Skeletal Maturity Is Associated With Increased Meniscal and Chondral Pathology in Patients Under 21 Years of Age Undergoing Primary Anterior Cruciate Ligament Reconstruction Within 6 Months of Injury

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL

ACS Applied Energy Materials Pub Date : 2024-09-01 DOI:10.1016/j.arthro.2024.01.022

{"title":"Skeletal Maturity Is Associated With Increased Meniscal and Chondral Pathology in Patients Under 21 Years of Age Undergoing Primary Anterior Cruciate Ligament Reconstruction Within 6 Months of Injury","authors":"","doi":"10.1016/j.arthro.2024.01.022","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div><span>To compare injury profiles of meniscal and/or chondral injury in skeletally mature (SM) with immature (SI) patients undergoing primary </span>anterior cruciate ligament reconstruction (ACLR).</div></div><div><h3>Methods</h3><div><span><em>Current Procedural Terminology</em></span><span> code 29888 was queried from January 2012 to April 2020. Patients younger than 22 years who underwent primary ACLR within 6 months of injury were included. Exclusion criteria included age older than 22 years, treatment after 6 months, revision ACLR, concurrent osteotomy, or multiligamentous injury. All patients required a minimum 1-year follow-up. Demographics and intraoperative pathology were recorded. Data were analyzed for factors affecting intra-articular injury and stratified by sport.</span></div></div><div><h3>Results</h3><div>Of 927 patients (739 SM, 188 SI), the mean age was 16.63 and 14.00 years for the SM and SI cohorts, respectively (<em>P</em> < .001). There were more SM males (51.4%) compared to SI males (81.9%) (<em>P</em><span> < .001); however, in univariate analysis, sex did not significantly affect the rates of meniscal (</span><em>P</em> = .519) or chondral injury (<em>P</em> = .961). In total, 887 meniscal injuries were recorded (344 medial, 543 lateral) in 659 patients. SM sustained greater rates of medial meniscal tear (MMT) (<em>P</em><span> < .001) and underwent higher rates of partial meniscectomy (</span><em>P</em> = .022). Male sex conferred meniscal injury (95% confidence interval [CI], 0.43-0.81; <em>P</em><span> = .001). Body mass index prognosticated medial meniscal (95% CI, 1.01-1.06; </span><em>P</em> = .002) and medial chondral injuries (95% CI, 1.02-1.09; <em>P</em> < .001). Skeletal maturity was a superior predictor of intra-articular pathology than age for all outcomes: MMT (95% CI, 0.00-0.06; <em>P</em> = .002), lateral meniscal tear (95% CI, 0.00-0.75; <em>P</em> = .034), and chondral injury (95% CI, 0.00-0.49; <em>P</em> = .049). In sport subanalysis, soccer anterior cruciate ligament (ACL) injuries were most common (32.6%). Soccer and basketball athletes were more likely SM (<em>P</em> = .016, <em>P</em><span> = .003 respectively) with increased medial compartment pathology. Football ACL injuries occurred significantly in SI athletes (</span><em>P</em> = .001) via contact mechanisms (<em>P</em> = .025).</div></div><div><h3>Conclusions</h3><div>Skeletal maturity affects the meniscal and chondral injury profile in ACL-injured patients. SM patients have greater risk of sustaining concomitant meniscal injury, while chondral injury profile depends more on the mechanism of injury. Mechanism of injury and skeletal maturity status affect risk of sports-related ACL rupture and ACL-concurrent pathology in young patients. Patient-specific variables influence injury profiles within each sport. Skeletal maturity rather than age predicts concomitant intra-articular injury risk.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":4,"journal":{"name":"ACS Applied Energy Materials","volume":null,"pages":null},"PeriodicalIF":5.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Energy Materials","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0749806324000665","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CHEMISTRY, PHYSICAL","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

To compare injury profiles of meniscal and/or chondral injury in skeletally mature (SM) with immature (SI) patients undergoing primary anterior cruciate ligament reconstruction (ACLR).

Methods

Current Procedural Terminology code 29888 was queried from January 2012 to April 2020. Patients younger than 22 years who underwent primary ACLR within 6 months of injury were included. Exclusion criteria included age older than 22 years, treatment after 6 months, revision ACLR, concurrent osteotomy, or multiligamentous injury. All patients required a minimum 1-year follow-up. Demographics and intraoperative pathology were recorded. Data were analyzed for factors affecting intra-articular injury and stratified by sport.

