Journal of Pediatric Orthopaedics最新文献

{"title":"Evaluation of Foot Osteotomies for Treating Residual Clubfoot Deformities in Ambulatory Children With Arthrogryposis.","authors":"Sadettin Ciftci, Anuj Gupta, Chris Church, John Henley, Maureen Donohoe, Freeman Miller, L Reid Nichols","doi":"10.1097/BPO.0000000000002956","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002956","url":null,"abstract":"<p><strong>Introduction: </strong>Clubfoot is the most common deformity seen in children with arthrogryposis. The primary method of treatment for this deformity is serial casting, which has a greater frequency of incomplete correction and recurrence than in idiopathic clubfoot. For both primary and recurring cases, surgical treatments vary from soft-tissue releases to talectomy. This research aimed to evaluate the effectiveness of bony surgical procedures in correcting clubfoot in ambulatory children with arthrogryposis.</p><p><strong>Methods: </strong>The study retrospectively examined ambulatory children with arthrogryposis, all of whom had at least 1 osteotomy procedure on their clubfoot. The treatment's effectiveness was assessed using passive range of motion (PROM), dynamic foot pressure, and the pediatric outcomes data collection instrument (PODCI) utilizing paired t tests. The frequency of subsequent bone surgeries following the initial operation was documented.</p><p><strong>Results: </strong>The study reviewed 20 children who had 49 surgical procedures performed on 24 feet at age 15.1±4.5 years. PROM revealed enhanced ankle dorsiflexion and forefoot abduction (P<0.05). In addition, evaluating dynamic foot pressure, coronal plane pressure index (CPPI), and the timing of heel rise demonstrated significant improvement (P<0.05). PODCI demonstrated improvement in transfer basic mobility (from 80.57±17.31 to 86.50±13.46) and global function (from 69.64±15.03 to 74.50±13.91) (P<0.05). Pain (from 69.58±25.39 to 79.21±26.57; P=0.067) and happiness (from 70.68±27.66 to 79.32±20.02; P=0.052) also improved and approached statistical significance. Moreover, a CPPI of <-94 was found to be predictive for suggesting the necessity of external fixator use according to the receiver operating characteristic analysis done based on our findings (area under the curve: 0.79, P=0.0007). Two children required an additional procedure at 26-months and 37-months postindex surgery because of residual equinus deformity and insufficient correction of forefoot adduction, respectively.</p><p><strong>Conclusion: </strong>This research highlights the substantial role surgical procedures can play in improving ankle PROM, hindfoot-forefoot alignment, dynamic foot position, and functional mobility in children with clubfoot secondary to arthrogryposis. It establishes a basis for future inquiries to delve into the longevity of these benefits and the overall outcomes.</p><p><strong>Level of evidence: </strong>Level III-retrospective study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700661","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":"Pathway for the Differential Diagnosis of Obstetrical Brachial Plexus Palsy.","authors":"Kyoko Okuno, Hidehiko Kawabata, Daisuke Tamura, Chikahisa Higuchi","doi":"10.1097/BPO.0000000000002957","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002957","url":null,"abstract":"<p><strong>Background: </strong>Obstetrical brachial plexus palsy (OBPP) is a common birth injury, generally presenting as upper limb paralysis at birth. While diagnosis is straightforward when associated with known risk factors, misdiagnoses can nevertheless occur. This study aimed to elucidate the process of differential diagnosis for OBPP by analyzing cases of suspected OBPP, ultimately diagnosed with other conditions.</p><p><strong>Methods: </strong>We reviewed the electronic medical records of patients under 1 year of age presenting with suspected or previously diagnosed OBPP at 2 tertiary childrens' centers in Osaka between 1994 and 2021. Cases were divided into the OBPP and non-OBPP groups, according to the final diagnosis, for comparison of demographic data and physical findings, to determine the clinical course that could be used to differentiate non-OBPP from OBPP.