Millett Peter J, Willis Andrew A, Warren Russell F
Department of Orthopaedic Surgery, Harvard Medical School, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
Arthroscopy. 2002 Nov-Dec;18(9):955-9. doi: 10.1053/jars.2002.36114.
To evaluate the incidence of associated injuries and meniscal tears in children and adolescents with anterior cruciate ligament (ACL) tears, we performed a retrospective review of patients, age 14 and younger, who were treated surgically at our institution.
Retrospective review.
We reviewed 39 patients (30 girls, 9 boys) with an average age of 13.6 years (range, 10 to 14 years) who underwent surgical treatment of the ACL; 24 right knees and 15 left knees were treated. Of the injuries treated, 24 occurred by a twisting mechanism, 10 were the result of contact, and 5 occurred from hyperextension. Thirty-five injuries occurred during sports activities, and 2 were sustained in motor vehicle accidents. The mean duration from injury to operative treatment was 101 days (range, 7 to 696 days). Injuries were classified as acute (n = 17) if surgery was performed within 6 weeks of injury and chronic (n = 22) if surgery was performed after 6 weeks from injury. Relationships between medial and lateral meniscal injuries and the time from injury to surgery were analyzed, and the 2 groups, acute and chronic, were compared. Finally, the patterns of meniscal injury were compared.
Twenty-six patients had associated injuries (10 medial meniscal tears, 15 lateral meniscal tears, 3 medial collateral ligament tears, and 1 fractured femur). The association between medial meniscal tears and time from injury to surgery was highly statistically significant (P =.0223). There was no statistical significance between the incidence of lateral meniscal tears and time. Medial meniscal tears were more common in the chronic group (36%) than in the acute group (11%), whereas lateral meniscal tears were found with equal frequency. Medial meniscal tears that required surgical treatment (either partial excision or repair) were more common in the chronic group, and lateral meniscal tear patterns were equally distributed.
Evidence from this study supports the contention that associated injuries are common in young individuals with ACL tears. Furthermore, the data also show that a delay in surgical treatment was associated with a higher incidence of medial meniscal tears.
为评估儿童和青少年前交叉韧带（ACL）撕裂时合并损伤及半月板撕裂的发生率，我们对在我院接受手术治疗的14岁及以下患者进行了一项回顾性研究。
回顾性研究。
我们回顾了39例患者（30名女孩，9名男孩），平均年龄13.6岁（范围10至14岁），他们接受了ACL的手术治疗；治疗了24个右膝和15个左膝。在接受治疗的损伤中，24例由扭转机制导致，10例是接触伤，5例因膝关节过伸所致。35例损伤发生在体育活动期间，2例在机动车事故中受伤。从受伤到手术治疗的平均时长为101天（范围7至696天）。如果在受伤后6周内进行手术，则损伤分类为急性（n = 17）；如果在受伤6周后进行手术，则分类为慢性（n = 22）。分析了内侧和外侧半月板损伤与受伤至手术时间之间的关系，并比较了急性和慢性两组。最后，比较了半月板损伤的模式。
26例患者存在合并损伤（10例内侧半月板撕裂，15例外侧半月板撕裂，3例内侧副韧带撕裂，1例股骨骨折）。内侧半月板撕裂与受伤至手术时间之间的关联具有高度统计学意义（P = 0.0223）。外侧半月板撕裂的发生率与时间之间无统计学意义。内侧半月板撕裂在慢性组（36%）比急性组（11%）更常见，而外侧半月板撕裂的发生率相同。需要手术治疗（部分切除或修复）的内侧半月板撕裂在慢性组更常见，外侧半月板撕裂模式分布均匀。
本研究的证据支持这样的观点，即ACL撕裂的年轻个体中合并损伤很常见。此外，数据还表明手术治疗延迟与内侧半月板撕裂的发生率较高有关。
