How much Improvement in Patient Reported Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction is associated with Surgeon-defined Satisfactory Outcomes? A JUPITER study.

Introduction: The extent of change in Patient Reported Outcome Measures (PROs) required to meet surgeon-defined satisfactory outcomes after isolated Medial Patellofemoral Ligament Reconstruction (MPFL-R) has not been reported. The primary aim of the study was to define the threshold value of maximal outcome improvement (MOI) in PROs associated with surgeon-defined satisfactory postoperative outcomes. The secondary aim was to identify the most effective PRO in predicting these outcomes and to evaluate the factors associated with it.

Surgical management of the discoid meniscus.

Background: Discoid meniscus is the most frequent intraarticular paediatric knee congenital condition. Only symptomatic patients require surgical attention with arthroscopy. The incidence of discoid meniscus repair is increasing.

Variation in Surgical Technique for Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: Data From the JUPITER Prospective Multicenter Study Group.

Background: Management approaches and surgical techniques for patellofemoral instability (PFI) continue to lack clear clinical guidelines and indications. Medial patellofemoral ligament reconstruction (MPFLR) is the most frequently used surgical procedure; however, variation in technique remains significant, particularly in skeletally immature patients.

Purpose/hypothesis: The purpose of this study was to examine variations in MPFLR technique in skeletally immature patients as represented by 20 orthopaedic surgeons with different experience levels and specialty training backgrounds who perform a high volume of PFI surgery in this age group.

Determination of Skeletal Age From Hand Radiographs Using Deep Learning.

Background: Surgeons treating skeletally immature patients use skeletal age to determine appropriate surgical strategies. Traditional bone age estimation methods utilizing hand radiographs are time-consuming.

Purpose: To develop highly accurate/reliable deep learning (DL) models for determination of accurate skeletal age from hand radiographs.

Eczema Is Not Associated with an Increased Risk of Postoperative Infection Following Arthroscopic Knee Surgeries: A Retrospective Matched Case-Control Study.

Prior studies have suggested a possible association between eczema and postoperative surgical site infections (SSI) following anterior cruciate ligament reconstruction (ACL-R), presumably due to higher rates of staphylococcal colonization in patients with eczema. We sought to determine if patients with a history of eczema are at an increased risk for postoperative SSI following ACL-R, medial patellofemoral ligament reconstruction (MPFL-R), and/or knee arthroscopy. We conducted a retrospective matched case-control study of patients aged 5 to 25 years who underwent ACL-R, MPFL-R, and/or knee arthroscopy from February 1, 2016 to February 8, 2023 at a single tertiary care facility.

Medial Patellotibial Ligament Reconstruction in Pediatric and Adolescent Patients With Patellofemoral Instability.

Recent literature trends toward early surgical intervention for optimal treatment of patellofemoral instability, typically involving medial patellofemoral ligament reconstruction. Medial patellotibial ligament (MPTL) reconstruction is an adjunctive procedure with medial patellofemoral ligament reconstruction, given its role as an additional restraint to patellar translation during knee flexion. The purpose of this Technical Note is to demonstrate the preferred MPTL reconstruction technique in pediatric and adolescent patients at this institution, which mimics an anatomic approach in which the tibial portion of the MPTL graft is secured to the epiphysis.

Spanish Translation and Cross-Cultural Adaptation of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Spanish HSS Pedi-FABS).

Background: Language barriers during clinical care are a cause for particular concern for individuals from diverse linguistic backgrounds, especially the Hispanic and Latino US population, who comprise >19% of the American population and speak Spanish, the second most spoken language globally. Ensuring the inclusion of these patients in pediatric sports medicine and rehabilitation research is critical in minimizing bias and necessitates the development of patient-reported outcome measures available for use in Spanish. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) quantifies activity levels, developed for children and adolescents.

Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures.

Background: Both tibial spine fractures (TSFs) and anterior cruciate ligament (ACL) tears result in functional loss of knee stability. Nonetheless, it remains unclear why some patients sustain ACL tears, whereas others have TSFs.

