Trochleoplasty Utilization in the Management of Patellofemoral Instability: Results From an International Survey of Surgeons.

Background: Considerable variability exists in the described clinical and radiographic indications for use, surgical techniques, postoperative management, and risk profile after trochleoplasty for the management of patellofemoral instability (PFI). In areas of clinical uncertainty, a cohesive summary of expert opinion and identification of areas of variation in current practice can be useful in guiding current practice and future research efforts.

Purpose: To assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of PFI among surgeons who perform this procedure.

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.

Survey Results Concerning Current Trends in Meniscus Repair Indications and Preferences from Members of the Pediatric Research in Sports Medicine (PRiSM) Society.

Meniscus repair has increased in frequency, especially among surgeons who focus on youth sports injuries. The aim of this study was to determine current trends in meniscus repair among a specific subset of meniscus repair surgeons. A cross-sectional survey utilizing several clinical vignettes was administered to orthopaedic surgeon members of the Pediatric Research in Sports Medicine (PRiSM) Society to investigate surgeon experience and training, number of meniscus repair procedures performed, and surgical and rehabilitation preferences.

Operative Treatment of Distal Tibial Fractures in Children Managed With Epiphyseal Screws: A Comparison of Outcomes When Screws Are Retained Versus Removed Following Fracture Union.

Background: Fractures of the distal tibial epiphysis in children are often accompanied by articular surface disruption. With increased displacement, internal fixation is frequently performed with an epiphyseal screw to close the fracture gap. Despite limited, high-level clinical evidence to support implant removal, epiphyseal screws are commonly removed after fracture healing due to potentially increased contact forces on the tibiotalar joint.

Medial Patellofemoral Ligament Augmentation Repair for Primary Patellar Dislocation With Concomitant Chondral or Osteochondral Injury in Children and Adolescents: Outcomes at Minimum 2-Year Follow-up.

Background: Treatment of primary patellar dislocation (PPD) with chondral or osteochondral injury without patellar stabilization in the adolescent population may lead to unsatisfactory outcomes. Surgical treatment, with or without traditional medial patellofemoral ligament (MPFL) reconstruction, is a topic of interest.

Purpose: To compare postoperative outcomes and rates of patellar redislocation and return to the operating room (OR) in patients who sustained a PPD with chondral or osteochondral injury and were surgically treated with versus without suture tape augmentation repair of the MPFL.

Detrimental Effects of Chlorhexidine on Articular Cartilage Viability, Matrix, and Mechanics.

Background: Chlorhexidine gluconate (CHG) solution is commonly used as an antiseptic irrigation for bacterial decontamination during orthopaedic surgery. Although the chondrotoxicity of CHG on articular cartilage has been reported, the full extent of CHG-related chondrotoxicity and its effects on the extracellular matrix and mechanical properties are unknown.

Purpose: To investigate the in vitro effects of a single 1-minute CHG exposure on the viability, biochemical content, and mechanics of native articular cartilage explants.

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.

An Overview of Pediatric Knee Arthroscopy With Use of the NeedleScope.

As sports-related injuries are becoming more common among children, there has been an increased need for knee arthroscopies in the pediatric population. Nevertheless, pediatric knee arthroscopy exposure is varied among orthopaedic surgeons, especially during residency training. There is a considerable difference in knee arthroscopy case volume between the adult and the pediatric population among orthopaedic residents.

Efficacy of DIY Cast Covers: An In Vivo Study.

Background: Casting is routinely used in orthopaedics. Preventing a wet cast is crucial for maintaining structural integrity and reducing unwanted complications like unnecessary skin irritation/ulceration, bacterial overgrowth, and unnecessary emergency department visits. Using experimental models, studies have tested various contemporary methods to prevent a wet cast.

The Pressure Is on: Dorsal Versus Volar Univalves for Long-arm Casts.

Background: Fiberglass casts are routinely used to treat fractures of the upper extremity. When posttraumatic edema is anticipated, the cast is often valved to hopefully prevent potential complications, especially compartment syndrome. Due to volar forearm compartments being most involved with upper extremity compartment syndrome, volar skin surface pressures (SSP) are paramount.

Does Liposomal Bupivacaine Injectable Suspension Peripheral Nerve Block Further Aid in Decreasing At-home Narcotic Utilization in Children and Adolescents After Anterior Cruciate Ligament Reconstruction.

Background: Opioid misuse and addiction among children and adolescents is an increasingly concerning problem. This study sought to determine whether liposomal bupivacaine injectable suspension admixture administered as a single-shot adductor canal peripheral nerve block (SPNB+BL) would decrease utilization of at-home opioid analgesics after anterior cruciate ligament reconstruction (ACLR) in adolescents compared with single-shot peripheral nerve block with bupivacaine (SPNB+B) alone.

Methods: Consecutive ACLR patients with or without meniscal surgery by a single surgeon were enrolled.

Adolescent Athletes Achieve High Levels of Athletic and Daily Function After Arthroscopic Marrow Stimulation for Elbow Capitellar Osteochondritis Dissecans.

Purpose: To determine the functional outcomes of adolescent athletes treated with arthroscopic marrow stimulation/microfracture for elbow capitellar osteochondritis dissecans (OCD).

