Knee surgery can disrupt kids' school performance

NEW YORK (Reuters Health) - For kids who need surgery to replace a torn knee ligament, the timing of the procedure may make a difference in their school grades, a new study suggests.

In the study, published in the American Journal of Sports Medicine, researchers followed 62 student athletes who received surgery to reconstruct a ruptured knee ligament -- usually the anterior cruciate ligament, or ACL.

Researchers found that students who received the surgery on a school day had more absences and more failing grades during their recovery than their peers who had surgery during a holiday break or over the summer.

The findings suggest that parents and doctors should be aware of the potential academic effects of children's knee surgery, according to Dr. Christopher S. Ahmad and colleagues at Columbia University and New York-Presbyterian Medical Center in New York.

That does not necessarily mean, however, that the surgery should be delayed until school vacation, the researchers write.

Putting off surgery to stabilize the injured knee could put kids at risk of further injury -- such as tears to the cartilage cushioning the joint. And that could mean a less successful long-term outcome after surgery.

"Academic benefits of delaying surgery during the school year must be weighed against potentially worse outcomes encountered with prolonged surgical delay," Ahmad and colleagues write.

The issue is important, according to the researchers, as injuries to the ACL are becoming more common among children and teenagers.

The ACL is a strong band of tissue that runs from the thigh bone to shin bone, playing an important part in stabilizing the knee joint. When it tears, it's often the result of a sudden, forceful twist -- such as an awkward landing from a jump that torques the knee.

The injury is most often seen in sports that require quick pivots and jumps -- including basketball, soccer and football.

All but 2 of the 62 students in the current study suffered a sports-related ligament tear -- mostly to the ACL, but in some cases to the medial patellofemoral ligament, which also helps stabilize the knee joint.

The students were surveyed an average of 21 weeks after their surgery to see what, if any, academic difficulties they'd had.

Overall, Ahmad's team found, only 4 percent of students who had their surgery on a school day were back to class on the following school day -- versus 36 percent of those who had surgery during a holiday, such as spring break or winter recess.

And among students who had never had a failing grade, more than one-third of those who had surgery on a school day failed a test after returning to school. In contrast, no student who had surgery during a break or over summer vacation failed a test during their recovery.

The findings suggest that, when it is feasible, students' knee surgery should be delayed to avoid school conflicts, the researchers write.

But the short-term effects on grades, they add, must be weighed against the risks of putting off surgery, especially if students plan on returning to sports.

Whether home schooling during recovery can lessen any negative academic effects is unclear, the researchers note. In this study, there was no evidence that students who received formal home schooling fared any better.

Therefore, Ahmad's team writes, "we cannot specifically recommend the need for focused formal home schooling in the setting of these surgeries."

SOURCE: American Journal of Sports Medicine, September 2009.