Journal of Pediatric Orthopaedics最新文献

{"title":"Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital.","authors":"Stephanie Chen, Jordan Ritchie, Jacob Hernandez, Nyma Khan, Vikki Nolan, Benjamin W Sheffer, Derek M Kelly","doi":"10.1097/BPO.0000000000002854","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002854","url":null,"abstract":"<p><strong>Background: </strong>In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital.</p><p><strong>Methods: </strong>A retrospective review identified pediatric patients with isolated, closed, and acute (below 3 wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs.</p><p><strong>Results: </strong>Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital.</p><p><strong>Conclusion: </strong>Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden.</p><p><strong>Level of evidence: </strong>Level III-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding: Identifying Risk Factors for Open Reduction in Pediatric Supracondylar Humerus Fractures.","authors":"Yavuz Şahbat, Servet İğrek, Ahmet Hamdi Akgülle","doi":"10.1097/BPO.0000000000002849","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002849","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibialis Anterior Tendon Transfer for Clubfoot Deformity: Cuboid Versus Lateral Cuneiform.","authors":"Madison Craft, Gage Calhoon, Thomas R Lewis","doi":"10.1097/BPO.0000000000002852","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002852","url":null,"abstract":"<p><strong>Background: </strong>Tibialis anterior tendon transfer in relapsing clubfoot deformity is a well-known treatment option for dynamic forefoot supination and adduction deformities. The tibialis anterior tendon can be anchored to the lateral cuneiform or the cuboid. A complication of this surgery is overcorrection to a flatfoot deformity or undercorrection that maintains the clubfoot deformity. We compared reoperation rates and clinical outcomes between these 2 groups.</p><p><strong>Methods: </strong>This is a retrospective study performed from 2005 to 2020. The primary outcome was repeat operation. The secondary outcome included clinical appearance scores described by Garceau and Palmer.</p><p><strong>Results: </strong>There were 114 clubfeet (111 patients) treated in our study. Of them, 67 (58.8%) had a transfer to the lateral cuneiform, whereas 47 (41.2%) had a transfer to the cuboid. Nine patients had reoperations which included 4 (44.4%) in the lateral cuneiform group and 5 (55.6%) in the cuboid group which was not statistically significant (P=0.485). Clinical appearance scores revealed significantly better clinical appearance in the lateral cuneiform group after surgery compared with the cuboid group (P=0.0172).</p><p><strong>Conclusions: </strong>There were no clinically significant differences in reoperation rates between transfers to the lateral cuneiform versus the cuboid. We did find better clinical appearance in the lateral cuneiform group after surgery compared with the cuboid group.</p><p><strong>Level of evidence: </strong>Level III retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemiology of Pediatric Shoulder Dislocations in the United States.","authors":"Stefano DiCenso, Ronald Justin Mistovich, David C Kaelber","doi":"10.1097/BPO.0000000000002841","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002841","url":null,"abstract":"<p><strong>Background: </strong>Shoulder dislocations are the most common of all major joint dislocations and are a frequent cause of emergency department (ED) presentations. While the epidemiology of shoulder dislocations has been characterized in adults, it has not yet been done for children in the United States. The primary goal of this study was to calculate the incidence rate of pediatric shoulder dislocations in the United States. Secondary goals were to characterize the demographic information of children with shoulder dislocations as well as trends in management.</p><p><strong>Methods: </strong>The US Collaborative Network in TriNetX, a network of clinical data repositories containing patient data from over 100,000,000 unique individuals within the United States, was queried for patients younger than 18 years old diagnosed with shoulder dislocation from 2014 to 2024 using ICD codes. The demographic details were then extracted from the data set, and treatment approaches were determined by CPT coding.