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.

Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results.

Background: The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series.

Purpose/hypothesis: Our purpose is to report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America.

Does the American College of Surgeons New Level I Children's Surgery Center Verification Affect Treatment Efficiency and Narcotic Administration in Treating Pediatric Trauma Patients with Femur Fracture?

Background: In 2015, the American College of Surgeons (ACS) created a new hospital improvement program to enhance the performance of pediatric care in US hospitals. The Children's Surgery Verification (CSV) Quality Improvement Program is predicated on the idea that pediatric surgical patients have improved outcomes when treated at children's hospitals with optimal resources. Achieving ACS level I CSV designation at pediatric trauma centers may lead to greater benefits for pediatric trauma patients; however, the specific benefits have yet to be identified.

Measuring the impact of a "Virtual Pediatric Trauma Center" (VPTC) model of care using telemedicine for acutely injured children versus the standard of care: study protocol for a prospective stepped-wedge trial.

Background: The current standard of care in the treatment of children with physical trauma presenting to non-designated pediatric trauma centers is consultation with a pediatric trauma center by telephone. This includes contacting a pediatric trauma specialist and transferring any child with a potentially serious injury to a regionalized level I pediatric trauma center. This approach to care frequently results in medically unnecessary transfers and may place undue burdens on families.

Three-Year Outcomes After MACI for Glenoid Cartilage Loss in an Adolescent Athlete: A Case Report.

Case: We report the 3-year outcomes of a 14-year-old boy who anteriorly dislocated his shoulder playing football and suffered a 9-cm2 chondral defect of the anterior glenoid and subsequently treated with matrix-applied characterized autologous chondrocytes (MACI) of the defect with open labral repair.

Conclusion: The management of glenohumeral chondral lesions in adolescent patients remains a challenge. Our case of the successful treatment of a glenoid chondral defect with MACI offers hope as a potential treatment option for adolescent patients with this challenging problem.

Defining length stability in paediatric femoral shaft fractures treated with titanium elastic nails.

Introduction: Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology.

Methods: A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period.

COVID-19 and Youth Sports: What Are the Risks of Getting Back on the Field Too Quickly?

The widespread shutdown in response to the coronavirus disease 2019 (COVID-19) pandemic, although varied across state and county levels, has undoubtedly impacted everyone to some degree. Within the pediatric population, the closure of schools and organized youth athletic programs has resulted in a unique situation that has made athletes physically deconditioned and at risk for injury. As sports and competition gradually restart, there are considerable risks to the skeletally immature athlete.

Orthopaedic In-Training Examination: History, Perspective, and Tips for Residents.

Introduced in 1963, the orthopaedic in-training examination (OITE) is a standardized, national test administered annually to orthopaedic residents by the American Academy of Orthopaedic Surgeons. The examination consists of 275 multiple-choice questions that cover 11 domains of orthopaedic knowledge, including basic science, foot and ankle, hand, hip and knee, oncology, pediatrics, shoulder and elbow, spine, sports medicine, trauma, and practice management. The OITE has been validated and is considered predictive of success in both orthopaedic surgery residency and on the American Board of Orthopaedic Surgery part I examination.

Preoperative 3D Modeling and Printing for Guiding Periacetabular Osteotomy.

Introduction: Achieving adequate acetabular correction in multiple planes is essential to the success of periacetabular osteotomy (PAO). Three-dimensional (3D) modeling and printing has the potential to improve preoperative planning by accurately guiding intraoperative correction. The authors therefore asked the following questions: (1) For a patient undergoing a PAO, does use of 3D modeling with intraoperative 3D-printed models create a reproducible surgical plan to obtain predetermined parameters of correction including lateral center edge angle (LCEA), anterior center edge angle (ACEA), Tonnis angle, and femoral head extrusion index (FHEI)? and (2) Can 3D computer modeling accurately predict when a normalized FHEI can be achieved without the need for a concomitant femoral-sided osteotomy?

Methods: A retrospective review was conducted on 42 consecutive patients that underwent a PAO.

What Neuromonitoring Changes Can Be Expected During Hip Arthroscopy in the Pediatric Population?

Background: As its indications have evolved, hip arthroscopy is now performed more frequently in pediatric patients. However, despite this increase, there is a lack of evidence in the literature about its safety in this population in regard to traction injury of the nerves of the lower extremity.

Purpose: To determine neuromonitoring changes of the sciatic, femoral, and obturator nerves during hip arthroscopy in the pediatric population and determine the rate of and risk factors for clinical neurapraxia.

Bilateral Destructive Hip Disease from Untreated Juvenile Idiopathic Arthritis.

We report a novel case of a pediatric patient with bilateral hip destruction from untreated Juvenile idiopathic arthritis (JIA). She was presented at the age of 9 with hip pain associated with bilateral acetabular dysplasia and a dislocated left femoral head. Only 1.

The medial epicondyle of the distal femur is the optimal location for MRI measurement of semitendinosus and gracilis tendon cross-sectional area.

Purpose: Graft diameter ≥ 8 mm reduces the risk of failure after anterior cruciate ligament reconstruction (ALCR) with hamstring tendon autograft. Pre-operative measurement of gracilis (GT) and semitendinosus (ST) cross-sectional area using MRI has been utilized but the optimal location for measurement is unknown. The main purpose of this study was to examine the cross-sectional areas of GT + ST at different locations and develop a model to predict whether a doubled hamstring graft of GT + ST will be of sufficient cross-sectional area for ACLR.

