Journal of Pediatric Orthopaedics最新文献

{"title":"Comment on \"Similar Return-to-Sports After Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair in Skeletally Immature Patients\".","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1097/BPO.0000000000003006","DOIUrl":"10.1097/BPO.0000000000003006","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e887-e888"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199450","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":"Reoperation Rates After Lumbar Discectomy in Pediatric Patients.","authors":"Andy M Liu, Adeesya Gausper, Suhas Etigunta, Karim Shafi, Kenneth Illingworth, David Skaggs, Alexander Tuchman, Corey Walker","doi":"10.1097/BPO.0000000000003030","DOIUrl":"10.1097/BPO.0000000000003030","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) is uncommon in the pediatric population but can cause significant low-back or radicular pain and, at times, neurological deficits. We aimed to study discectomy operations in pediatric patients to provide insight into surgical outcomes that may inform clinical decision-making and patient counseling.</p><p><strong>Methods: </strong>A national insurance claims database (PearlDiver) was queried to identify pediatric patients (<21 y old) who underwent discectomy. Procedures were characterized by demographics features, including age of patient, year, and location. Reoperations was defined as discectomy, re-exploration discectomy, fusion, or laminectomy occurring within 5 years of the initial discectomy. A subsequent parallel analysis looked at reoperations following re-exploration discectomies. Kaplan-Meier survival and cox proportional regression analyzed factors impacting survival postprimary discectomy.</p><p><strong>Results: </strong>A total of 4410 primary discectomy patients were identified, with an overall 12% reoperation rate within 5 years of the initial discectomy. Specifically, patients under 18 and between the ages of 18 and 21 having a reoperation rate of 7% (115 patients) and 15% (406 patients), respectively. The incidence of discectomy operations increased with patient age. 78% of pediatric cases were performed on an outpatient basis compared with 75% of adult cases. The rate of reoperation was highest within the first year postdiscectomy, with nearly half of reoperations occurring in this time. Specifically, reoperation rates were 2.3% at 3 months, 4% at 6 months, 6% at 1 year, 7% at 2 years, and 12% at 5 years. The most common reoperation procedure was another discectomy. The reoperation rates following these revision operations were 2% at 3 months, 4% at 6 months, 6% at 1 year, 10% at 2 years, and 14% by 5 years. Fusion was the most common procedure following a failed revision discectomy (42% at 5 y). The Kaplan-Meier survival analysis similarly showed most procedures occurred in the first 3 years, with obesity and Elixhauser Comorbidity Index inversely correlated with survival.</p><p><strong>Conclusions: </strong>Overall, pediatric reoperation rates following discectomy are 11.8%. Obesity and Elixhauser Comorbidity Index significantly increased risk of reoperation. This study provides real-world, large-scale data that may guide surgeons caring for pediatric patients undergoing microdiscectomy.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e881-e885"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369011","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 Process Variation During Musculoskeletal Infection Evaluation at 6 Pediatric Centers.","authors":"Yida Liu, Naureen G Tareen, Shyam Kishan, Lauren E LaMont, Dustin M Loveland, Scott B Rosenfeld, Christopher D Souder, Matthew R Hammer, Norman A Lapin, Kristy Reyes, Niamh McMahon, Grace S Anand, Justine Kasay, Lawson A Copley","doi":"10.1097/BPO.0000000000003018","DOIUrl":"10.1097/BPO.0000000000003018","url":null,"abstract":"<p><strong>Introduction: </strong>Magnetic resonance imaging (MRI) is heavily utilized for evaluation of children suspected to have musculoskeletal infection (MSI). This allows early visualization of the anatomic and spatial extent of evolving inflammation to guide treatment decisions. Organized protocols for efficient and effective use of this diagnostic modality have been published but may not be actively followed at most pediatric centers. The purpose of this study is to comparatively evaluate MRI processes and workflows at 6 pediatric centers in the state of Texas.