Journal of Pediatric Orthopaedics最新文献

{"title":"Novel Use of the O-Arm Following Open Reduction of a Dislocated Hip for a Walking Age Patient Provides a Low-Radiation Alternative to CT.","authors":"Alexander Aretakis, Jordyn Adams, Rachael Martino, Patrick Carry, Jennifer Stickel, Nancy Hadley-Miller, Gaia Georgopoulos, Courtney Selberg","doi":"10.1097/BPO.0000000000003003","DOIUrl":"10.1097/BPO.0000000000003003","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of a dislocated hip at walking age includes open reduction (OR) with or without osteotomies of the pelvis and/or femur. Three-dimensional imaging, such as computerized tomography (CT), can be utilized postoperatively to determine femoral head position following cast placement. Alternatively, intraoperative 3D imaging (O-arm) may be used for the same purpose. Disadvantages of CT include limited access to the patient's airway and high radiation dose. The current study aimed to determine the ability of O-arm imaging to visualize femoral head position following surgical treatment of a dislocated hip, and compare radiation dosage between CT and O-arm.</p><p><strong>Methods: </strong>Thirteen patients (16 hips) with a dislocated hip at walking age who underwent OR with pelvic ± femoral osteotomies at a single institution were retrospectively reviewed. All patients underwent CT or O-arm evaluation following surgery and spica cast application. Total radiation dose per kilogram was compared between the CT (n=8 hips) and O-Arm 14 (n=8 hips) groups. Radiographic parameters and complication rates were analyzed. Image quality was blindly assessed by 3 fellowship-trained pediatric orthopedic surgeons with hip expertise.</p><p><strong>Results: </strong>The mean age was 4.68 years (range: 3.1-7.8) in the CT group and 4.31 (range: 1.2-7.5) in the O-Arm group. The average radiation dose from the O-arm was lower than CT (4.51 19 mGy/kg vs. 6.12 mGy/kg, P =0.37). Five hips in the CT cohort were scanned post-extubation. All surgeons agreed that femoral head position was adequately visualized in all images from both groups. No patient in either group required a cast change post-scanning due to a malpositioned femoral head.</p><p><strong>Conclusion: </strong>The O-arm is a reasonable alternative to CT following surgical treatment of a dislocated hip. It may decrease radiation dose and provides adequate visual information to determine femoral head position following surgical intervention and casting. Utilization of the O-arm keeps the patient in the operating room during the study, allowing for immediate revision of the cast position or revision reduction if necessary, while maximizing access to the patient's airway and minimizing risk for adverse anesthetic events.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"474-480"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675062","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":"A New Skeletal Maturity Methodology for Children With Legg-Calve-Perthes Disease.","authors":"William Woodhams, K Aaron Shaw, Michael O'Sullivan, Chanhee Jo, J Anthony Herring","doi":"10.1097/BPO.0000000000003001","DOIUrl":"10.1097/BPO.0000000000003001","url":null,"abstract":"<p><strong>Background: </strong>Legg-Calve-Perthes disease (LCPD) outcomes are largely determined by their age and maturity at onset. In LCPD, there is a known association with delayed skeletal maturity of up to 1.9 years in affected children based on maturity assessment with the Greulich and Pyle (GP) maturity atlas. The GP atlas is the standard for assessing bone age but requires obtaining a separate radiograph of the hand. A new methodology for assessing skeletal maturation in comparison to the GP bone age in children with LCPD was sought.</p><p><strong>Methods: </strong>A retrospective review of a prospective, multicenter study of patients with LCPD treated from 1984 to 1991 and followed to skeletal maturity was performed. Patients were included if they had LCPD diagnosed on anteroposterior pelvis radiographs that included the contralateral hip who had bone age radiographs obtained at the time of presentation. Patients were excluded if they presented with bilateral LCPD, the contralateral hip was not visualized on their presenting radiographs, they lacked bone age radiographs at the time of presentation, or they presented outside the range for the Optimized Oxford system. A formula using the greater trochanteric height to femoral head diameter ratio and patient sex (GT+ Sex) for predicting GP bone age was developed. The GP and GT+ Sex bone ages were compared with the chronologic age (CA) to determine the mean discrepancy.