Evaluating Avascular Necrosis-Related Content Across Social Media Platforms.

Background Avascular necrosis (AVN) of the bone can progress to subchondral collapse, often requiring surgical intervention. Given the debilitating nature of this condition, patients may seek information and support through social media. AVN-related content on social media platforms remains uncharacterized in the literature.

The Anatomic Relationship of Medial Femoral Condyle Osteochondritis Dissecans to the Posterior Cruciate Ligament.

Background: The purpose of this study was to define the anatomic relationship between the femoral origin of the posterior cruciate ligament (PCL) and medial femoral condyle (MFC) osteochondritis dissecans (OCD) lesions.

Methods: Ninety-four magnetic resonance imaging (MRI) studies of a series of patients with MFC OCDs seen at a single institution from 2004 to 2014 were reviewed. The distances from the center of the PCL to the center of the OCD as well as the shortest distance from the PCL to the OCD were calculated in both the sagittal and coronal planes.

Risk Factors for Corticosteroid-associated Osteonecrosis in Children: A National Database Study.

Background: Corticosteroid-associated osteonecrosis presents a risk for severe pain and joint collapse. While the relationship between corticosteroid treatment and osteonecrosis in pediatric patients is well-documented, less is known about which patients are at greatest risk across medical conditions. The purpose of this study was to identify high-risk pediatric populations for developing osteonecrosis following corticosteroid treatment across autoimmune, inflammatory, and oncologic conditions.

Physeal-Sparing MPFL Reconstruction Technique With Lateral Retinaculum Lengthening.

Background: In skeletally immature patients, medial patellofemoral ligament (MPFL) reconstruction must consider the femoral physis while also trying to reproduce the ligament as anatomically as possible. There is currently no gold-standard surgical approach.

Indications: Previous surgical techniques for MPFL reconstruction in skeletally immature patients have described methods to avoid the physis, but it is difficult to accomplish this and still place the tunnel at Shottle's point.

Decline in Pediatric Anterior Cruciate Ligament Reconstructions Seen Over 20 Years in the American Board of Orthopaedic Surgeons Part II Oral Examination Database.

Introduction: Although increased treatment of pediatric anterior cruciate ligament (ACL) injury is well-documented, surrounding trends remain unknown. We evaluated national trends over 21 years using data from pediatric ACL reconstructions (ACLR) submitted to the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Examination and compared fellowship training, geographic variation, and case volume trends.

Methods: The ABOS SCRIBE database was queried for ACLR in pediatric (<19) patients between 2000 and 2021.

Osteochondritis dissecans in children: location-dependent differences : (Part I: knee).

The classic terminology "osteochondritis dissecans (OCD)" describes a pathologic alteration, centered at the osteochondral junction, involving the subchondral bone and/or its cartilaginous precursor, with risk for lesion instability and disruption of the overlying articular cartilage. Among children and young adults, these sites of osteochondrosis can be a cause of chronic joint pain and are most often found within the knee, the ankle, and the elbow joints. No consensus exists on the precise pathophysiology underlying the development and progression of these lesions, which likely varies slightly among lesions at different anatomic locations as the result of region-specific differences in tissue quality, vascular perfusion, and biomechanical forces.

Panel Discussion: Profiles in Surgical Innovation & Entrepreneurship.

Unlabelled: Innovation is crucial to the field of pediatric orthopaedic surgery. However, the process of developing a new surgical technology is complex and can be daunting. In this panel discussion, 5 surgeons who have successfully developed new technologies share their personal stories as well as mistakes made, lessons learned, and reflections on key questions related to innovation and entrepreneurship in the modern healthcare landscape.

Trends in Complications Following Pediatric Anterior Cruciate Ligament Reconstruction as Reported to the American Board of Orthopaedic Surgery Part II Oral Examination Database.

Background: Pediatric anterior cruciate ligament reconstructions (ACLR) have increased dramatically in recent years. However, a comprehensive list of short-term complications related to this procedure has yet to be reported. This study aimed to report complication rates in pediatric ACLR using submissions to the American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination.

Osteochondritis dissecans in children: location-dependent differences (part II: ankle and elbow).

The classic terminology "osteochondritis dissecans (OCD)" describes a pathologic alteration, centered at the osteochondral junction, involving the subchondral bone and/or its cartilaginous precursor, with risk for lesion instability and disruption of adjacent articular cartilage. Among children and young adults, these sites of osteochondrosis can be a cause of chronic joint pain and are most often found within the knee, the ankle, and the elbow joints. While Part I of this review series focused on shared key definitions, pathophysiologic principles, and imaging considerations, as well as unique differences between lesions at different locations within the knee joint, the current Part II article is devoted to lesions that involve the ankle and elbow joints.