Anterior centre-edge angle on sagittal CT: a comparison of normal hips to dysplastic hips.

Purpose: The anterior centre-edge angle (ACEA) describes anterior acetabular coverage on false profile radiographs. Variability associated with pelvic tilt, radiographic projection, and identifying the true anterior edge, causes discrepancies in measuring an accurate ACEA. Computed tomography (CT) has the potential of improving the accuracy of ACEA.

Septic Arthritis and Osteomyelitis after Closed Reduction and Percutaneous Pinning of a Supracondylar Humerus Fracture: A Case Report and Review of the Literature.

Infectious complications of closed reduction and percutaneous pinning of supracondylar humerus fractures are exceedingly rare. Although postoperative infection is a feared complication associated with noncompliance and a wet cast, there are no reports in the literature of this occurring. We present the devastating complication of a pediatric patient who developed subperiosteal abscess, osteomyelitis, and elbow septic arthritis after presenting to the clinic multiple times with a wet cast after closed reduction and percutaneous pinning of a supracondylar humerus fracture.

Surgical Management of Multijoint Septic Arthritis due to Rat-Bite Fever in a Pediatric Patient: A Case Study.

In the United States, rat-bite fever is a rare systemic illness principally caused by , an organism found in the nasopharyngeal flora of rodents. Infection through direct exposure to rat excreta such as saliva, urine, or feces can lead to fever, rash, and an asymmetric migratory polyarthritis. As rodents are becoming more popular as pets, more pediatric cases are being documented.

Nerve Wrapping of the Sciatic Nerve With Acellular Dermal Matrix in Chronic Complete Proximal Hamstring Ruptures and Ischial Apophyseal Avulsion Fractures.

Background: Patients with chronic injuries of the proximal hamstring can develop significant impairment because of weakness of the hamstring muscles, sciatic nerve compression from scar formation, or myositis ossificans.

Purpose: To describe the surgical outcomes of patients with chronic injury of the proximal hamstrings who were treated with hamstring repair and sciatic neurolysis supplemented with nerve wrapping with acellular dermal matrix.

Study Design: Retrospective case series; Level of evidence, 4.

Back pain in the pediatric and adolescent athlete.

Clinicians taking care of athletes are likely to see many young patients complaining of back pain. The young athlete places significant repetitive stresses across the growing thoracolumbar spine, which can cause acute and overuse injuries that are unique to this age and patient population. Fortunately, by using a careful and systematic approach, with a sport-specific history, careful physical exam, and proper imaging, most problems can be properly identified.

Effect of anterior cruciate healing on the uninjured ligament insertion site.

The effect of anterior cruciate healing on the uninjured ligament insertion site after enhanced suture repair with collagen-platelet composites (CPC) has not yet been defined. In this study, we hypothesized that fibroblasts and osteoclasts would participate in generating histologic changes in insertion site morphology after transection and bioenhanced repair of the ACL, and that these changes would be age-dependent. Skeletally immature, adolescent, and adult Yucatan mini-pigs underwent ACL transection and bioenhanced suture repair.

Long-term follow-up of the surgical management of neuropathic arthropathy of the spine.

Background Context: No studies have discussed the long-term surgical management and outcomes of Charcot arthropathy of the spine. This case series presents nine patients treated over 30 years. The study hypothesis was that surgery would reduce instability, pain, recurrence, and the need for revision surgery in the long-term, given previous study findings of successful fusion of Charcot spine in the short-term.

Immature animals have higher cellular density in the healing anterior cruciate ligament than adolescent or adult animals.

There has been recent interest in the biologic stimulation of anterior cruciate ligament (ACL) healing. However, the effect of age on the ability of ligaments to heal has not yet been defined. In this study, we hypothesized that skeletal maturity would significantly affect the cellular and vascular repopulation rate of an ACL wound site.

Enhanced acute responses in an experimental exposure model to biomass smoke inhalation in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary diseases (COPD) may increase air pollution-related mortality. The relationship of immune mechanisms to mortality caused by fine particulates in healthy and COPD populations is incompletely understood. The objective of this study was to determine whether fine particulates from a single biomass fuel alter stress and inflammation biomarkers in people with COPD.

Case report: nonoperative treatment of an unstable Jefferson fracture using a cervical collar.

The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs.

Quality of occupational history assessments in working age adults with newly diagnosed asthma.

Background: Approximately 10 to 15% of new-onset asthma in adults is attributable to occupational exposure. The occupational history is the most important instrument in the diagnosis of occupational asthma (OA).

Study Objectives: To assess the quality of occupational histories obtained by health-care providers and to measure the prevalence of clinician-diagnosed OA in a population at elevated risk for OA.

Endo-robotic resection of the submandibular gland in a cadaver model.

Background: By means of a prospective, nonrandomized investigation, we evaluated the feasibility of performing endo-robotic resection of the submandibular gland in a cadaver model and compared the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique.

Methods: Procedural times were recorded in a consecutive series of 11 endoscopic submandibular gland resections using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) and a modified endoscopic surgical approach previously developed in a porcine model. The presence of neurovascular injury was assessed postoperatively, and the specimens were examined histologically.