Most of the controversy surrounding timing of knee surgeries for children has centered on how developed is the child's skeletal frame. They also worry about the risks and benefits of delaying surgery versus early intervention. We don't want to discount the importance of those questions, but we also recognized there are more facets to deciding on the timing of surgery
Rosemont, IL (Vocus) September 1, 2009
Delaying surgery for a pediatric patient until a school break may decrease the number of future missed school days and the chances of disturbing academic performance, say authors of a new study published in the September issue of the American Journal of Sports Medicine.
The study evaluated 62 school-aged athletes who underwent an anterior cruciate ligament (ACL) or a medial patellofemoral ligament (MPFL) reconstruction. Authors separate the athletes into three groups: those who had surgery during the school year, those who had surgery during a school holiday, and those who underwent surgery during summer break. Gathering data on how many school days were missed before the student returned to school and how students performed on tests after they returned, the study concluded that surgery on a school day causes more academic difficulties than surgery during a holiday or summer break.
"Most of the controversy surrounding timing of knee surgeries for children has centered on how developed is the child's skeletal frame. They also worry about the risks and benefits of delaying surgery versus early intervention. We don't want to discount the importance of those questions, but we also recognized there are more facets to deciding on the timing of surgery," explains Christopher S. Ahmad, MD, one of the study's authors and an Associate Professor of Clinical Orthopaedic Surgery at the Columbia University College of Physicians and Surgeons.
While ACL and MPFL reconstructions are two different surgeries, both of these surgeries require the use of a knee brace, crutches or wheelchair, and long and intensive physical therapy. The study suggested that these factors hinder a student's ability to return to school. Of the 63.1% of patients who did not return to school immediately after their surgeries, the averaged missed days of school was around 14.7. Further, 36 percent of students who had surgery during the school year were likely to fail a test after returning to school. None of those who had surgery during a school break failed a test. School-year surgeries led to higher rates of summer school than school-break surgeries. The study's findings were further confirmed by past studies.
"Deciding when surgery is appropriate in a school-aged patient must be coupled with an understanding of the risks of delaying surgery. However, if reconstruction of the student's injury will not be negatively affected by delaying surgery, the academic benefits of delaying the surgery may be significant enough," said Ahmad.
For those who cannot delay surgery, the study noted that homeschooling or obtaining instructional materials and homework from the school can be a way to minimize the impact of a surgery on a student's academic performance.
The American Orthopaedic Society for Sports Medicine (AOSSM) is a world leader in sports medicine education, research, communication and fellowship, and includes national and international orthopaedic sports medicine leaders. The Society works closely with many other sports medicine specialists, including athletic trainers, physical therapists, family physicians, and others to improve the identification, prevention, treatment, and rehabilitation of sports injuries. For more information visit AJSM online at http://www.ajsm.org or contact Lisa Weisenberger at lisa(at)aossm(dot)org or 847-292-4900.
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