</p><p><strong>Results: </strong>Of the 414 enrolled cases, 387 (93%) were confirmed as OBPP, while 27 (7%) were diagnosed with other conditions. Statistically significant differences were found in gestational age, birth weight, and age of first visit, between the 2 groups, although these were not clinically meaningful for differential diagnosis. Shoulder dystocia was observed in 54% of OBPP cases, but not in non-OBPP cases. The key characteristics of OBPP included paralysis from birth, paralysis following an anatomic distribution, and paralysis that gradually improved without worsening. Conversely, joint contracture immediately after birth was a key indicator for ruling out OBPP. Using these criteria, 24 of 27 suspected cases were excluded from OBPP diagnosis. Of the remaining 3 cases, spinal cord infarction was detected on MRI in 1 case. In the remaining 2 cases, although normal MRI and surgical findings could rule out OBPP, a definite diagnosis could not be made.</p><p><strong>Conclusions: </strong>This study highlights that accurate OBPP diagnosis requires careful verification of specific characteristics. If these characteristics are not met, OBPP becomes less likely, and diagnostic uncertainty persists. An MRI of the brachial plexus is needed in such cases.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692410","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":"Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version.","authors":"Benjamin Yao, Don Li, Jonathan Cui, Kira L Smith, Vineet Tyagi, Joseph B Kahan, Allen Daniel Nicholson, Brian G Smith, Raymond Liu, Daniel Roy Cooperman","doi":"10.1097/BPO.0000000000002920","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002920","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of the femoral version can be challenging in the operating room. We evaluated if an observer can reliably and accurately determine when a femoral neck is parallel to the floor with a modified C-arm technique. We compared this technique to the previously reported modified Ogata-Goldsand technique for determining the intraoperative femoral version.</p><p><strong>Methods: </strong>To evaluate if an observer can determine when the femoral neck is level to the ground, 72 cadaveric femurs were photographed laterally at the proximal femur with the bone rotated to simulate a version ranging from -20 degrees to +20 degrees in 5-degree increments. These were arranged in a grid layout and validated through 3-fold randomization and blinding. Five investigators selected the orientation they believed to be closest to the neutral (0 degrees) femoral version. Then, 4 full-size cadavers were examined in a surgical suite. The femoral version of each full-size femoral cadaver was estimated utilizing the modified C-arm technique versus the modified Ogata-Goldsand technique, with the Kingsley and Olmsted technique used as the widely accepted standard to measure the femoral version.</p><p><strong>Results: </strong>In determining the neutral femoral neck position, observers were able to determine 0 degrees of version accurately, with the average deviation being 4.4 ± 2.4 degrees. The modified C-arm technique produced an average measurement deviating 3.2 ± 4.2 degrees from the true value. The modified Ogata-Goldsand technique had an average measurement deviation of 2.3 ± 2.6 degrees from the true angle. The modified C-arm technique had an intraclass correlation coefficient of 0.82 for different observers and 0.81 when compared to the Kingsley and Olmsted method as the standard, versus 0.72 and 0.90 for the modified Ogata-Goldsand technique.</p><p><strong>Conclusions: </strong>Observers can accurately perceive when a femoral neck is parallel to a virtual floor, supporting the inclusion of this parameter in the modified C-arm technique. Utilization of the modified C-arm technique is comparable to the modified Ogata-Goldsand technique.</p><p><strong>Clinical relevance: </strong>The relative simplicity of the modified C-arm technique versus the modified Ogata-Goldsand technique makes the modified C-arm technique a reasonable additional option for measuring intraoperative femoral version.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700570","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":"Intermediate Duration Outcomes of Surgical Management for Chronic Exertional Compartment Syndrome in Adolescents and Young Adults: The Mubarak Fasciotome.","authors":"Katherine D Wilson, James D Bomar, Eric W Edmonds","doi":"10.1097/BPO.0000000000002924","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002924","url":null,"abstract":"<p><strong>Objective: </strong>Chronic exertional compartment syndrome (CECS) poses challenges in diagnosis and management, particularly in young athlete populations. Current surgical approaches have been successful after failed conservative management, but with only short-term follow-up detailed in the literature. This study aimed to evaluate intermediate outcomes (>2 y) of surgical management for CECS in adolescents and young adults using the Mubarak fasciotome, with attention to complications and patient-reported outcomes.