Emergency Action Planning in Secondary School Settings: Updates for Athletic Trainers and Doctors.

Background: Proper implementation of an emergency action plan (EAP) in the secondary school setting has been shown to reduce response times for a medical emergency but should be reinforced with regular EAP practice and maintenance.

Indications: Understanding the proper implementation and maintenance of an EAP as well as the pivotal role athletic trainers play in adopting and rehearsing a successful EAP.

Relevance: Many secondary school settings have EAPs in place but have a higher risk of failing to properly implement them without regular EAP rehearsal and maintenance.

On-Field Diagnosis and Management of Sports-Related Concussion in Pediatric Athletes.

Background: In pediatric sports medicine, the accurate diagnosis of sports-related concussions (SRCs) relies on keen observation and precise evaluation during athletic endeavors. Unlike many medical conditions, SRC is not readily diagnosed through traditional imaging studies or laboratory tests.

Indications: The absence of objective diagnostic tools for the diagnosis of concussion emphasizes the critical need for a set of evidence-based examination skills to empower health care professionals, including physicians, physical therapists, and athletic trainers, in making reliable diagnoses.

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).

Medial and lateral posterior tibial slope in the skeletally immature: Variability across pediatric ages without a consistent trend.

Introduction: Increased knee posterior tibial slope (PTS) angle elevates anterior cruciate ligament (ACL) strain and ACL injury risk. Adult biomechanical research indicates that decreasing the PTS may reduce ACL injuries. Younger patients have much higher risk of ACL injury than adults, with limited anatomic research on tibial slope.

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.

Retrospective Analysis and Characterization of Avascular Necrosis By Bone Location in Pediatric Leukemia/Lymphoma Patients.

Background: Avascular necrosis (AVN) is a serious complication of high-dose steroid therapy for pediatric patients with leukemia/lymphoma. AVN affects multiple bones and joints, leading to significant pain in different bone regions, early-onset osteoarthritis, and early joint replacement. Early detection and intervention for AVN may prevent pain and progressive joint collapse.

Impact of Pediatric Knee Anatomy on ACL Reconstruction: Lessons Learned From Cadaveric Dissections-A Review.

Anterior Cruciate Ligament (ACL) injuries in pediatric patients are rising and present unique challenges for orthopedic surgeons due to skeletal immaturity and risk for physeal damage during ACL reconstruction. This review aims to share insights from pediatric cadaveric anatomic studies and related research to inform surgical management of ACL injuries in skeletally immature patients. We highlight age-dependent variations in the distances between the ACL and medial collateral ligament and their respective physes, developmental variability in the anterolateral structures of the pediatric knee, and variability in the proximity of the neurovascular bundle's proximity to the iliotibial band graft pathway during ACL reconstruction.

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.

A Cadaveric Study of the Sagittal Patellar Insertion of the Medial Patellofemoral Ligament in Children: Implications for Reconstruction.

Background: Patellofemoral instability is a common problem, and medial patellofemoral ligament (MPFL) reconstruction is a standard treatment approach for recurrent instability. The accurate restoration of anatomy in MPFL reconstruction is essential. While coronal-plane anatomy of the MPFL patellar insertion has been previously reported, sagittal-plane anatomy has not been widely studied.

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.

Suture anchor fixation of the pediatric posteromedial and posterolateral meniscotibial ligament complex matches or exceeds native tissue strength: A cadaveric study.

Objectives: This study aimed to compare the biomechanical strength and stiffness of the native posteromedial and posterolateral meniscotibial ligament complex (MTLC) to suture anchor repair of the MTLC.

Methods: Biomechanical testing was performed on 24 fresh-frozen pediatric human knees. Four conditions were tested: native posteromedial MTLC (n ​= ​14), native posterolateral MTLC (n ​= ​14), posteromedial MTLC repair (n ​= ​5), and posterolateral MTLC repair (n ​= ​5).

Which Osteochondritis Dissecans Lesions Will Heal Nonoperatively? An Application of Machine Learning to the ROCK Prospective Cohort.

Background: There are limited evidence-based guidelines to predict which osteochondritis dissecans (OCD) lesions will heal with nonoperative treatment.

Purpose: To train a set of classification algorithms to predict nonoperative OCD healing while identifying new clinically meaningful predictors.

Study Design: Case-control study; Level of evidence, 3.

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.

Surgical Predictors of Clinical Outcome 6 Years After Revision ACL Reconstruction.

Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown.

Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up.