</p><p><strong>Results: </strong>Over the past 10 years, there were 16,460 pediatric and adolescent patients diagnosed with a first-time shoulder dislocation in either an ED or ambulatory clinic. The overall incidence rate was 60.31 per 100,000 patients, while the incidence rate was 116.61 per 100,000 patients presenting in the ED and 33.95 per 100,000 patients presenting in ambulatory clinics that were under the age of 18 years. Most patients were male (73%), White (59%), and came from the southeastern region of the United States (36%). The most common treatment was a closed reduction (25%), followed by arthroscopic surgery (17%). The number of annual shoulder dislocations has increased over the past decade without an increase in the number of patients undergoing surgical treatment.</p><p><strong>Conclusions: </strong>There remains a high incidence rate of shoulder dislocations in the pediatric population of the United States. Despite evidence that early surgical treatment of shoulder dislocations offers improved outcomes, nonoperative treatment continues to be the most common modality without any increase in the percentage of patients undergoing surgical treatment.</p><p><strong>Level of evidence: </strong>Level IV-descriptive epidemiological analysis.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteochondral Autograft Transplantation for Symptomatic Full-thickness Patellar Cartilage Defects in Adolescents.","authors":"Javier Masquijo, Miguel Carabajal Mattar, Alejandra Ron Marqués, Alberto Losa, Juan Cabello Blanco, Joaquín Nuñez de Armas, Maria J Tuca","doi":"10.1097/BPO.0000000000002850","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002850","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to review the clinical, radiographic, and magnetic resonance imaging (MRI) outcomes of osteochondral autograft transplantation applied to patellar cartilage lesions of patients under 18 years of age.</p><p><strong>Methods: </strong>Data from nine consecutive patients were retrospectively analyzed for indications, preoperative complications, and clinical-radiographic outcomes. Patients were clinically evaluated using the Pedi-IKDC and Lysholm scores. In addition, return to sports and knee pain were assessed. MRI evaluation included an analysis of osteochondral graft integration using the magnetic resonance observation of cartilage repair tissue 2.0 score and radiographic classification of osteoarthritis using the Kellgren-Lawrence system.</p><p><strong>Results: </strong>Nine patients (9 knees, 6 males) with a mean age of 14 years (SD: 1.7, range; 11 to 17 y) were analyzed. Lesions were located on the medial facet (N=5), lateral facet (N=3), and central ridge of the patella (N=1). One or 2 cylindrical osteochondral grafts were transplanted, with a median diameter of 9 mm (range: 8 to 10 mm). The average lesion size was 102.9 mm2. At a mean follow-up of 45.1 months (range: 23 to 117 mo), the mean Pedi-IKDC score was 89.2 (SD: 9.8), and the Lysholm score was 94.4 (SD: 4.8). Patients returned to sports in an average of 7.3 months (SD: 2, range: 6 to 12 mo). MRI of 8 patients showed osteochondral graft integration with a mean magnetic resonance observation of cartilage repair tissue 2.0 score of 86.9 (SD: 7, range: 80 to 100). Six knees showed Kellgren-Lawrence grade 0 joint space on radiographs, and 3 showed grade 1. Eight patients were asymptomatic at the last follow-up, and 1 reported occasional mild pain with intense physical activity. One patient developed arthrofibrosis, requiring arthroscopic lysis of adhesions and manipulation.</p><p><strong>Conclusion: </strong>Osteochondral autograft transplantation is a safe and effective technique for treating symptomatic patellar full-thickness chondral lesions in adolescents. Long-term follow-up studies will determine whether the affected area maintains structural and functional integrity over time.</p><p><strong>Level of evidence: </strong>Level IV-therapeutic study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forearm Fractures in Older Children and Adolescents: ORIF is Safer Than IMN With Equivalent Outcomes.","authors":"Stephen Chen, Matthew E LaBarge, Abigail L Henry, Jacquelyn Pennings, Jeffrey E Martus","doi":"10.1097/BPO.0000000000002853","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002853","url":null,"abstract":"<p><strong>Background: </strong>Greater understanding of the impact of skeletal maturity on outcomes is needed to guide operative treatment of diaphyseal forearm fractures in children and adolescents. The purpose of this study was to compare the complications and outcomes of pediatric diaphyseal forearm fractures treated with intramedullary nailing (IMN) or open reduction internal fixation (ORIF) and to identify a radiographic marker of skeletal maturity that will aid in selecting between treatment options.