</p><p><strong>Methods: </strong>A retrospective review of patients identified over a 13-year period who underwent lower extremity fasciotomy was performed. Those with CECS were included based on the history of lower extremity symptoms and elevated intracompartmental pressure readings meeting Pedowitz criteria. Fasciotomy was performed with the Mubarak fasciotome under general anesthesia. Single-incision approaches were used for anterior/lateral compartments, and/or a medial incision for posterior compartments. Patients received postoperative therapy and underwent patient-reported outcomes assessment, including MARX and SANE scores, and pain ratings at various time points and final follow-up. Descriptive statistics were calculated using SPSS.</p><p><strong>Results: </strong>We identified 6 patients (10 limbs) undergoing fasciotomy for CECS with a mean follow-up of 7.2 years (range: 2 to 12.5 years). Following surgery, patients reported significant improvements in pain, with mean scores decreasing from 7.7 to 1.5. MARX scores indicated a return to high physical activity, with a mean of 8.7. SANE scores for activities of daily living and athletics were high, indicating functional recovery. Yet only 66% of patients returned to their original sport or a comparable activity level. No major complications were noted.</p><p><strong>Conclusion: </strong>The Mubarak fasciotome for CECS surgery in adolescents and young adults resulted in favorable intermediate outcomes that persist throughout the athlete's career, including pain reduction, functional improvement, and high satisfaction. This minimally invasive technique offers a promising alternative to traditional fasciotomy when careful attention is placed on fasciotome placement to avoid nerve injury.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692409","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":"Stability of Idiopathic Lumbar Curves During Growth in Pediatric Patients After Instrumented Isolated Thoracic Fusion.","authors":"Jake H Goldfarb, Edward M Barksdale, Scott J Luhmann, Brian A Kelly, Kirsten Brouillet, Simon Y Tang, Blake K Montgomery","doi":"10.1097/BPO.0000000000002948","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002948","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated thoracic fusion (ITF) for idiopathic scoliosis preserves lumbar segment motion but risks lumbar curve progression. This study examined if Lenke classification, residual disc wedging, or tilting at the lowest instrumented vertebrae (LIV) are associated with lumbar curve progression or adding-on after ITF.</p><p><strong>Methods: </strong>A retrospective analysis of idiopathic scoliosis patients aged 8 to 12 years treated with primary ITF was conducted. Inclusion criteria were a diagnosis of idiopathic scoliosis, LIV T10-L1, and ≥2 years of postoperative follow-up. Growth, Lenke classification, lumbar magnitude, angle of disc wedging below the LIV, and LIV tilt were assessed preoperatively, at 6 weeks postoperative, and at final follow-up. Standard descriptive statistics and repeated measures ANOVA were performed, with significance set at P<0.05.</p><p><strong>Results: </strong>Fifty-seven patients were included, with a mean follow-up of 4.6 years (2 to 12 y). At surgery, 67% (38 patients) were Risser 0. There was no significant lumbar curve increase from the first (24 degrees±12) to the final follow-up (22 degrees±14, P=0.21). Patients with a lumbar curve ≥30 degrees at first follow-up (n=16) also showed no increase in curve magnitude (40 degrees±8 at first follow-up vs. 37 degrees±17 at final follow-up, P=0.47). Disc wedging ≥5 degrees and LIV tilt ≥5 degrees were not associated with lumbar curve progression (29 degrees±14 at first follow-up vs. 28 degrees±17 at final follow-up for disc wedging, P=0.52; and 30 degrees±12 at first follow-up vs. 27 degrees±16 at final follow-up for LIV tilt, P=0.28) or adding-on. Lenke classification was not associated with lumbar curve progression. However, Lenke 3 and 4 patients had larger curves immediately after surgery and final lumbar curves ≥45 degrees. Of 9 Lenke 3 and 4 patients, 3 had lumbar curves ≥45 degrees at the final follow-up. No Lenke 1 or 2 patients (0 out of 41) had lumbar curves ≥45 degrees at the final follow-up (P<0.01).</p><p><strong>Conclusion: </strong>In pediatric ITF patients, disc wedging and LIV tilt were not associated with adding-on or lumbar curve progression.