</p><p><strong>Methods: </strong>Institutional Review Board approval and data use agreements were established at the centers for retrospective study of MRI practices and experience. A survey of pediatric orthopaedic surgeon principal investigators at each center assessed MRI acquisition strategies and satisfaction. Data were collected and analyzed for demographics, diagnoses, MRI indications, processes, and outcomes.</p><p><strong>Results: </strong>Seventy children who underwent MRI evaluations over a 3-year period were included with a range of 5 to 20 children per center. Two centers had protected MRI scan time, organized MRI protocols, and facilitated immediate transfer to the operating room when surgical indications were present for sedated children. The 2 centers demonstrated significantly shorter MRIs (median 21.0 vs. 52.0 m), fewer sequences (median 3.0 vs. 7.0), less contrast use (4.0% vs. 53.3%), and a shorter delay from MRI to OR for children who underwent surgery (median 26.0 vs. 967.5 m) when compared with the remaining centers ( P <0.0001).</p><p><strong>Conclusions: </strong>Organized MRI workflows were not followed at most centers studied. While challenging to implement and sustain, a multidisciplinary MRI protocol for MSI evaluation will make this heavily scheduled resource substantially more efficient and improve provider satisfaction.</p><p><strong>Level of evidence: </strong>Level III-retrospective study of nonconsecutive patients.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e782-e788"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642792","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":"Surgical Treatment for Painful Pediatric Pes Planovalgus: How Does Subtalar Extra-articular Screw Arthroereisis Compare to the Standard Technique of Modified Evans Reconstruction?","authors":"Adam Nasreddine, Alexandra Dunham, Michelle Mo, Patricia E Miller, Susan T Mahan","doi":"10.1097/BPO.0000000000003004","DOIUrl":"10.1097/BPO.0000000000003004","url":null,"abstract":"<p><strong>Background: </strong>A subset of patients with flexible pediatric pes planovalgus (PPV) will have recalcitrant symptoms and functional impairment despite maximizing nonoperative methods and seeking surgical care. The primary aim of this study was to compare the clinical course and radiographic improvement including final alignment for patients who underwent the minimally invasive corrective subtalar extra-articular screw arthroereisis (SESA) technique compared with the traditional modified Evans reconstruction (MER) technique for flexible PPV correction.</p><p><strong>Methods: </strong>Forty-five feet in 31 PPV patients aged 10 to 19 years treated at a single institution with (1) SESA +/- Vulpius or accessory navicular or tarsal coalition excision (22 feet) or (2) MER +/- Vulpius (23 feet) from 2010 to 2022 were identified. Patients with no weight-bearing postoperative x-rays were excluded. Comprehensive preoperative and postoperative radiographic measurements were obtained from standing radiographs. Radiographic outcomes were evaluated across treatment groups using noninferiority analysis. Comparisons in clinical characteristics were conducted using mixed-effects regression modeling to account for the correlation between bilateral measurements within the same patient.</p><p><strong>Results: </strong>Surgery was performed at an average age of 13.7 years (SD, 1.9); the cohort was 53% male. There were no differences in age, BMI, or laterality between the SESA and MER cohorts. The SESA cohort had a significantly shorter operative time compared with MER (51 vs. 167 min; P <0.001). One patient in the MER cohort required a return to the operating room for hardware removal in the setting of pseudoarthrosis, and another for a buried pin. Time to weightbearing in the SESA cohort was a median 3 weeks earlier than the MER cohort ( P =0.004). The SESA procedure was found to be noninferior to MER with respect to postoperative radiographic alignment as well as in the improvement in alignment from preoperative to postoperative measurement (all P <0.05).</p><p><strong>Conclusions: </strong>For painful pediatric pes planovalgus (PPV), subtalar extra-articular screw arthroereisis (SESA) offers a less invasive approach with noninferior outcomes compared with modified Evans reconstruction (MER). Our study found similar radiographic improvements and deformity correction in adolescents treated with SESA versus MER, along with shorter procedures and earlier weightbearing. No major complications were observed. Long-term follow-up and patient-reported outcome studies are needed, especially postscrew removal.