Methods: The medical records for all patients younger than 18 years of age with capitellar OCD who underwent arthroscopic treatment at a single institution were retrospectively reviewed. The variables examined included patient characteristics, bone age, pre- and postoperative lesion grade/size and range of motion (ROM), intraoperative lesion grade/size, time to postoperative return to sport, and validated outcome scores.

Patellar Instability in Young Athletes.

This article summarizes the latest research related to pediatric patellar instability. The epidemiology, patterns of patellar instability, and underlying pathoanatomy are unique in children and adolescents. Information related to the natural history and predictive factors of patellar instability in young patients would allow for better patient counseling and management decisions.

Comprehensive Arthroscopic Characterization of Discoid Meniscus Tears and Instability Using the PRiSM Discoid Meniscus Classification.

The discoid meniscus is a congenital abnormality, with the vast majority occurring in the lateral meniscus. More commonly seen in pediatric populations, patients present with acute or chronic knee symptoms such as joint line pain, audible or palpable mechanical symptoms, and the inability to achieve terminal extension. The classic discoid classification system by Watanabe excludes anterior and horizontal instability and tearing that commonly occur with this pathology.

Magnetic Resonance Imaging of Lateral Meniscus Root Tears in the Pediatric and Adolescent Knee: Is the Diagnosis Missed, Mentioned, or Made?

Background: Failure to address meniscus root tears may place undue loads on anterior cruciate ligament (ACL) reconstructive surgery in the adult population. Because the intraoperative management of lateral meniscus posterior root tears (LMPRTs) may diverge from standard meniscal work and requires specialty items, preoperative diagnosis may be advantageous.

Purpose: To evaluate the reliability of radiologist interpretations of preoperative knee magnetic resonance imaging (MRI) scans of lateral meniscus root pathology in a mixed pediatric and adolescent population.

Investigating particulate production in the operating suite following the use of waterless alcohol based dry scrub versus traditional hand washing and drying with commonly used surgical towels: An experimental study.

Background: An often-overlooked item that could cause contamination in the operating suite are the towels used for hand drying following surgical scrub. The purpose of this current study was to determine if there was a difference in the particulate count from different hand drying methods following surgical hand preparation.

Methods: Three simulated hand drying groups were established: disposable sterilized surgical towels, reusable sterilized surgical towels, and a waterless alcohol-based dry rub.

COVID-19 pandemic restrictions unmasks dangers of frequent injury mechanisms for common surgically treated pediatric fractures.

Purpose: This study examined the volume and characteristics of common surgically treated fractures in children during the COVID-19 pandemic. The worldwide spread of COVID-19 affected the society in numerous ways. Social distancing led to changes in the types of activities performed by individuals, including children.

Reliability of a New Arthroscopic Discoid Lateral Meniscus Classification System: A Multicenter Video Analysis.

Background: The discoid lateral meniscus (DLM) is one of the most common congenital anomalies of the knee. The pathomorphology of DLM varies. Current classification systems are inadequate to describe the spectrum of abnormality.

Do Continuous Peripheral Nerve Blocks Decrease Home Opioid Use Following Anterior Cruciate Ligament Reconstruction in Children and Adolescents? The Envelope Please.

Background: Levels of opioid misuse and addiction among children and adolescents have reached alarming proportions. Exposure to opioids after surgery for anterior cruciate ligament reconstruction (ACLR), which is commonly performed in young athletes, increases this risk. This study was designed to evaluate whether continuous peripheral nerve block (CPNB) with placement of an elastomeric reservoir ball, compared with single-shot peripheral nerve block (SPNB), would decrease the need for home opioid analgesia and improve pain control after ACLR in children and adolescents.

Use of an Accessory Anteromedial Portal to Facilitate Repair of Mid-Body Radial Tears of the Lateral Meniscus in Children and Adolescents.

Meniscal tears in adolescent patients are commonly treated with repair to preserve meniscal tissue and prevent future degenerative changes. Historically, meniscal tears best suited for repair are acute vertical tears in patients aged <40 years with a normal mechanical axis, >1 cm and <4 cm in size, within the red-red zone, and concurrent with anterior cruciate ligament reconstruction. However, with continued advancements in technology and the development of new techniques, the possibilities and indications for meniscal repair have broadened.

Magnetic Resonance Imaging Predictive Model Determines Hamstring Autograft Size for Anterior Cruciate Ligament Reconstruction in Patients Under 18 Years Old.

Purpose: To evaluate the predictive value of magnetic resonance imaging in determining hamstring autograft size preoperatively for pediatric anterior cruciate ligament reconstruction.

Methods: We conducted an analysis of patients younger than 18 years who underwent quadrupled hamstring autograft anterior cruciate ligament reconstruction. Semitendinosus tendon (ST) and gracilis tendon (GT) cross-sectional areas were measured on preoperative knee magnetic resonance imaging scans.

Measuring the Acetabular Index: An Accurate and Reliable Alternative Method of Measurement.

In children (4 months to 8 years old), radiographic measurements of the acetabular index are the preferred method to assess developmental hip dysplasia. However, the acetabular index has been criticized as having variable reliability owing to difficulty identifying the correct anatomic landmarks. An alternative method of measuring the acetabular index using the ischium is being proposed to avoid the variability of the triradiate cartilage line as a reference point.