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649466","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":"Incidence and Risk Factors for Steroid-associated Osteonecrosis in Children and Adolescents: A Systematic Review of the Literature.","authors":"Taylor Johnson, Hiba Naz, Vanessa Taylor, Saima Farook, Grady Hofmann, Kathryn Harbacheck, Nicole S Pham, Stephanie M Smith, Karen Chao, Tzielan Lee, Stuart Goodman, Kevin Shea","doi":"10.1097/BPO.0000000000002919","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002919","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Steroid-associated osteonecrosis in pediatric patients with inflammatory and oncologic disease is an uncommon yet debilitating condition causing significant functional disability. Pediatric orthopaedic surgeons encounter this population during stages in which surgical intervention may be necessary for joint preservation. Various risk factors for steroid-associated osteonecrosis have been suggested, but a comprehensive systematic review of the literature has not been performed. The purpose of this systematic review is to investigate incidence and risk factors for steroid-associated osteonecrosis in pediatric, adolescent, and young adult patients to help guide clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review of the literature according to the preferred reporting items for systematic reviews and meta-analyses guidelines. MEDLINE, Embase, PubMed databases, and the Cochrane Central Registry of Controlled Trials were used to search for studies assessing risk factors for osteonecrosis in patients 0 to 21 years of age with systemic corticosteroid exposure. Two reviewers independently screened titles, abstracts, and full texts of retrieved studies for inclusion. Quality assessment of retrospective and prospective nonrandomized case-control and cohort studies was completed using the MINORS criteria. Outcomes and variables of interest included reported incidence and demographic, clinical, radiographic, and genetic risk factors for steroid-associated osteonecrosis. Reported statistics were deemed significant if P &lt;0.05. Due to heterogeneous and limited reporting, data were not combined in a meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The literature search revealed 895 articles and 37 articles were included. Of the included studies, 47% were retrospective cohort studies, and 39% were prospective cohort studies. There were 3 randomized controlled trials included. of the included studies, 95% were conducted in patients with leukemia and/or lymphoma. The overall prevalence of steroid-associated osteonecrosis ranged from 1% to 39%. Osteonecrosis was diagnosed with a mean or median of 1 to 2 years after the start of steroid therapy, and the most frequently involved joints were knees, followed by hips. Age older than 10 years, female gender, greater body mass index, and white and non-Hispanic race were the most reported risk factors for steroid-associated osteonecrosis. Core decompression was a frequent operative treatment with variable improvement in outcomes. For pediatric leukemia patients, those stratified as High risk and Intermediate risk were at the greatest risk for steroid-associated osteonecrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This systematic review summarizes specific risk factors and demographics of steroid-associated osteonecrosis and helps lay the foundation for future studies to delineate the causal role of risk factors and guides clinical decision-making for current an","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615527","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":"Validation of Parental Reports in Assessing Idiopathic Toe Walking Using Quantitative In-Shoe Device Measurements.","authors":"Logan Morrison, Susan Sienko, Mark McMulkin, Bruce MacWilliams, Jon Davids, Paige Lemhouse, Jeremy Bauer","doi":"10.1097/BPO.0000000000002950","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002950","url":null,"abstract":"<p><strong>Background: </strong>Toe walking is prevalent among children, affecting 5% to 24% of the pediatric population. Clinicians rely on parental reports of frequency of toe walking to guide clinical decision making and outcomes assessment. However, recall accuracy and differing environments challenge the reliability of parental reports. This study aims to validate parental reports against quantitative in-shoe device measurements (NURVV/RUN).