Mending Meniscals in Children, Improving Diagnosis and Recovery

Greater awareness leads to more accurate diagnoses

ROSEMONT, Ill., Nov. 3 /PRNewswire-USNewswire/ -- The meniscus is a
rubber-like, crescent moon-shaped cartilage cushion that sits between the leg
and thigh bone. Each knee has two menisci: one on the inside of the knee joint
and one on the outside. In recent years, more children have been diagnosed
with tears to this area (meniscal tears); however, according to a literature
review published in the November 2009 issue of the Journal of the American
Academy of Orthopaedic Surgeons (JAAOS), prospects for a full recovery are
high.

"Seventy-five to 90 percent of children who have meniscal tears heal
successfully when they are treated appropriately. In adults, the success rate
is often less than 50 percent," said study co-author Dennis Kramer, M.D., an
attending orthopaedic surgeon at Children's Hospital Boston and instructor in
Orthopaedic Surgery at Harvard Medical School. "A child's physiology is
different than an adult's--they are growing and therefore have a greater blood
flow to the meniscus. This helps in the healing process."

How Meniscal Tears Occur
Meniscal tears often occur when a child twists his or her knee while playing
sports (the area becomes painful and swollen and tears are sometimes dismissed
as knee sprains). Children can continue to experience pain, but often do not
seek help because they do not want to miss out on sporting events or have to
go to the doctor.

Additionally, a small percentage of children are born with abnormally shaped
"discoid" menisci that are larger and therefore more prone to tearing. If your
child complains of a "snapping" or "popping" knee, it may be due to a discoid
meniscus.

According to the study, several factors are contributing to the increase in
diagnosis of meniscal tears in children:
-- more children are participating in sports, where knee injuries often
occur;
-- more healthcare professionals are aware of and recognize the signs of
meniscal tears; and

-- the use of magnetic resonance imaging (MRI) helps physicians to better
diagnose them.

Early Treatment Important for Long-Term Health
Dr. Kramer stresses that although meniscal tears in children can often be
repaired successfully, they should be treated quickly.

"Tears that are repaired within three months seem to heal better than those
treated at a later time," he said. "Additionally, if a child has a meniscal
tear that cannot be repaired but instead has to be removed, studies indicate
that it can lead to arthritis later in life."

Diagnosing and Treating a Tear in a Child
If you believe your child has a meniscal tear, visit your doctor. Dr. Kramer
suggests parents may expect the following:

1. The doctor will conduct a simple physical. Your child will be asked to bend
and twist the leg in a certain way to cause stress to the meniscus, as well as
push on the area of the knee where the meniscus is located to determine if it
is injured.

2. The doctor will attempt to perform the exam to minimize any pain. Ask if
your physician knows how to make these modifications. If he or she is not
comfortable making this assessment, you may want to visit an orthopaedic
surgeon or physician who specializes in sports medicine who has experience
conducting these tests.

3. If the physical tests indicate there is a tear, your doctor may schedule an
MRI. Dr. Kramer notes that pediatricians, radiologists or physicians
specializing in sports medicine may be better equipped to interpret the
results of your child's MRI.

4. If the MRI indicates that your child has a meniscal tear, your child may
need arthroscopic surgery. This is a minimally invasive surgical technique
using small incisions and tiny pencil-sized instruments that contain a small
lens and lighting system to magnify and illuminate the structures inside the
knee.

Smaller Injuries Can Progress, So Talk to Your Doctor
"Smaller injuries can progress and get worse if left untreated, said Dr.
Kramer. "If you suspect your child has a meniscal tear, talk to your doctor
and discuss treatment options as soon as possible."

Disclosure: Dennis E. Kramer, M.D., is an Instructor, Department of
Orthopaedic Surgery, Children's Hospital Boston, Boston, MA. Lyle J. Micheli,
M.D., co-author of the study, is Director of Sports Medicine, Department of
Orthopaedic Surgery, Children's Hospital Boston. Dr. Micheli or a member of
his immediate family is affiliated with the publications BMC Musculoskeletal
Disorders and the Journal of Bone and Joint Surgery. Neither Dr. Kramer nor a
member of his immediate family has received anything of value from or holds
stock in a commercial company or institution related directly or indirectly to
the subject of this article.

JAAOS

www.orthoinfo.org

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SOURCE American Academy of Orthopaedic Surgeons

Lauren Pearson, +1-847-384-4031, pearson@aaos.org; or Kristina Findlay,
+1-847-384-4034, findlay@aaos.org, both of AAOS