According to a study, anterior cruciate ligament (ACL) injury, a form of a knee injury that occurs most often during sports, is growing more common in children and teenagers.

When surgery is advised for adolescents and teenagers with ACL injuries, the procedure should be performed as soon as possible. However, children and teenagers whose parents speak a language other than English are twice as likely to have postponed surgery.

The findings of the study were published in the journal Clinical Orthopaedics and Related Research. ACL tears are painful and left untreated, they can be debilitating. When surgery is called for--as usually is the case for young athletes--most surgeons believe it should be performed within a month or two of the injury. Longer delays may result in additional, irreparable knee damage.

Neeraj M. Patel, MD, MPH, MBS, an orthopaedic surgeon who has a speciality in sports medicine, and colleagues studied 543 children and teenagers who underwent ACL surgery at the Ann and Robert H. Lurie Children's Hospital in Chicago. The average patient age was 16, and boys and girls were represented equally. The authors compared surgical timing between 430 patients whose families spoke English at home with 113 whose preferred language was other than English (of those, more than 90% spoke Spanish in the home).

The researchers found that patients whose parents preferred a language other than English were twice as likely as patients from English-speaking families to undergo surgery more than 90 days after injury. This difference was observed even though the researchers accounted for the patient's type of insurance coverage.

Dr. Patel and his colleagues urge orthopaedic surgery departments to provide more equitable care for children and teenagers whose parents prefer a language other than English. Some of the strategies they suggest include:

* Hiring more bilingual healthcare professionals,
* Arranging for better availability of interpreters,
* Providing easy access to health information translated into the languages used in the local community,
* Partnering with schools, community organisations, and primary care physicians to increase understanding of ACL injuries and reduce delays to diagnosis and treatment, and
* Training healthcare teams on how to verify that families understand the recommendations for treating the ACL injury and are actively involved in decision-making about whether to proceed with surgery.

"Institutions should foster a culture of care that is sensitive to and prepared for the needs of those whose preferred language is not English," the authors conclude. "This should involve inquiry and interaction with such families to better determine their specific barriers to care, biases they encounter, as well as their healthcare needs."