral tears, time from injury to ACLR was not associated with increased risk (ARR, 1.01; 95% CI, 0.99-1.02). However, for medial meniscal tears, there was a significant association (P = 0.04) between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.00-1.04). A ten-week delay was associated with a 22.8% increased risk of medial meniscal injury.

Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased each week from injury to surgery.

Significance: Delays to ACLR are associated with an increased risk of medial meniscal tears.