What should be the standard in returning young athletes from a severe knee injuries.

I would like to hear discussion dilemma of returning the high school athlete to competition after severe knee injury, and what are the ethical questions.How should we be treating our athletes in 2012 with these issues.

I recently treated a 17-year-old high school sophomore basketball player who tore his ACL. In addition to the ACL injury he had a focal impaction fracture of the far lateral femoral condyle, an impaction and osteochondral fragment off the far posterior tibial plateau, and an irreparable lateral meniscus. The lateral meniscus was shredded in the area of the popliteus recess with a through-and-through radial tear and a small segment actually missing that was not ever recovered. There was no possibility of a repair as all of the meniscal tissue was not even present.

The anterior cruciate reconstruction was carried out. Assuming the anterior cruciate heals appropriately and the patient has reasonable stability, I wondered about the issues in 2012 and the way we sometimes return people to sports, in the past, and what should we be doing from here on.

Naturally the patient is wanting to play. I feel like at his age he should probably have a meniscal allograft. Several scenarios have been talked about among the patient, myself, and the family.

The one obvious scenario is to treat this as it has been treated for many years, and that is just to let the patient return to athletics, knowing with this severe injury on the lateral side that he will have no doubt have trouble in the future on his knee. A second scenario would be to consider a meniscal allograft. If that were the case, the question I have as to timing when that should that be done? Should it be done soon?? Or would the patient be able to play his junior and senior year and have an allograft after his high school career? Should the patient have an allograft now or some point in the near future? If left up to the patient, of course he would want to go ahead and play basketball. A third scenario would be to quit athletics. Experienced orthopedists have all seen lots of 35-year-old people coming into the office with arthritic knees. There is no right answer, I realize. I just wanted to create a discussion here and get a perspective from the many talented viewers and participants of Vu Medi. Thank you for your time.

ken wertzberger
ANNA '88
ASSOM '91