Research Details Increasing Knee Injuries in Child and Adolescent Athletes

The numbers of tibial spine fractures, anterior cruciate ligament (ACL) tears, and meniscus tears have all increased over the last 12 years, according to the results of a study presented at the American Academy of Pediatrics National Conference and Exhibition in Boston.

An increase in sports-related knee injuries in children and adolescents is a given. It has been attributed to more participation in sports, better clinician awareness and recognition of the signs and symptoms of ACL and meniscal tears, and the expanded role of MRI in the diagnosis of intra-articular knee pathology.  But there has been a paucity of research showing the specifics of any increase in ACL and meniscus tears. 

Researchers at the Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, used  ICD-9 and CPT codes to perform a retrospective review of billing records for all patients under 18 with tibial spine fractures, ACL, and meniscal tears who were treated at their institution from January 1, 1999 to January 1, 2011. (Tibial spine fractures were included to account for increased referral to the facility.) Cases were sorted by year.  Multivariate linear regression was employed to compare the trends over time using tibial spine fractures as a control in the case of ACL reconstructions and overall meniscal surgeries.

The researchers identified a total of 155 tibial spine fractures, 914 ACL tears, and 996 meniscus tears.  All three increased significantly. On average, tibial spine fractures increased by 1.07 per year, ACL tears by 11.35 per year, and meniscus tears by 13.95 per year.  The increase in ACL tears and meniscal surgeries (both P <0.001) was  significantly greater than the increase in tibial spine fractures seen during the study period.

"The etiology of this increase is unknown, but possible causes include increased diagnosis, earlier referral, more aggressive treatment, and increased incidence," the authors concluded. "Because the increase in tibial spine fractures would likely account for other causes encompassed by increased referral patterns, our analysis suggests that more ACL and meniscus tears are being diagnosed in this age group and may suggest that the true incidence is actually increasing."