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.

MPFL Reconstruction and Implant-Mediated Guided Growth in Skeletally Immature Patients With Patellar Instability and Genu Valgum.

Background: There is a higher rate of failure of isolated MPFL reconstruction in skeletally immature patients with patellar instability compared to skeletally mature patients. Genu valgum is a known risk factor for patellar instability. There is potential for concomitant surgical correction of genu valgum to achieve better clinical outcomes and to decrease failure rates of MPFL reconstruction.

Tibial Tubercle Osteotomy in the Adolescent Patient.

Patellofemoral instability (PFI) is an increasingly prevalent issue affecting pediatric and adolescent patients. Anatomic factors, including lateralization of the tibial tubercle and patella alta, can contribute to increased risk of initial and recurrent PFI. In the case of recurrent PFI, chondral injuries of the patellofemoral compartment can occur.

Treatment of proximal tibial buckle fractures: removable knee immobilizer versus long leg cast.

The purpose of this study was to compare outcomes and management of patients with buckle fractures of the proximal tibia treated with either a knee immobilizer or a long leg cast (LLC). A retrospective review was performed of pediatric patients with a buckle fracture of the proximal tibia over a 5-year period. Two cohorts were included, those treated with a LLC versus a removable knee immobilizer.

Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction.

Background: The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population.

What's New in Pain Management for Pediatric Orthopaedic Surgery.

Background: Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery.

Methods: An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery.

Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis.

Background: Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up.

Interrater and Intrarater Reliability and Discriminant Validity of a Pediatric Lower Extremity Physical Therapy Clearance Test.

Background: Few studies have validated when an athlete can safely return to sports, and even fewer have identified when he or she no longer requires physical therapy after surgery. Discontinuing physical therapy is often dictated by insurance restrictions, but most studies have suggested that the decision should be multifactorial, stemming from patient-derived subjective outcome questionnaires, clinical examination, and isokinetic and functional testing.

Purpose/hypothesis: The purpose of this study was to establish discriminant validity and reliability of an objective physical therapy clearance (PTC) test in a clinical setting.

Rectus Femoris Transfer Versus Rectus Intramuscular Lengthening for the Treatment of Stiff Knee Gait in Children With Cerebral Palsy.

Background: Rectus femoris transfer (RFT) is used to treat stiff knee gait in spastic cerebral palsy. Recently, rectus femoris lengthening has been reported as treatment for stiff knee gait. The purpose of this study was to compare short-term outcomes of 2 surgical procedures.

Pediatric Elbow and Wrist Pathology Related to Sports Participation.

Pediatric overuse injuries are becoming more prevalent in today's society with more children competitively playing year-round sports at a younger age. The importance of prompt diagnosis and treatment is paramount to the treatment for these injuries, second only to rest and activity modification. This article will focus on overuse injuries of the upper extremity, specifically: little league elbow, elbow osteochondritis dissecans, and gymnast wrist.

Relationship of bone mineral density of spine and femoral neck to distal radius fracture stability in patients over 65.

Purpose: We hypothesized that an increasing degree of osteopenia in the femoral neck and lumbar spine would be associated with loss of reduction after closed manipulation and splinting of distal radius fractures in patients over 65 years of age.

Methods: We performed a retrospective review, evaluating 78 patients with displaced distal radius fractures managed with closed reduction and splinting. T-scores from the lumbar spine and femoral neck were recorded from dual-energy x-ray absorptiometry scans performed either within 1 year before or after injury.

Plateau-patella angle in evaluation of patellar height after total knee arthroplasty.

The plateau-patella angle (PPA) has been proposed as a new and simpler method to describe patellar height. This method has not been used or validated in knees following total knee arthroplasty (TKA). A modified PPA (mPPA) was developed for use in this population.