Big Decisions When a Teenie Bops Her KneeWhen a teenager injures the anterior cruciate ligament (ACL) of the knee, is it the same as in adult? Do they need surgery right away? What happens if treatment is delayed?
These and other questions are unknown at this time. It's not even known yet how many teenagers injure their ACL each year. It does seem to be more common all the time. Doctors and parents would like to know if surgery is needed for this problem and how soon it should be done. The concern is that without treatment, other injuries might occur. For example, in adults, a torn ACL can lead to damage in the meniscus or other ligaments in the knee.
Doctors at several hospitals in Boston report the results of treatment for ACL injury in teenagers. All patients were between 10 and 14 years old. The injuries were the result of an accident or sports activity. Two-thirds had other injuries along with the ACL tear. Most of these were tears of the meniscus.
The meniscus is the pad of cartilage inside the knee joint. There is one meniscus on the inner (medial) half of the joint and one on the outer (lateral) half. When surgery to repair the damaged ACL is delayed, more medial meniscal tears occur. Without surgery to repair this, the joint starts to break down.
Surgery to repair damaged meniscus and ligaments in the adolescent knee is not standard. Doctors say that this is another area of debate for them when treating these patients. Each patient requires a slightly different approach based on the damage. The bone is not fully matured, and this affects the treatment. Sometimes, the meniscus can be repaired. At other times, it must be removed, either partially or completely.
The first study to report patterns of injury in teenagers with ACL tears has been published. As suspected, teens are not different from adults when it comes to ACL tears. Many teens tear the meniscus along with the ACL. Early treatment to repair the meniscus can save it, preventing future damage to the joint.
Peter J. Millett, MD, MSc, et al. Associated Injuries in Pediatric and Adolescent Anterior Cruciate Ligament Tears: Does a Delay in Treatment Increase the Risk of Meniscal Tear? In Arthroscopy. November/December 2002. Vol. 18. No. 9. Pp. 955-959.