</p><p><strong>Level of evidence: </strong>Therapeutic case-control study, level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"559-565"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000172","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":"Strength Recovery from Nonsurgical Treatment of Apophyseal Avulsions of the Pelvis.","authors":"Terrul Ratcliff, Patrick O Ojeaga, Nolan D Hawkins, Alex Loewen, Robert L Van Pelt, Jeffrey Nepple, Philip L Wilson, Henry B Ellis","doi":"10.1097/BPO.0000000000003023","DOIUrl":"10.1097/BPO.0000000000003023","url":null,"abstract":"<p><strong>Background: </strong>Strength deficits, strength recovery, and return to sports timing following nonoperative apophyseal avulsion fractures are relatively unknown, as is the effect of displacement of the avulsed fragment. This study aims to assess strength recovery following a pelvic apophyseal avulsion and determine whether a relationship between radiographic characteristics and strength exists.</p><p><strong>Methods: </strong>Twenty-eight patients from a prospective pelvic apophyseal avulsion study database, were treated nonoperatively with physical therapy, and a minimum 3-month follow-up was included. Patients were categorized by location of injury and fracture displacement (greater or less than 15 millimeters). Strength measurements obtained at a minimum of 3 months postinjury were used to quantify overall hip and knee strength across several strength measurements. Limb symmetry index (LSI) was calculated as a percentage of the affected limb strength compared with the unaffected limb. Affected and unaffected sides were compared with t tests. Spearman correlation coefficients were calculated to assess radiographic characteristics and affected limb strength correlations.</p><p><strong>Results: </strong>Twenty-three (82.1%) patients were male, with an average age of 14.7±1.1 years. The mean fracture displacement was 10.87±10.24 mm. The most common location of injury was the anterior inferior iliac spine (35.7%, n=10). Among all patients, no strength deficits were observed on the affected limb compared with the unaffected limb, and affected knee extension (KE) strength was greater than unaffected (LSI 110.94%, P =0.013). In fractures displaced <15 millimeters, the affected limb KE strength was stronger than the unaffected limb (LSI 110.92±15.52, P =0.022). Increasing fracture displacement positively correlated with hip flexion ( P =0.008), hip extension ( P =0.049), hip abduction strength ( P =0.040), and KE strength ( P= 0.011).</p><p><strong>Conclusion: </strong>No strength deficits were identified in the affected limbs following pelvic avulsion injuries compared with the unaffected limb. Affected limb knee extension strength was greater compared with the uninjured side following physical therapy. A majority of apophyseal avulsion fractures have near complete recovery of strength at 3 months with conservative management.</p><p><strong>Level of evidence: </strong>Level II-prospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e797-e803"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199453","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":"Do Rib-Based Anchors Impair Chest Wall Motion in Early Onset Scoliosis? - A Novel Investigation via Dynamic MRI.","authors":"Yubing Tong, Jayaram K Udupa, Joseph M McDonough, Lipeng Xie, Caiyun Wu, Yusuf Akhtar, Mahdie Hosseini, Mostafa Alnoury, Shiva Shaghaghi, Samantha Gogel, David M Biko, Oscar H Mayer, Drew A Torigian, Patrick J Cahill, Jason B Anari","doi":"10.1097/BPO.0000000000003015","DOIUrl":"10.1097/BPO.0000000000003015","url":null,"abstract":"<p><strong>Background: </strong>There is a concern in pediatric spine surgical practice that rib-based fixation may limit chest wall motion in early onset scoliosis (EOS). The purpose of this study is to assess the contribution of chest wall excursion to respiration before and after growth-friendly surgery.</p><p><strong>Methods: </strong>Quantitative dynamic magnetic resonance imaging (QdMRI) is performed on 49 EOS patients (before and after surgery) and 191 normal children in this retrospective study. QdMRI is an image-based approach and allows for free-breathing image acquisition. Tidal volume parameters for chest walls (CWtv) and hemidiaphragms (Dtv) were analyzed on the concave and convex sides of the spinal deformity. EOS patients (1 to 14 y) and normal children (5 to 18 y) were enrolled, with an average interval of 2 years for dMRI acquisition before and after surgery.