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Study Shows Advanced Knee Repair Procedure in Children and Adolescents May Prevent the Adult Onset of Arthritis
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Study Shows Advanced Knee Repair Procedure in Children and AdolescentsMay Prevent the Adult Onset of Arthritis
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| SAN FRANCISCO – An advanced arthroscopic suturing procedure can successfully save a crucial part of the knee – the meniscus – in adolescents and children as young as nine years of age, says leading orthopaedic surgeon Frank R. Noyes, MD of Cincinnati Sportsmedicine and Orthopaedic Center. Dr. Noyes presented his findings on March 3, 2001 at the annual American Orthopaedic Society for Sports Medicine’s Specialty Day presentation, in conjunction with the American Academy of Orthopaedic Surgeons meeting in San Francisco, the largest meeting of orthopaedic surgeons in the world. Meniscal tears are one of the most common types of knee injuries and are typically removed by surgeons during arthroscopic surgery. According to the National Center for Health Statistics (data extracted and analyzed by the American Academy of Orthopaedic Surgeon’s department of research and scientific affairs) there were nearly 500,000 meniscal excisions in 1996 and 28,000 were in children aged 9 – 19 years of age. Because the meniscus is the knee’s shock absorber, patients who have their meniscus removed usually develop a painful joint arthritis within 10 to 15 years. For the past two decades, surgeons have been working on repair techniques to tears of the meniscus where there is a rich blood supply. Dr. Noyes’ technique is different because it repairs complex tears that extend into areas of the meniscus without a blood supply, called the avascular area. Most surgeons have believed these to be non-repairable but Noyes began repairs as early as 1983. Over the 14-year period of the study, sixty-one patients aged 9-19 years of age were followed after undergoing the suturing repair of the medial and/or lateral meniscal avascular tear at Cincinnati Sportsmedicine and Orthopaedic Center. Four years following surgery, the researchers found that 3 out of 4 of these young patients were pain-free. Dr. Noyes explains that losing a meniscus is like driving a car without any shock absorbers – you’ll eventually wear your tires out. “Too often in my practice I’ve had to treat patients under the age of 30 with severe arthritis because they had their meniscus removed years earlier,” he says. “At this point, there’s little we can often provide - a total knee replacement at this young age is not a promising prospect. The impact of being able to save the meniscus in patients is extremely satisfying.” He estimates that half of the 28,000 meniscal excisions in these young patients could be repaired rather than excised. “This is good news for our young patients to save their knees. I hope these findings will prompt more surgeons to aggressively attempt meniscal repair instead of meniscal excision,” says Dr. Noyes. In the arthroscopic technique described by Dr. Noyes, many fine sutures are placed on the top and bottom of the tear, much like repairing a torn skin edge. A small 1-½” incision is made about the knee joint allowing the sutures to secure the meniscus back to its natural bed. Because the procedure uses the arthroscope, the procedure is outpatient and recovery is fairly rapid. The patient must remain on crutches for a period of four to six weeks. Over the course of two to three months, the repair matures to provide a strong construct and necessary cushioning. Full return to sports is allowed in six months. Cincinnati Sportsmedicine and Orthopaedic Center is one of the preeminent research centers across the country exploring better methods to improve repair of this structure – this study is the first of its kind in the English literature. Dr. Noyes is the president and medical director of Cincinnati Sportsmedicine and Orthopaedic Center and of the Cincinnati Sportsmedicine Research and Education Foundation. He is an adjunct professor at the University of Cincinnati’s College of Engineering, and is a member of the American Orthopaedic Society for Sports Medicine and the American Academy of Orthopaedic Surgeons. The American Orthopaedic Society for Sports Medicine (AOSSM) – a world leader in sports medicine education, research, communication and fellowship is a national organization of orthopaedic sports medicine specialists, including national and international sports medicine leaders. The AOSSM works closely with many other sports medicine specialists and clinicians, including family physicians, emergency physicians, pediatricians, athletic trainers, and physical therapists to improve the identification, prevention, treatment and rehabilitation of sports injuries.
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Source:
AOSSM
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