Purpose: To identify the common morphological risk factors for pediatric ACL tears and TSFs and to determine the morphological differences between them using multiplanar reconstruction of magnetic resonance imaging (MRI).

Age and Sex-based Frequency of Graft and Technique Used in Pediatric Anterior Cruciate Ligament Reconstruction: A Multicenter Study.

Objective: As the incidence of pediatric and adolescent anterior cruciate ligament (ACL) reconstruction rises, knowledge of contributing factors to decision-making regarding graft selection and technique is important. Variations in ACL reconstruction (ACLR) regarding graft choice, tunnel placement, and technique may depend on patient age, sex, and surgeon preference. The purpose of this study was to review technique and graft source of pediatric ACLR based on these factors.

The lateral patellar retinaculum is thicker in paediatric and adolescent patients with patellofemoral instability: An MRI analysis.

Purpose: The purpose of this study was to examine the thickness of the lateral patellar retinaculum (LPR) and patellar tilt in paediatric and adolescent patients who undergo a medial patellofemoral ligament (MPFL) reconstruction. The authors hypothesise that patients undergoing MPFL reconstruction will have a thicker LPR and increased patellar tilt when compared to a comparison cohort.

Methods: Preoperative magnetic resonance imaging (MRI) of patients ≤ 18 years old who underwent an MPFL reconstruction was retrospectively reviewed.

Improved Biomechanical Performance of Tibial Spine Fracture Repair With Suture and Anchor Fixation in Pediatric Cadaveric Knees.

Background: Prior studies in porcine and adult human bone suggest that suture fixation is superior to screw fixation of pediatric tibial spine fractures (TSFs). However, we have previously demonstrated that 2-suture repair was biomechanically comparable with 2-screw repair in human pediatric cadaveric knees.

Purpose: To evaluate whether TSF fixation with sutures attached to anchors placed in stronger metadiaphyseal bone would produce biomechanically superior repair to 2-screw and 2-suture constructs.

Increased Tibial Tubercle-Trochlear Groove Distance and Sulcus Angle Are Associated With Patellar Osteochondritis Dissecans in Pediatric Patients.

Background: Osteochondritis dissecans (OCD) lesions in the knee are most commonly found in the medial femoral condyle (MFC). However, a paucity of literature has explored the characteristics or morphology of patellar OCD lesions.

Purpose/hypothesis: The purpose of this study was to analyze patellar tracking and patellofemoral measurements of pediatric patients with patellar OCD compared with patients with MFC OCD.

Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Prospective Multicenter PLUTO Study.

Background: Anterior cruciate ligament (ACL) injuries are common in pediatric and adolescent patients. Understanding this population's injury characteristics and treatment strategies is vital for managing this high-risk group.

Purpose: To report the descriptive epidemiology and treatment strategies of a large cohort of skeletally immature patients with complete ACL tears.

What's up with patella alta?

Purpose Of Review: Patella alta, which describes an abnormally proximally positioned patella, has become of particular interest as it has been identified as a potential factor in patellofemoral instability (PFI) and other common pediatric orthopedic conditions. The purpose of this review is to describe the condition, measuring techniques, and its association with pediatric orthopedic conditions, and to evaluate methods of correction of patella alta.

Recent Findings: Recent literature has explored the etiology of patella alta by investigating patellar height as age increases, with inconclusive findings as to whether the condition is congenital or acquired over time.

A Simple Clinical Predictive Model for Arthroscopic Mobility of Osteochondritis Dissecans Lesions of the Knee.

Background: Osteochondritis dissecans (OCD) of the knee is a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent cartilage. Treatment options focused on preventing premature osteoarthritis vary depending on multiple patient and lesion characteristics, including lesion mobility.

Purpose: To differentiate lesion mobility before arthroscopy using a multivariable model that includes patient demographic characteristics and physical examination findings.