</p><p><strong>Methods: </strong>A retrospective review of patients aged 10 to 16 years treated operatively for diaphyseal forearm fractures was performed. Markers of skeletal maturity including the olecranon apophysis score, the presence of the thumb adductor sesamoid, and radial epiphyseal capping. Complications were graded with the modified Clavien-Dindo system. Outcomes were scored based on final postoperative range of motion combined with complication grade.</p><p><strong>Results: </strong>A total of 260 patients were included: 163 treated with IMN, 97 treated with ORIF, mean age 12.7 years, 72% male. Among closed forearm fractures treated with IMN, open reduction was required in 45% (53/118). Patients treated with IMN had a higher complication rate than ORIF (27.0% vs. 9.3%, P<0.05), including when stratified by age. Complication rates were not impacted by greater skeletal maturity as indicated by the presence of thumb sesamoid or radial epiphyseal capping. There was no significant difference in outcomes between the ORIF and IMN groups. More skeletally immature patients, as identified by a lack of either the thumb adductor sesamoid or radial epiphyseal capping, had significantly better outcomes with ORIF than patients with greater maturity.</p><p><strong>Conclusions: </strong>Across all age groups and levels of skeletal maturity, ORIF had a significantly lower rates of complications compared with IMN with equivalent outcomes. More skeletally immature patients had significantly better outcomes with ORIF treatment when compared with older patients. The thumb adductor sesamoid, radial epiphyseal capping, and the olecranon apophysis score did not provide useful information to select between ORIF over IMN in this population.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey.","authors":"Brennan Roper, S Rose Purtell, Sayan De, Dell McLaughlin, Walter H Truong, Mark L Miller, Ishaan Swarup, Wendy Ramalingam, Julia S Sanders","doi":"10.1097/BPO.0000000000002847","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002847","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns.</p><p><strong>Methods: </strong>Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results.</p><p><strong>Results: </strong>Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice >5 y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing <10 acetabular (72.2%) but >10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients <10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred.</p><p><strong>Conclusions: </strong>There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging Can Predict Hamstring or Quadriceps Tendon Autograft Diameter in Pediatric or Adolescent Anterior Cruciate Ligament Reconstruction: A Systematic Review.","authors":"Prushoth Vivekanantha, Bryan Sun, Naveen Parasu, Darren de Sa","doi":"10.1097/BPO.0000000000002846","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002846","url":null,"abstract":"<p><strong>Objective: </strong>Insufficient graft diameter is an important factor that contributes to failure rates after anterior cruciate ligament reconstruction (ACLR). Although modalities, such as magnetic resonance imaging (MRI), have been well investigated in the adult population to predict graft diameter preoperatively, it is unclear whether similar strategies can be used in the pediatric population. This review aims to evaluate the utility of MRI in the preoperative estimation of autograft parameters in pediatric or adolescent patients undergoing ACLR.</p><p><strong>Methods: </strong>Three databases were searched on January 31, 2024. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Revised Assessment of Multiple Systematic Reviews guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, graft characteristics, MRI imaging techniques, and statistical analyses correlating MRI parameters with graft length or diameter were recorded.</p><p><strong>Results: </strong>Five studies consisting of 450 patients were included in this review (48.4% females). The mean (SD) age at ACLR was 14.7 (6.8) years. Three studies using hamstring tendon (HT) autografts found that combined semitendinosus and gracilis tendon cross-sectional area (ST+GT CSA) were able to predict graft diameter. One study reported an ST+GT CSA cutoff of 31.2 mm2 to have an 80% and 74% sensitivity and specificity, respectively, in predicting HT autograft diameter above 8 mm. Two studies using quadriceps tendon (QT) autografts found that tendon thickness on sagittal MRI view was able to predict graft diameter. One study reported a QT cutoff of 6.7 mm to have 97.5% and 46.6% sensitivity and specificity, respectively, in predicting the diameter of the QT graft to be above 8 mm. Associations between MRI parameters and graft length were not reported.