</p><p><strong>Results: </strong>Seventy-one patients were included (mean 9.5 ± 1.2 y at presentation, 42.2% females). Skeletal maturity assessment by the GP bone age method demonstrated a mean discrepancy of 1.4 years younger than CA (95% CI: 1.01-1.76 y). GT+ Sex bone age assessment demonstrated a mean discrepancy of 1.4 years younger than CA (95% CI: 1.03-1.75 y). The GP bone age was a mean of 0.00 years different than the GT+ Sex assessment bone age (95% CI: -0.3 to 0.3 y). The GT+ Sex assessment bone age correlated significantly with GP bone age ( R =0.89, P <0.0001). Male patients had a significantly younger GP bone age relative to CA compared with female patients (1.8 vs. 0.86 y, P = 0.02); however, there were fewer sex differences in the GT+ Sex assessment bone age relative to CA (male, 1.77 y younger vs. 1.12 y younger; P = 0.01).</p><p><strong>Conclusions: </strong>The GT+ Sex skeletal maturity assessment system in children with LCPD significantly correlated with the GP bone age system when compared. The GT+ Sex assessment may provide an assessment of the true bone age in LCPD patients without the need for hand radiographic imaging studies.</p><p><strong>Level of evidence: </strong>Level III-retrospective review and analysis.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"481-484"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015935","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":"Selecting Patient-Reported Outcome Measures for Pediatric Upper Extremity Function: A Systematic Review.","authors":"Miguel Fiandeiro, Holly Cordray, John R Vaile, Sarah L Struble, Manisha Banala, Meagan Pehnke, Apurva S Shah, Shaun D Mendenhall","doi":"10.1097/BPO.0000000000002991","DOIUrl":"10.1097/BPO.0000000000002991","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures (PROMs) are important in understanding pediatric upper extremity outcomes. Little guidance is available to help clinicians select appropriate PROMs, which are often used beyond their scope of validation. This systematic review analyzed the content, readability, and psychometrics of existing PROMs of pediatric upper extremity function.</p><p><strong>Methods: </strong>PubMed, Embase, CINAHL, and Scopus were searched. Eligible studies evaluated psychometrics of global upper extremity function PROMs in pediatric patients. Following PRISMA guidelines, 2 reviewers screened studies, extracted data, assessed risk of bias, and rated psychometrics using the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Content was analyzed using the Occupational Therapy Practice Framework and well-established readability indices.</p><p><strong>Results: </strong>Reviewers screened 2513 studies; 44 reports on 9 PROMs were included. The Pediatric Outcomes Data Collection Instrument (PODCI) showed strong evidence of validity and responsiveness for the widest range of conditions, covered all upper extremity functional categories and occupational domains, and easily achieved the American Medical Association's readability standards. The Upper-Extremity Cerebral Palsy Profile of Health and Function Computerized Adaptive Test (UE-CP-PRO) showed stronger psychometrics for cerebral palsy and brachial plexus birth injury. The Infant Motor Activity Log (IMAL) is the strongest option for infants under 2 years old. The Patient-Reported Outcomes Measurement Information System Upper Extremity Module (PROMIS-UE) has strong potential but requires more diagnosis-specific validation.</p><p><strong>Conclusions: </strong>We recommend the PODCI, UE-CP-PRO, and IMAL as outlined. We also urge further validation of the PROMIS-UE computerized adaptive test and short form as shorter, more customizable alternatives to the PODCI.</p><p><strong>Level of evidence: </strong>Level II-systematic review of level I and level II studies.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"508-518"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001147","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":"Financial Implications Associated With the Use of Waterproof Casting Material in Pediatric Patients.","authors":"Alexis L Clifford, Aaron Jennings, Catalina Baez, Emily Boschert, Stephanie Ihnow, Jessica McQuerry","doi":"10.1097/BPO.0000000000002978","DOIUrl":"10.1097/BPO.0000000000002978","url":null,"abstract":"<p><strong>Background: </strong>Waterproof casting materials have been demonstrated to improve the patient experience through subjective patient satisfaction and discomfort measures. However, the increased cost of raw materials has limited its wide adoption as a standard of care. The purpose of this study was to compare unplanned healthcare utilization and the financial implications of using waterproof versus cotton liners for nonoperative fractures in pediatric patients.