No Association Between Growth Hormone Therapy and Upper Extremity Physeal Tension Injuries: A Matched Case-control Study.

Background: Recent evidence has identified a strong association between growth hormone therapy and physeal injuries in the lower extremity; however, few studies have investigated this association in the upper extremity.

Questions/purposes: (1) Do pediatric patients with physeal tension injuries of the shoulder and elbow have higher odds of having exposure to recombinant growth hormone therapy than matched controls? (2) Are the odds of having exposure to recombinant growth hormone therapy in physeal tension injuries different when stratified by shoulder and elbow injuries?

Methods: Using a matched case-control study design, patients between 4 and 18 years of age treated at a large, urban, academic center from February 1, 2016, to November 6, 2023, were identified by ICD-10 codes using EPIC SlicerDicer, an electronic medical record-based data mining tool. Patients diagnosed with physeal tension injuries in the shoulder or elbow were included in the case group, and those with midshaft radius, metaphyseal radius, or both-bone forearm fractures were included in the control group.

Characteristics and Outcomes of Operatively Treated Discoid Lateral Meniscus in Pediatric and Young Adult Patients: A Multicenter Study.

Background: Discoid lateral meniscus (DLM) is the most common congenital abnormality of the meniscus. Tears are common; treatment is frequently not definitive, often requiring reoperation.

Purpose: To report the clinical manifestations, physical characteristics, operative treatments and findings, complications, and reoperations of DLM in pediatric patients from multiple centers across North America.

The Intra-articular Tendinous Graft Diameter of 10-mm Bone-Patellar Tendon-Bone Autografts in Adolescent Patients: An MRI Analysis of 100 Patients.

Background: Bone-patellar tendon-bone (BPTB) autograft size may be one modifiable predictor of anterior cruciate ligament (ACL) reconstruction postoperative success, as smaller graft diameter has been associated with higher rates of rupture requiring revision. However, measuring the true intra-articular tendinous graft diameter of the soft tissue portion of a BPTB graft with standard intraoperative methods is difficult while keeping the graft intact.

Purpose/hypothesis: The purpose of the study was to use 3-dimensional magnetic resonance imaging (MRI) measurements to determine the cross-sectional area of the soft tissue, tendinous portion of a standard BPTB autograft with 10-mm diameter bone plugs, and, by calculation, the collagen graft size (ie, graft diameter), as would typically be reported in ACL reconstruction studies that consider soft tissue graft size.

Patellofemoral Instability in Pediatric and Adolescent Athletes: A Review of Risk Factors and Treatments.

Pediatric patellar instability can impair function and restrict activity participation. If left untreated, it can lead to a degenerative knee. The incidence of patellar dislocations is highest in adolescents between 10 and 17 years of age; more than half of all first-time patellar dislocations occur during sports.

Temporary hemi-epiphysiodesis with tension band plates in skeletally immature patients with genu valgum: Faster correction in patients with more than 2 years of expected time of growth remaining.

Purpose: Hemi-epiphysiodesis procedures in skeletally immature patients are commonly done to correct genu valgum over time. This study seeks to demonstrate the average rate of deformity correction for genu valgum using hinged tension band plates, while examining different age groups and sex-related differences.

Methods: A retrospective chart review of patients who underwent hemi-epiphysiodesis with hinged tension band plates for valgus knee deformity from 2012 to 2022 by one pediatric orthopaedic surgeon was performed.

Evaluation of Tibial Slope on Radiographs in Pediatric Patients With Tibial Spine Fractures: An Age- and Sex-Matched Study.

Background: A recent study has reported that the radiographic measurement of posterior tibial slope (PTS) is larger in male pediatric patients with tibial spine fractures (TSF) than in controls. However, they found no difference in PTS between female patients and controls.

Purpose: (1) To identify whether PTS is larger in female pediatric patients with TSF than in female controls and (2) to validate the relationship between PTS and pediatric TSF in male patients.