</p><p><strong>Methods: </strong>Twenty children with persistent idiopathic toe walking (ITWp) (mean age: 9.6y; 13 males, 7 females) from 8 pediatric orthopaedic specialty care sites participated in this multicenter study. Parents assessed toe walking frequency using a 6-point scale, while children wore NURVV/RUN insoles for 8 hours/day over 7 days. Insole sensors recorded foot strike patterns (rearfoot, midfoot, and forefoot), which were classified using the same severity scale. Agreement between parental reports and NURVV data was assessed using weighted Kappa statistics (P<0.05).</p><p><strong>Results: </strong>Before intervention, children with ITWp exhibited daily walking patterns: 61.7% forefoot, 15.3% midfoot, and 22.8% hindfoot contact. Agreement analysis showed substantial agreement (k=0.688, P<0.001) for combined forefoot and midfoot contacts and fair agreement (k=0.381, P<0.005) for isolated forefoot contact.</p><p><strong>Conclusion: </strong>Parental reports of toe walking prevalence in their children are relatively accurate, supporting their use in clinical management. However, quantitative in-shoe devices provide a more objective and quantitative understanding of ITWp frequency and have the potential to guide clinical decision-making and outcomes assessment children with ITWp.</p><p><strong>Level of evidence: </strong>Level II-diagnostic study. See instructions to authors for a complete description of levels of evidence.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615793","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":"Similar Return-to-Sports After Anterior Cruciate Ligament Reconstruction With or Without Meniscal Repair in Skeletally Immature Patients: A Prospective, Comparative Cohort Study.","authors":"Győző Lehoczky, Clara Flumian, Jerome Sales de Gauzy, Franck Accadbled","doi":"10.1097/BPO.0000000000002912","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002912","url":null,"abstract":"<p><strong>Background: </strong>Pediatric anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients is still controversially debated, with several gaps in its literature. More information is needed about the role of concomitant meniscal injuries in postoperative outcomes and return to pre-injury sports level (RTS).</p><p><strong>Methods: </strong>Fifty skeletally immature patients who underwent ACLR were enrolled prospectively: 21 had meniscal injury additionally, and 29 did not. Patients were assessed with Tegner, Lysholm, Pedi-IKDC, and subjective knee value (SKV) scores presurgery and 6, 12, and 24 months postoperatively. The primary outcome was RTS at 24 months. Secondary outcomes were the 24-month clinical results and the mapping of prognostic factors to RTS in the meniscal injury group. Logistic regression model to estimate OR [95% CI], t test for parametric and Wilcoxon test for nonparametric variables (comparisons of 2 independent groups) were used, as well as t test or Wilcoxon test for paired data, according to the distribution of differences (postoperative-preoperative, paired groups) were used.</p><p><strong>Results: </strong>Out of 50 patients with a mean age of 13.2 years (range 9 to 16), the meniscal injury group had 67% RTS (12/18), and the isolated ACLR group had 75% RTS (18/24) after 24 months, which was not statistically significant, OR=0.67 [0.17 to 2.60], P=0.6. 24-month Lysholm scores were significantly higher in the isolated ACLR group (medians, 95.5 vs. 100.0, P=0.01). There was no significant difference between the groups of Tegner scores, Pedi-IKDC and SKV. No prognostic factors were found for worse RTS after meniscal injury.</p><p><strong>Conclusions: </strong>There is no difference in RTS 24 months after ACLR with or without meniscal injury in the skeletally immature patient.</p><p><strong>Level of evidence: </strong>Level of evidence I-prospective, comparative cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597165","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":"Anterior Hip Clearance in Residual Legg-Calvé-Perthes Disease.","authors":"Luke G Johnson, Honglin Zhang, Benjamin Joseph, Emily K Schaeffer, Kishore Mulpuri, David R Wilson","doi":"10.1097/BPO.0000000000002949","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002949","url":null,"abstract":"<p><strong>Background: </strong>The mechanical environment in the hip in people with residual Legg-Calvé-Perthes disease (LCPD) deformity is still poorly understood. Anterior impingement is thought to contribute to poor long-term outcomes such as early-onset osteoarthritis, but it has not been measured directly using imaging in high flexion. Our objective in this study was to determine the association between radiographic morphologic scores of LCPD deformity and reduced anterior hip clearance.