Postponing surgery can lead to more problems, study finds
TUESDAY, July 14 (HealthDay News) -- New research confirms what many orthopedists have long suspected -- it's better to operate quickly on a young athlete's ACL injury than it is to wait a few years for the child to grow some more.
"The gold standard has moved," said study co-author Dr. Theodore J. Ganley. "If we have a message, it's to treat these injuries when they occur."
Athletes of all ages commonly tear the anterior cruciate ligament, better known as the ACL, that helps to anchor the knee. The piece of tissue "prevents the lower leg from gliding forward, preventing forward motion of the tibia on the femur," explained Dr. Lyle Micheli, a professor of orthopedic sports medicine at Harvard Medical School.
A variety of activities that require athletes to jump or pivot can cause the ACL to tear. "In the 1950s, it was a guy's football injury," said Ganley, director of the Sports Medicine and Performance Center at The Children's Hospital of Philadelphia. "Now it shows up in soccer, basketball, volleyball."
Young female athletes are especially prone to injury. "Since the early 1970s, there's been a thousand-fold increase in participation for females in organized sports. It's been shown that the girls have somewhere between a two- and eight-fold higher risk of sustaining ACL injuries compared to males," Ganley said.
An ACL tear can lead to a cascade of other problems, including ligament tears around the knee.
In the past, surgeons chose to wait to repair ACL injuries if athletes were under age 15. The theory was that they should wait a few years until a child's bones had more time to grow. "We'd think, we don't want to drill through the [bone] growth plates, it's too risky," Micheli said.
But some orthopedists challenged the prevailing assumptions and performed such surgery on children aged 14 and under. The new study suggests they made the right call.
Ganley and colleagues examined the records of almost 70 patients who underwent ACL reconstruction surgery between 1991 and 2005. All were aged 14 and under.
Twenty-nine of the patients were treated more than three months after their injury, while the rest were operated on right after the damage occurred.
The study authors reported their findings Monday at the American Orthopaedic Society for Sports Medicine's annual meeting in Keystone, Colo.
The researchers found that the patients who delayed surgery had three to 11 times the risk of some types of related injuries, including torn cartilage. In some cases, the injuries couldn't be repaired.
The findings are "basically confirming what many of us had begun to realize about these kids," Micheli said. "Some of us have been doing this, but I think the average orthopedist doesn't know this, and is very reluctant to recommend surgery on a 10-year-old."
Essentially, "it's better to fix something sooner," said Ganley. "It's like fixing your car: you can change a few spark plugs, or you can wait and change more significant things."
Learn more about ACL injuries from the U.S. National Institutes of Health.
SOURCES: Theodore Ganley, M.D., director, Sports Medicine and Performance Center, The Children's Hospital of Philadelphia; Lyle Micheli, M.D., head, sports medicine division, Children's Hospital Boston, and professor, orthopedics sports medicine, Harvard Medical School, Boston; July 12, 2009, presentation, American Orthopaedic Society for Sports Medicine annual meeting, Keystone, Colo.
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