Meniscus tears in kids and teens are on the rise. What’s the best treatment?
By Marianne Russ Sharp
UC Davis orthopaedic surgeon leads national effort to find best strategy for pediatric patients with these knee injuries
(SACRAMENTO)
Knee injuries like meniscus tears are occurring more often in young people. UC Davis Health pediatric orthopaedic surgeon Brian Haus is leading a North American study to determine what treatment is best for young athletes with meniscus tears.
Haus has noticed a dramatic increase in meniscus tears and other injuries in young people over the past two decades. He attributes it mostly to an increase in children who take part in organized competitive sports year-round.
“This is a huge area of interest for me as a pediatric orthopaedic surgeon. The rise in pediatric injuries due to the explosion of organized sports has become a significant public health problem. Meniscus tears are only one example of many pediatric injuries that can cause life-long disability and pain.”
The three-year study is a collaboration of leaders in pediatric sports medicine from 20 major children’s hospitals in North America. Surgeons will track injuries, treatments and outcomes of meniscus tears to see what treatments are most effective in young patients. The goal is to create a registry of at least 1,000 patients.
“The outcomes of the registry will revolutionize the way we approach meniscus injuries in pediatric patients in North America,” Haus predicted. “For how common meniscus tears have become in young patients, it’s shocking how much we don’t understand about how best to treat them. This study is much needed to improve future mobility, function, and quality of life.”
In this Q&A, Haus explains the challenges in treating meniscus tears in young people and shares tips for athletes and families on how to avoid these debilitating injuries.
Pediatric orthopaedic surgeon Brian Haus is leading a North American study that may revolutionize the way meniscus tears are treated in children and teens.
What is the meniscus?
The meniscus works like a shock absorber for the knee joint. It’s crescent-shaped and made up of two pieces of cartilage-like tissue. The medial meniscus is on the inside of the knee, while the lateral is on the outside. Both can tear during physical activity and sports.
Why are more children and teens getting meniscus tears?
The primary reason is that so many more children and adolescents are playing year-round organized competitive sports. Kids in our society no longer do free play. Kids and teens now commit to a competitive sport early and play the same sport all year long for an excessive number of hours per week. Without time to rest, it’s too much for their bodies during growth and development.
Sadly, they are getting adult-type major injuries at a young age that will affect them the rest of their lives. Meniscus tears used to be relatively rare in children and adolescents, and now they have become much more common. They are probably the best example of this growing problem.
How are meniscus tears treated?
Historically, meniscus tears were much more common in adults. As a result, kids and adolescents with meniscus tears were treated like adults. So the treatment for everyone, kids or adults, was to do what’s called a debridement. This is where you shave out the torn part of the meniscus, rather than repairing it. Historical studies suggested the meniscus has a limited blood supply and intrinsic ability to heal.
The rise in pediatric injuries due to the explosion of organized sports has become a significant public health problem. —Brian Haus, Department of Orthopaedic Surgery
Is the treatment for children with meniscus tears changing?
Yes. We have a group of 20 pediatric sports medicine surgeons and researchers from major children’s hospitals in North America who are pushing the limits of what has been done historically. We focus on repairs rather than debridement when possible. I try to repair every single meniscus tear that I see in a kid because you need your meniscus for the rest of your life.
It’s been our experience that most of these kids do well, even though the thinking is that the meniscus doesn’t have a blood supply and won’t heal.
Why are you studying the best way to treat meniscus tears in young people?
There’s a huge gap in our understanding of how to take care of kids with pediatric sports injuries and meniscus tears, so this prospective study is critical. Because of the lack of understanding, there are many kids who get injured and don’t see a specialist for weeks or months. This can affect the ability to repair the tear.
We’re also studying repairs in adolescents who have tears due to a discoid meniscus, a congenital condition where kids are born with a thicker meniscus that develops a different shape — like the letter “C.” They are more prone to tears.
What are the challenges for a young person who has a meniscus tear that isn’t repaired?
The meniscus is an important structure. It’s responsible for decreasing the contact forces in the joint. If you’re missing your meniscus, or part of it, you can have cartilage loss and an increased risk of arthritis. So, if you’re doing a debridement — shaving the injured part of the meniscus away — in, say a 12-year-old, they can end up with arthritis a lot sooner in life — even as early as in their teenage years. We need to do better.
What advice do you have for parents whose children are athletes?
Overuse injuries and acute injuries are much more common when a child is playing the same sport year-round. The thinking is that kids are specializing in a sport way too early. At 8, 9 or 10 years old, the kids are growing and sensitive to injury. There are risks to playing the same sport year-round because the muscle groups never get a rest. We promote rotating sports and recommend not specializing until high school.
