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Strides Seen in Orthopedic Surgery for Kids

Repairing ACL, meniscus at same time is one advance, 'Tommy John' elbow reconstruction another

SUNDAY, March 14 (HealthDay News) -- Repairing a torn knee meniscus at the same time as anterior cruciate ligament (ACL) reconstruction is safe and effective in children, a new study finds.

Meniscus cartilage acts as a cushion/shock absorber in the knee joint. The ACL is one of four major ligaments in the knee.

This study included 99 patients, 18 and younger, who had meniscus repair at the time of an ACL reconstruction. The overall success rate of meniscus repair was 74 percent. The rate was 84 percent for patients with simple tears (one major tear), 59 percent for displaced bucket-handle tears (a tear around the rim of the meniscus, causing the central portion to displace into the joint), and 57 percent for complex tears (a tear in multiple planes).

The freedom-from-failure rate was 90.9 percent after two years and 76.8 percent after eight years.

Knee function on a 100-point scale improved from a median of 48 (range of 38-70) before surgery to 90 (range of 52-100) after surgery. On a sporting activity scale of 0-10 (with 10 being national elite competitive sports), the patients improved from 1.9 before surgery to 6.2 after surgery.

"We have a wealth of information regarding adults who have a meniscus tear repaired at the time of ACL reconstruction, but there was very little data regarding the pediatric population," Dr. Aaron Krych, chief resident in the orthopedic surgery department at the Mayo Clinic, Rochester, Minn., said in a news release. "To our knowledge, this is the largest study reported on the pediatric population. These knee injuries are common in kids that play football, wrestling and soccer."

The study was to be presented Saturday at the American Orthopaedic Society for Sports Medicine's annual meeting in New Orleans.

At the same meeting, another team of researchers said they found that "Tommy John" elbow reconstruction was 95 percent successful in teen baseball pitchers with fully mature bones.

The procedure -- named for the Hall of Fame pitcher who was the first to have the operation in 1974 -- involves using a tendon from elsewhere in the body to replace a damaged elbow ligament called the ulnar collateral ligament (UCL).

The study of 20 high school pitchers who had the surgery found that 17 were very satisfied and two were somewhat satisfied with the outcome. Of those 19 patients, 18 said they returned to competitive baseball -- three in the highest level of competition in the minor leagues, 13 in intercollegiate baseball, and three in high school baseball.

"High school kids have been a gray zone for this surgery," Dr. Michael J. Angel, of Premier Orthopaedics of Westchester and Rockland. "Obviously, surgeons would avoid surgery on young patients whose growth plates had not closed. But this study can give surgeons the confidence to recommend this surgery to teenage, skeletally mature athletes. It also gives the teen and their parents assurance that the surgery should go well."

More information

The Nemours Foundation explains how to prevent sports injuries in children.

-- Robert Preidt

SOURCE: American Orthopaedic Society for Sports Medicine, news release, March 13, 2010

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