</p><p><strong>Results: </strong>CWtv significantly increased after surgery in all EOS patients ( P <0.05) by 51% for left CWtv and 41% for right CWtv without age correction, and 17% for LCWtv and 25% for right CWtv with age correction, respectively. For main thoracic curve (MTC) EOS patients, CWtv significantly improved after surgery by 50% (concave side) and 35% (convex side) after age correction ( P <0.05). The average ratio of Dtv to CWtv on the convex side in MTC EOS patients was not significantly different from that in normal children ( P =0.78). However, the concave side showed the difference to be significant ( P =0.019).</p><p><strong>Conclusion: </strong>Chest wall component tidal volumes in EOS patients measured through QdMRI did not decrease after rib-based surgery, suggesting that rib-based fixation does not impair chest wall motion in pediatric patients with EOS. The proposed QdMRI method can be used to quantify the motion of the individual 3D chest wall and diaphragm before and after surgery, to assess deviations from normality, and to quantify alterations due to corrective surgery in EOS.</p><p><strong>Level of evidence: </strong>Level III evidence-retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e761-e768"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248460","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":"Growth-friendly Technique or Posterior Spinal Fusion With T-construct Pelvic Fixation in Nonambulatory Spinal Muscular Atrophy With Severe Scoliosis.","authors":"Mathilde Gaume, Sophie Denamur, Guillaume Aubertin, Clélia Thouement, Jessica Taytard, Raphael Vialle","doi":"10.1097/BPO.0000000000003008","DOIUrl":"10.1097/BPO.0000000000003008","url":null,"abstract":"<p><strong>Background: </strong>The surgical treatment of scoliosis in type 2 spinal muscular atrophy (SMA2) is challenging and little described in the literature due to its rarity and fragility of the patients. The aim of this study was to review the surgical strategies and outcomes in patients with SMA2 who underwent surgery for scoliosis at a French reference neuromuscular center.</p><p><strong>Methods: </strong>All consecutive patients with genetically confirmed SMA2 who underwent spinal surgery between 2009 and 2022 at our French reference center were retrospectively analyzed. They were divided into 2 groups, according to their primary surgery: either magnetically controlled growing rods (MCGR) or posterior spinal fusion (PSF). Demographic, respiratory, and radiologic parameters were collected preoperatively and at the latest follow-up. All complications were reported. Patients and/or caregiver-reported outcome questionnaires were also used to assess the improvement of sitting posture.</p><p><strong>Results: </strong>Seventeen patients underwent MCGR, and 9 patients underwent PSF during the inclusion period. Mean follow-up was 5.3±1.8 years in the MGCR group, and 8.0±4.5 years in the PSF group. The average age at surgery was 9.7±1.6 years in the MCGR group and 12.6±1.7 years in the PSF group. Pelvic fixation was performed using a Tconstruct (2 sacral and 2 iliac screws). PSF was performed with all levelled pedicle screws. In the MGCR group, upper thoracic fixation was lateral ribs (n=4), vertebral on three levels (n=9), or hybrid costo-vertebral (n=4). No blood transfusion was required. No differences were found between preoperative and postoperative lung function tests for the 2 surgical procedures. The major curve correction rate was 44% in the MCGR group and 55% in the PSF group. The pelvic obliquity at last follow-up was <5 degrees in all patients. Three unplanned surgeries occurred: 1 MGCR change after lengthening and 2 PSF-one for proximal hook migration and one for infection. All patients improved their ability to sit.</p><p><strong>Conclusion: </strong>In this series, PSF and MGCR allowed stable radiographic and respiratory results, with a reduced rate of global complications. Pelvic fixation with T-construct was a reliable and effective technique to correct pelvic obliquity in this population of patients.