If a young patient needs anterior cruciate ligament (ACL) surgery, it's better to get it done. Postponing is risks secondary knee injuries, according to a paper at the American Orthopaedic Society for Sports Medicine's (AOSSM) Annual Meeting.

The anterior cruciate ligament is one of the four major ligaments connecting the thighbone (femur), shinbone (tibia), and kneecap (patella) to form the knee joint. The cruciate Ligaments are found inside the knee joint and control its back and forth motion and they cross each other to form an 'x' shape, with the posterior cruciate ligament in back and the anterior cruciate ligament in front.

Researchers analyzed the records of 130 patients between ages 8 and 16 who had an ACL reconstruction, and divided them into three groups based on timing. Sixty-two patients were treated less than 6 weeks after injury, 37 were treated 6-12 weeks after, and 36 were treated more than 3 months after. The surgeries occurred between 2000 and 2012, and the majority of patients (64%) were male.
 The new study adds to existing research noting the risk of secondary meniscal and chondral injuries in pediatric patients.


How ACL injuries happen. Credit: Brown University


Additional risk factors for secondary injuries included younger age, return to sport activities prior to surgery, and prior episodes of knee instability.

"In reviewing records of young patients who received ACL reconstructions, our data showed higher rates and severity of secondary meniscus injuries when surgery is delayed," noted lead author Allen F. Anderson, MD, from the Tennessee Orthopaedic Alliance in Nashville, Tennessee. "Patients who had surgery 6-12 weeks after ACL injury had 1.45 greater odds of lateral meniscus injury, and those waiting 3+ months increased their risk 2.82 times. The risk for medial meniscal tears was 4.3 times greater when delaying surgery at least 6 weeks."

"While parents and other caregivers have obvious reasons for concern over ACL surgery in young patients, it's important to recognize when it may be beneficial," commented Anderson. "If surgery now helps eliminate long-term knee problems, it's certainly a good choice."