Results

Of 927 patients (739 SM, 188 SI), the mean age was 16.63 and 14.00 years for the SM and SI cohorts, respectively (P < .001). There were more SM males (51.4%) compared to SI males (81.9%) (P < .001); however, in univariate analysis, sex did not significantly affect the rates of meniscal (P = .519) or chondral injury (P = .961). In total, 887 meniscal injuries were recorded (344 medial, 543 lateral) in 659 patients. SM sustained greater rates of medial meniscal tear (MMT) (P < .001) and underwent higher rates of partial meniscectomy (P = .022). Male sex conferred meniscal injury (95% confidence interval [CI], 0.43-0.81; P = .001). Body mass index prognosticated medial meniscal (95% CI, 1.01-1.06; P = .002) and medial chondral injuries (95% CI, 1.02-1.09; P < .001). Skeletal maturity was a superior predictor of intra-articular pathology than age for all outcomes: MMT (95% CI, 0.00-0.06; P = .002), lateral meniscal tear (95% CI, 0.00-0.75; P = .034), and chondral injury (95% CI, 0.00-0.49; P = .049). In sport subanalysis, soccer anterior cruciate ligament (ACL) injuries were most common (32.6%). Soccer and basketball athletes were more likely SM (P = .016, P = .003 respectively) with increased medial compartment pathology. Football ACL injuries occurred significantly in SI athletes (P = .001) via contact mechanisms (P = .025).

Conclusions

Skeletal maturity affects the meniscal and chondral injury profile in ACL-injured patients. SM patients have greater risk of sustaining concomitant meniscal injury, while chondral injury profile depends more on the mechanism of injury. Mechanism of injury and skeletal maturity status affect risk of sports-related ACL rupture and ACL-concurrent pathology in young patients. Patient-specific variables influence injury profiles within each sport. Skeletal maturity rather than age predicts concomitant intra-articular injury risk.

Level of Evidence

Level III, retrospective cohort study.

查看原文本刊更多论文

21 岁以下、在受伤后 6 个月内接受初级前交叉韧带重建手术的患者，其骨骼成熟度与半月板和软骨病变的增加有关

目的比较骨骼成熟（SM）和不成熟（SI）患者在接受初级前交叉韧带重建术（ACLR）时半月板和/或软骨损伤的情况。纳入了受伤后 6 个月内接受初级 ACLR 的 22 岁以下受试者。排除标准包括年龄大于 22 岁、6 个月后接受治疗、翻修性 ACLR、同时接受截骨术或多韧带损伤。所有受试者都需要至少一年的随访。记录人口统计学和术中病理情况。结果 927 名患者（739 名 SM，188 名 SI）中，SM 和 SI 组群的平均年龄分别为 16.63 岁和 14.00 岁（p<.001）。SM男性（51.4%）多于SI男性（81.9%）（p< .001）；但在单变量分析中，性别对半月板（p=.519）或软骨损伤（p=.961）的发生率没有显著影响。659名患者中有887例半月板损伤（344例内侧，543例外侧）。SM型半月板内侧撕裂（MMT）的发生率更高（p< .001），半月板部分切除术的发生率更高（p=.022）。男性会导致半月板损伤（95%CI[0.43,0.81],p=.001）。体重指数预示着内侧半月板损伤（95%CI[1.01,1.06],p=.002）和内侧软骨损伤（95%CI[1.02,1.09],p<.001）。在所有结果中，骨骼成熟度对关节内病变的预测均优于年龄：MMT（95%CI[0.00,0.06],p=.002）、LMT（95%CI[0.00,0.75],p=.034）和软骨损伤（95%CI[0.00,0.49],p=.049）。在运动分项分析中，足球运动员的前交叉韧带损伤最为常见（32.6%）。足球和篮球运动员更可能是SM（分别为p=.016,p=.003），内侧室病变增加。结论骨骼成熟度会影响前交叉韧带损伤患者的半月板和软骨损伤情况。SM患者合并半月板损伤的风险更大，而软骨损伤情况更多地取决于损伤机制。损伤机制和骨骼成熟度对年轻患者运动相关前交叉韧带断裂和前交叉韧带并发病变的风险有影响。患者的特异性变量会影响每项运动的损伤情况。骨骼成熟度而非年龄可预测伴随的关节内损伤风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.