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The Role of Crutches and Bracing in Preventing Secondary Meniscal Tears After Anterior Cruciate Ligament Injury in Pediatric Patients

Year: 2025

Type: article

Abstract: Background: Secondary meniscal tears are a well-described sequela of delay in anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL injury. This study aimed to evaluate whether preoperative conservative interventions (ie, crutches, bracing, and physical therapy) are associated with a reduced risk of secondary meniscal pathology in pediatric patients. Hypothesis: Preoperative conservative interventions of the ACL-deficient knee would be associated with fewer secondary meniscal tears in pediatric patients undergoing delayed (≥8 weeks postinjury) ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: All pediatric patients (age, <18 years) undergoing primary ACLR with a single surgeon between October 1, 2013, and January 31, 2022, were retrospectively identified. The exclusion criteria were as follows: previous ipsilateral knee injury; multiligamentous knee injuries; or time frommagnetic resonance imaging to surgery ≥52 weeks. Adherence to conservative management recommendations (ie, crutches, bracing, and physical therapy) was assessed through medical record review. Secondary meniscal injuries were defined as major tears that were discovered intraoperatively and required repair or substantial meniscectomy. Meniscal tears that occurred concomitantly with ACL rupture and were detectable on the initial (<3 weeks after injury) magnetic resonance imaging scans were not considered secondary. In total, 71 pediatric patients (35 girls; 36 boys) were included. Results: = .017). Since no new medial meniscal tears were observed in patients who used crutches, the adjusted odds ratio could not be calculated. Conclusion: Bracing and crutches were associated with the preservation of the menisci in the ACL-deficient knee in pediatric patients undergoing early and delayed ACLR, respectively. Surgeons should strongly encourage adherence to these conservative modalities in patients awaiting operative reconstruction to reduce the risk of secondary meniscal pathology.

Source: Orthopaedic Journal of Sports Medicine

DOI: 10.1177/23259671241309862

Authors: Arjun Gupta, Daniel Badin, R. Jay Lee

Institutions: Rutgers, The State University of New Jersey, Johns Hopkins University, Rutgers New Jersey Medical School

Language: English

Topic: Knee injuries and reconstruction techniques

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,500