Association Between Knee Alignment and Meniscal Tear in Pediatric Patients with Anterior Cruciate Ligament Injury

Outcome of meniscal repairs in paediatric population: A tertiary centre experience

BACKGROUND

Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis. However, there is limited data in the literature on meniscal repair outcomes in skeletally immature patients.

AIM

To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents.

METHODS

We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018. All patients were under the age of 18 at the time of surgery. Procedures were all performed by a single surgeon. Information was gathered from our hospital Electronic Patient Records system. The primary outcome measure was re-operation rate (need for further surgery on the same meniscus). Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee (IKDC), Tegner and Lysholm scores.

RESULTS

We identified 59 patients who underwent 66 All-inside meniscal repairs (32 medial meniscus and 34 Lateral meniscus). Meniscal repairs were performed utilizing FasT-Fix (Smith and Nephew) implants. There were 37 males and 22 females with an average age of 14 years (range 6-16). The average follow-up time was 53 months (range 26-140). Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair. There were no intra-operative complications. The re-operation rate for meniscal repairs was 16.6% (11 cases) with 2 patients requiring further meniscal repairs and 9 patients underwent partial meniscectomies. The mean postoperative IKDC score was 88 (44-100), Tegner score was 7(2-10) and Lysholm score was 94 (57-100).

CONCLUSION

Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.

Intrarater and Interrater Reliability of Radiographic Characteristics in Skeletally Immature Patients With Anterior Cruciate Ligament Tears: A PLUTO Study Group Reliability Study

BACKGROUND

Radiographic measurements of limb alignment in skeletally immature patients with anterior cruciate ligament (ACL) tears are frequently used for surgical decision-making, preoperative planning, and postoperative monitoring of skeletal growth. However, the interrater and intrarater reliability of these radiographic characteristics in this patient population is not well documented.

HYPOTHESIS

Excellent reliability across 4 raters will be demonstrated for all digital measures of length, coronal plane joint orientation angles, mechanical axis, and tibial slope in skeletally immature patients with ACL tears.

STUDY DESIGN

Cohort study (diagnosis).

METHODS

Three fellowship-trained orthopaedic surgeons and 1 medical student performed 2 rounds of radiographic measurements on digital imaging (lateral knee radiographs and long-leg radiographs) of skeletally immature patients with ACL tears. Intrarater and interrater reliability for continuous radiographic measurements was assessed with intraclass correlation coefficients (ICCs) across 4 raters with 95% CIs for affected and unaffected side measurements. Interrater reliability analysis used an ICC (2, 4) structure and intrarater reliability analysis used an ICC (2, 1) structure. A weighted kappa coefficient was calculated for ordinal variables along with 95% CIs for both interrater and intrarater reliability. Agreement statistic interpretations are based on scales described by Fleiss, and Cicchetti and Sparrow: <0.40, poor; 0.40 to 0.59, fair; 0.60 to 0.74, good; and >0.74, excellent.

RESULTS

Radiographs from a convenience sample of 43 patients were included. Intrarater reliability was excellent for nearly all measurements and raters. Interrater reliability was also excellent for nearly all reads for all measurements.

CONCLUSION

Radiographic reliability of long-leg radiographs and lateral knee x-rays in skeletally immature children with ACL tears is excellent across nearly all measures and raters and can be obtained and interpreted as reliable and reproducible means to measure limb length and alignment.

LEVEL OF EVIDENCE

Level III.

Is Delayed Anterior Cruciate Ligament Reconstruction Associated With a Risk of New Meniscal Tears? Reevaluating a Longstanding Paradigm

Background

Delayed anterior cruciate ligament (ACL) reconstruction has been associated with an increased risk of meniscal tears. However, studies comparing early versus delayed ACL reconstruction have not clearly demonstrated that meniscal tears diagnosed arthroscopically are new injuries as opposed to concomitant injuries sustained during ACL rupture.

Purpose

To determine whether and how delay of ACL reconstruction is associated with risk of "new" meniscal tears (defined as those visualized arthroscopically that had not been detected on magnetic resonance imaging [MRI]) in adult and pediatric patients.

Study Design

Cohort study; Level of evidence, 3.