</p><p><strong>Methods: </strong>We measured the anterior clearance (β-angle) of 20 LCPD-affected hips (17 patients) scanned in 4 functional postures using an upright open MRI scanner. Mixed effects models were used to describe the relationship between β, posture, and morphologic measures of deformity (Stulberg classification and Sphericity Deviation Score).</p><p><strong>Results: </strong>Hip β-angle was significantly associated with posture (P<0.001). Aspherical (Stulberg III to V) hips had lower β across all postures compared with spherical (Stulberg I to II) hips (difference in β = -39.1 degrees; 95% CI: -71.9 to -6.2 degrees; P=0.020). An increased SDS was strongly associated with reduced β in neutral hip postures (P=0.002, 0.005, respectively), but not with elevated adduction and internal rotation. Due to morphologic heterogeneity, 6 hips (out of 20 overall) did not fit the overall trend.</p><p><strong>Conclusions: </strong>Our results show an association between more severe radiographic deformity and a greater potential for anterior impingement, a known contributor to cartilage degradation. However, the large proportion of cases where morphologic deformity does not align with functional clearance suggests current radiographic measures of deformity may not be sufficient to predict long-term outcomes in every LCPD patient.</p><p><strong>Clinical relevance: </strong>(1) Hip joint asphericity in LCPD is associated with less anterior clearance and a greater potential for anterior impingement in high flexion postures. (2) Considering both morphologic and functional parameters may improve our understanding of the causes of pain and early-onset osteoarthritisin LCPD, as opposed to morphology alone.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586096","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":"All-Epiphyseal Versus Micheli-Kocher Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review.","authors":"Alexander Zakharia, Fares Al Katanani, Ahmed Hatem, Saihaj Dhillon, Prushoth Vivekanantha, Dan Cohen, Darren de Sa","doi":"10.1097/BPO.0000000000002953","DOIUrl":"https://doi.org/10.1097/BPO.0000000000002953","url":null,"abstract":"<p><strong>Background: </strong>Early physeal-sparing anterior cruciate ligament reconstruction (ACLR) is considered the optimal treatment method in the skeletally immature population to preserve the integrity of the knee joint while reducing the risk of growth disturbances and angular deformities. Contemporary treatment algorithms recommend the use of all-epiphyseal (AE) or Micheli-Kocher (MK) ACLR techniques in patients with considerable growth remaining. Nevertheless, no research exists comparing the 2 techniques. Therefore, the purpose of this review is to comprehensively compare postoperative outcomes and complication profiles following AE and MK ACLR in skeletally immature patients.</p><p><strong>Methods: </strong>A systematic search of Embase, Medline, and PubMed was conducted from inception to April 30, 2024. All studies reporting outcomes and/or complications following AE or MK ACLR were included. Screening and data abstraction were designed in accordance with PRISMA and R-AMSTAR guidelines.</p><p><strong>Results: </strong>Twenty-nine studies with 1177 patients were included. AE ACLR and MK ACLR yielded similar results for rates of return to preinjury level of activity (91.8% and 93.4%, respectively), negative pivot-shift (93.9% and 95.2%, respectively) and Lachman test grades (93.9% and 90.8%, respectively), IKDC subjective scores (94.0 and 93.6, respectively), ROM flexion (144.1 degrees and 136.3 degrees, respectively) and hyperextension (2.5 degrees and 3.1 degrees, respectively). AE ACLR yielded a greater risk of growth disturbances, angular deformities, and graft failures (1.5%, 1.3%, and 10.6%, respectively) but a lower risk of contralateral ACL tears (4.2%) relative to MK ACLR (0.0%, 0.0%, 6.6%, and 6.6%, respectively).</p><p><strong>Conclusions: </strong>Both AE and MK ACLR yield promising rates of RTS, substantially limit anteroposterior laxity, surpass IKDC thresholds for substantial clinical benefit, and regain fully functional ROM to comparable levels, though they yield marginally different complication profiles. However, the majority of the included studies were moderate-quality or low-quality evidence with high statistical heterogeneity. Therefore, no statistical conclusions regarding the differences in complication profiles can be drawn. Future randomized controlled trials or large prospective cohort studies should compare the efficacy and complication profile of QT autograft AE ACLR relative to MK ACLR.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573146","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}