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"525-530"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111277","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":"Bedside Aspiration for Workup of the Pediatric Septic Hip: Avoid Trips to the OR and Expedited Time to Diagnosis.","authors":"Kira F Skaggs, Olivia Okoli, Hiba Naz, Nicole S Pham, John S Vorhies, Kali R Tileston","doi":"10.1097/BPO.0000000000002996","DOIUrl":"10.1097/BPO.0000000000002996","url":null,"abstract":"<p><strong>Background: </strong>Septic arthritis of the hip is a pediatric orthopaedic emergency. Joint synovial fluid aspiration is a critical step of diagnosis, which may be delayed due to limited personnel or operating room (OR) availability. To expedite diagnosis, orthopaedic residents perform ultrasound-guided bedside arthrocentesis in the emergency department (ED). This study aims to evaluate the impact of this practice on time to diagnosis and definitive treatment of septic arthritis of the hip and minimizing trips to the operating room.</p><p><strong>Methods: </strong>This is a retrospective study of patients presenting to our pediatric orthopaedic tertiary care emergency room requiring a hip aspiration to rule out septic arthritis between 2003 and 2023. We identified all patients who had resulted hip synovial fluid nucleated cell count during the above time period. Chart review was performed to determine how synovial fluid was collected via interventional radiology (IR), in the OR with an orthopaedic surgeon, or via bedside aspiration with the on-call resident. Clinical outcomes were primarily defined as time points in clinical care. Patient demographics, Kocher criteria values, time to aspiration, and final treatment are presented. Kruskal-Wallis and Fisher exact tests were used to compare demographic and clinical differences in RStudio using a two-sided level of significance of 0.05.</p><p><strong>Results: </strong>Hip aspiration was performed in the workup of septic arthritis in 57 patients (median age 5.1 y; 58% female). Aspiration occurred in the ED for 28 patients, interventional radiology (IR) for 11, and in the OR for 18 patients. Bedside aspiration avoided a trip to the OR for 15 patients (54%). Median time to obtaining joint fluid was significantly shorter for patients undergoing bedside or IR-guided aspiration compared with OR aspiration (7.4 vs. 5.3 vs. 15.7 h, respectively; bedside vs. OR P =0.007, IR vs. OR P =0.013). Time from presentation to OR for open surgical debridement, total operative time, and the percentage of patients requiring open surgical debridement did not significantly differ between groups.</p><p><strong>Discussion: </strong>Bedside aspiration decreases the time to diagnosis of septic arthritis and can prevent ~50% of children from going to the OR. This is beneficial for the patient as it may allow for earlier antibiotic administration, provide pain relief, and avoid possible complications of general anesthesia.</p><p><strong>Level of evidence: </strong>Level III-retrospective chart review.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"540-545"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101755","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":"Impact of Hip Versus Knee Pain as the Presenting Symptom of Slipped Capital Femoral Epiphysis on Time to Imaging, Surgery, and Complications.","authors":"David Momtaz, Shayan Hosseinzadeh, Mehul M Mittal, Rishi Gonuguntla, Beltran Torres-Izquierdo, Abhishek Tippabhatla, Rohit Siddabattula, Pooya Hosseinzadeh","doi":"10.1097/BPO.0000000000003016","DOIUrl":"10.1097/BPO.0000000000003016","url":null,"abstract":"<p><strong>Background: </strong>Slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder affecting roughly 1 in 10,000 children and adolescents, with delayed diagnosis and treatment leading to poor outcomes. This study compares the association between presenting hip or knee pain symptomatology and its effects on time to diagnosis and treatment of SCFE, mid- to long-term complications, and risk of requiring hip reconstructive surgeries.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted comparing SCFE presentations with chief complaints of either hip or knee pain that led to SCFE surgery. Propensity score matching adjusting for demographic factors, was performed on these cohorts. Survival analysis was implemented on the matched cohorts to compare time to imaging, primary SCFE surgery, complications, and the need for additional interventions.