Correlation of Tanner Stage and Hypermobility with Meniscal and Articular Cartilage Injury in the Pluto Cohort

BACKGROUND: ACL injuries in adults are frequently accompanied by meniscal and articular cartilage damage. However, little is known regarding the correlation of Tanner stage and hypermobility in ACL-deficient skeletally immature patients and the risk of these associated injuries. HYPOTHESIS/PURPOSE: The relationship between hypermobility and meniscal and/or articular cartilage injury varies by stage of pubertal development. Patients with hypermobility will have a lower risk of meniscal and articular cartilage injury than patients with normal laxity. METHODS: At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Beighton score was collected at the preoperative physical exam; bone age was determined from a hand/wrist radiograph; and the presence of meniscal tears and articular cartilage injuries was collected from the surgical assessment. Tanner stage was documented at time of surgery. Univariable and multivariable logistic regression analysis was used to assess the effect of Tanner stage and Beighton score on the likelihood of cartilage injury and meniscal tear. RESULTS: Seven hundred forty-seven skeletally immature patients with complete ACL tears were analyzed with an average age at surgery of 12.3 years; the cohort was 62% male. Eighty-five patients had documented cartilage injuries for an event rate of 11.4%. Bivariate analysis found that those with cartilage injuries had a slightly higher bone age (13.9 versus 13.1 years; p=0.001) and a higher Tanner stage (p=0.009). For each additional Tanner stage, the odds of cartilage injury increased by approximately 1.6 (p<0.001). No association was detected between hypermobility and the likelihood of a cartilage injury. Four hundred twenty-three patients had documented meniscal tears for an event rate of 56.6%. Bivariate analysis found that those with meniscal tears were slightly older (12.6 versus 12.0 years; p<0.001), had a slightly higher bone age (13.5 versus 12.8 years; p<0.001) and a higher Tanner stage (p=0.002). For each additional Tanner stage, the odds of a meniscal tear increased by approximately 1.3 times (p<0.001). No association was detected between hypermobility and the likelihood of a meniscal tear. CONCLUSION: There is a high rate of concomitant articular cartilage and meniscal injuries in skeletally immature patients who sustain ACL tears. The risk of concurrent injury is associated with increasing bone age and Tanner score. There was no association between these concurrent injuries and hypermobility.