</p><p><strong>Conclusion: </strong>Although there is limited evidence, ST+GT CSA and QT thickness on sagittal view on MRI can be used to predict intraoperative HT and QT autograft diameter, respectively, in pediatric or adolescent ACLR. Future investigations should investigate correlations between imaging parameters and graft length, especially when using QT autografts in the pediatric population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Disadvantage and Transportation Insecurity in Clubfoot Clinic.","authors":"Melissa A Bent, Michelle Jhun, Veronica Beltran, Barbara Fimbres, Tishya A L Wren","doi":"10.1097/BPO.0000000000002823","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002823","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the association of missing clubfoot clinic visits with transportation barriers and measures of socioeconomic status including the child opportunity index (COI).</p><p><strong>Methods: </strong>An 11-question survey was administered to caregivers of patients with clubfoot seen at a single pediatric tertiary hospital between August 2020 and September 2023. A chart review was conducted to obtain zip codes used to determine COI 2.0 scores. The impact of race/ethnicity, income, persons per household, COI, and transportation methods on missing at least one clinic visit was analyzed using descriptive and nonparametric statistics.</p><p><strong>Results: </strong>The transportation survey was completed by a total of 99 caregivers. The median travel time to the clinic was 45 minutes (IQR: 33, range: 1 to 180). Most participants reported use of a personal car (108/128, 83%), and 72% took time off work to attend the appointment. Those with lower COI had longer travel time (P=0.02) and were less likely to use personal cars (P=0.05). Missed clubfoot clinic visits were more common for families reliant on transportation other than a personal vehicle (P=0.01) and those with annual income under $30,000 (P=0.02).</p><p><strong>Conclusions: </strong>Transportation insecurity was associated with greater social disadvantage as indicated by COI and more missed clinic visits.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing the Knee Arc of Motion in Patients With Arthrogryposis: Minimum 2-year Follow-up.","authors":"Aaron J Huser, Michael W Brown, Hans K Nugraha, David S Feldman","doi":"10.1097/BPO.0000000000002826","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002826","url":null,"abstract":"<p><strong>Background: </strong>Surgery for knee flexion contractures in patients with arthrogryposis multiplex congenital (AMC) have achieved extension to redirect the arc of motion and improve ambulation but has not demonstrated maintained increases in total range of motion (ROM). This study aimed to review the clinical outcomes of combined posterior knee release, proximal femoral shortening, and nerve decompression in patients with arthrogryposis.</p><p><strong>Methods: </strong>A retrospective chart and radiographic review were performed on patients with AMC who underwent treatment for knee flexion deformities ≥30 degrees. ROM, ambulation status, and orthotic use were reviewed and analyzed. Complications were recorded.</p><p><strong>Results: </strong>Twenty-nine patients with 51 knees and a mean age of 5.7 years were included. The mean follow-up was 36.9 months. The mean ROM increased from 49 to 80 degrees between pre-op and latest follow-up (P<0.0001). The mean final follow-up flexion deformity was 10 degrees (P<0.0001). Preoperative ROM was moderately correlated with final ROM (rs=0.51). The percentage of ambulatory patients improved from 39% to 93%. Five limbs experienced a fracture either intraoperatively or postoperatively, and 5 limbs required a return trip to the operating room.</p><p><strong>Conclusions: </strong>Improved ambulation and knee ROM can be maintained in patients with AMC at a minimum 2-year follow-up. Prospective investigation and longer follow-up are required to validate these findings.</p><p><strong>Level of evidence: </strong>Level IV-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}