Methods

We retrospectively identified patients who underwent primary ACL reconstruction between 2013 and 2022 at our institution. To ensure that MRI reflected initial intra-articular pathology, we included only patients who had an MRI scan within 3 weeks after injury (173 pediatric and 369 adult patients). Multivariate Poisson regression was performed to calculate the adjusted relative risk (ARR) of new meniscal tears after delayed (≥8 weeks from injury) operative treatment.

Results

The mean (± SD) time from injury to MRI was 1.0 ± 0.8 weeks for pediatric patients and 1.1 ± 0.7 weeks for adults. Less than half of the meniscal tears observed arthroscopically had been absent on initial MRI. New medial meniscal tears occurred in 15% of pediatric patients and 16% of adults. New lateral meniscal tears occurred in 48% of pediatric patients and 34% of adults. Among pediatric patients, delayed ACL reconstruction was associated with higher risk of new medial tears (ARR, 3.9; 95% CI, 1.5-10) but not lateral tears (ARR, 0.8; 95% CI, 0.4-1.5). In contrast, adults had no significant increase in risk of meniscal tears associated with operative delay.

Conclusion

Delayed ACL reconstruction may be acceptable in adults, who may be less active and less injury-prone than children and adolescents.

Age, Sex, and BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients

BACKGROUND

The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options.

PURPOSE

To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort.

RESULTS

There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears (P = .001). Higher BMI was associated with "complex" and "radial" tear repairs of the lateral meniscus (P < .001) but was variable with regard to medial tear repairs.

CONCLUSION

In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.

Effect of Nursing in Operating Room Combined with Intraoperative Heat Preservation Intervention on Prevention of Incision Infection and Improvement of Hemodynamics in Patients with Anterior Cruciate Ligament Injury and Reconstruction under Knee Arthroscopy

Objective

To explore the effect of nursing in operating room combined with intraoperative heat preservation intervention on preventing incision infection and improving hemodynamics in patients with anterior cruciate ligament (ACL) injury and reconstruction under knee arthroscopy.

Methods

About 200 patients with knee arthroscopic ACL reconstruction in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into two groups: the control group and the study group. The former group received nursing care in the operating room operating room and the latter group received nursing care in operating room combined with intraoperative heat preservation intervention. Nursing satisfaction, incidence of incision infection, knee joint VAS score, knee joint range of motion, knee joint Lysholm score, and hemodynamic indexes were compared.

Results

First of all, we compared the nursing satisfaction, the study group was very satisfied in 78 cases, satisfactory in 20 cases, and general in 2 cases, and the satisfaction rate was 100.00%, while in the control group, 445 cases were very satisfied, 20 cases were satisfied, 15 cases were general, and 8 cases were dissatisfied. The satisfaction rate was 82.00%. The nursing satisfaction of the study group was higher compared to the control group (P < 0.05). Secondly, we compared the incidence of incision infection. The incidence of incision infection in the study group was lower compared to the control group (P < 0.05). With regard to the knee joint VAS score, the knee joint VAS score of the study group was lower compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). In terms of the range of motion of the knee joint, the range of motion of the knee joint in the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). Regarding the knee joint Lysholm score, the knee joint Lysholm score of the study group was higher compared to the control group at 2 weeks, 4 weeks, 8 weeks, and 12 weeks after operation (P < 0.05). Finally, we compared the hemodynamic indexes. Before nursing, there exhibited no significant difference (P > 0.05). During and after nursing, the indexes of HR and MAP in the study group fluctuated little (P < 0.05).

Conclusion

During the perioperative period of patients with ACL injury and reconstruction under knee arthroscopy, standardized and necessary operating room combined with intraoperative thermal insulation intervention measures should be given, attention should be paid to the management of operating room, and intraoperative thermal insulation intervention should be strengthened. It includes preoperative visit, psychological nursing of patients, strict application of antibiotics before operation, monitoring of air quality in operating room, disinfection and sterilization of surgical instruments, shortening operation time, maintaining body temperature during operation, and paying attention to hand hygiene of medical staff. It plays a supervisory role in promoting the attention of medical staff to the prevention of wound infection, which is beneficial to the healing of surgical wounds of patients. It plays a positive role in enhancing hemodynamic indexes. Comprehensive nursing intervention on the risk factors of each link can effectively prevent postoperative wound infection and strengthen the prognosis and quality of life of patients.