</p><p><strong>Results: </strong>A total of 724 patients undergoing surgery for SCFE were identified, with either an initial presentation of hip or knee pain. After propensity score matching, 145 patients were included in each group. The average age of patients was 11.5 years old. Children in the knee pain cohort experienced a significantly longer delay of ∼92 days in obtaining hip/pelvis imaging [98.51 vs. 6.79 d, hazard ratio (HR) 1.62, 95% CI: 1.22-2.14; P =0.034] and an average delay of ∼82 days in undergoing surgery from presentation [106.38 vs. 24.34 d; HR 2.39, 95% CI: 1.83-3.14; P <0.0001] compared with the hip cohort. Furthermore, knee pain patients had an increased risk of chondrolysis and osteoarthritis [risk ratio (RR) 1.88, 95% CI: 1.10-3.24; P =0.019] and higher need for hip reconstruction (RR 1.68, 95% CI: 1.002-2.83; P =0.045).</p><p><strong>Conclusion: </strong>This study is the first report attributing increased risks of chondrolysis, osteoarthritis, and need for future hip reconstructive surgeries to the delay in diagnosis among SCFE patients presenting with knee pain. Maintaining a high index of suspicion for SCFE among children presenting with knee pain, particularly among overweight adolescents, is crucial.</p><p><strong>Level of evidence: </strong>Level III-therapeutic studies-investigating the results of treatment.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e810-e817"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150836","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":"Do Social Determinants of Health Impact the Initial Evaluation and Management of Pediatric Patients With First-Time Patellofemoral Dislocation?","authors":"Casey C Kuka, David M Kell, Caroline L Kim, Kevin J Orellana, Brendon C Mitchell, Elliot M Greenberg, Sulagna Sarkar, Neeraj M Patel, Brendan A Williams","doi":"10.1097/BPO.0000000000003025","DOIUrl":"10.1097/BPO.0000000000003025","url":null,"abstract":"<p><strong>Background: </strong>Under-resourced communities face greater barriers to care. However, this relationship is not well-defined in the management of patellofemoral instability. We hypothesized that pediatric patients from under-resourced neighborhoods and those with public insurance would experience delays in care for first-time patellofemoral dislocation.</p><p><strong>Methods: </strong>A retrospective cohort study was performed of patients younger than or equal to 18 years evaluated at a single institution after a first-time patellofemoral dislocation between 2011 and 2022. Demographic, clinical, and radiographic characteristics were collected. Neighborhood conditions were categorized using the Child Opportunity Index (COI). Time from injury to presentation, magnetic resonance imaging (MRI), and physical therapy (PT) initiation were compared across COI categories and insurance types.</p><p><strong>Results: </strong>Three hundred seventy-five patients with first-time patellofemoral dislocation met inclusion criteria. Injuries occurred at a mean age of 14.2±2.1 years, with a majority occurring in female patients (55%). Time to evaluation by orthopaedic provider was longer in patients with very low COI (8.4 vs. 5.6 d for very high COI patients, P <0.001) and those with public insurance (7.4 vs. 6.1 d in those with private insurance, P =0.001). Time to MRI was also longer in patients with very low COI (mean 18.6 vs. 11.2 d in the very high group, P <0.001) and those with public insurance (mean 17.4 d vs. 12.5 d in those with private insurance, P <0.001). Time to initial PT evaluation was longer in patients of very low COI (67.0 d vs 39.4 in the very high group, P =0.02) and in patients with public insurance (49.5 vs 47.5 d in those with private insurance, P =0.03).</p><p><strong>Conclusion: </strong>Neighborhood resources and insurance are associated with statistically significant delays across multiple phases of care for pediatric patients with first-time patellar dislocation. The specific mechanisms underlying these disparities and the clinical significance of these delays require further evaluation. Efforts should be made to develop interventions that address these barriers and providers should be aware of these inequities.</p><p><strong>Levels of evidence: </strong>Level III (retrospective comparative study).</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e841-e846"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248461","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}