</p><p><strong>Methods: </strong>A single institution retrospective chart review analyzed 950 pediatric patients with 977 nonoperative upper and lower extremity fractures who received either standard or waterproof cast liners from January 1, 2020, to December 31, 2021. Generalized logistic and linear models were used to determine whether cast liner material was associated with recasting and to what extent this was associated with the total cost of casting materials over the course of fracture care. Incremental Cost Effectiveness Ratio (ICER) was calculated based on casting material costs and the likelihood of unplanned cast changes between groups.</p><p><strong>Results: </strong>Of the 977 castings included, 804 (82.3%) had standard casts, and 173 (17.7%) had waterproof casts placed as initial treatment. The proportion of casts requiring recasting was significantly higher in patients with standard casts (43.3%) compared with those with waterproof casts (11.6%) ( P <0.001). Similarly, the rate of unplanned recasting was higher in the standard cast group (23.8%) than in the waterproof cast group (7.5%) ( P <0.001). When accounting for factors affecting cost in nonoperative fracture care, casts with waterproof lining were, on average, $16.46 more expensive than standard ( P <0.001). The ICER for waterproof cast liners was $81.42.</p><p><strong>Conclusions: </strong>The findings of this study show that standard cotton liners are associated with increased unplanned recasting rates. While only accounting for raw material costs to the provider, waterproof liner material costs were greater than standard. However, we argue that waterproof casting is cost-effective when considering other associated costs with unplanned recasting, such as application time and additional visits.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e693-e700"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010268","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":"High Preoperative Body Mass Index Is Associated With Implant Breakage in Patients Treated With Magnetically Controlled Growing Rods for Early-onset Scoliosis.","authors":"Antti J Saarinen, Lindsay Andras, Oheneba Boachie-Adjei, Patrick Cahill, Tenner Guillaume, Brian Snyder, Paul Sponseller, Peter Sturm, Michael Vitale, Ilkka Helenius","doi":"10.1097/BPO.0000000000002988","DOIUrl":"10.1097/BPO.0000000000002988","url":null,"abstract":"<p><strong>Introduction: </strong>Magnetically controlled growing rods (MCGRs) have become the current standard in the growth-friendly treatment of patients with early-onset scoliosis (EOS). MCGRs allow noninvasive lengthenings with external lengthening device and reduce the need for surgical procedures. The association of preoperative body mass index (BMI) and the outcomes of the MCGR treatment is not well known.</p><p><strong>Methods: </strong>Prospectively collected international database was reviewed for EOS patients treated with MCGR. Patients without preoperative BMI data or follow-up <2 years were excluded. Patients were classified as healthy weight, overweight, and underweight using Centers for Disease Control and Prevention (CDC) growth charts. Quality of life was assessed using EOSQ-24. Results were analyzed from the 2-year follow-up.</p><p><strong>Results: </strong>A total of 663 patients were categorized into underweight (n=91), healthy weight (n=417), and overweight (n=155) groups. There were no significant differences in major curve correction or thoracic height increase among the BMI groups, irrespective of etiology. Distribution of BMI categories differed significantly by etiology ( P =0.009), with lower healthy weight proportions in the syndromic group (92/167, 55%) compared with idiopathic (131/177, 74%) (adjusted P =0.004), and a higher underweight proportion in neuromuscular (36/244, 15%) compared with idiopathic (15/177, 8.5%) (adjusted P =0.044). Higher BMI z-scores were associated with an increased incidence of complications, including implant-related complications (RR 1.1, 95% CI 1.0-1.3) and implant breakage (RR 1.3, 95% CI 1.1-1.7). Healthy weight and underweight patients experienced lower overall complication rates compared with overweight patients. Implant-related complications were less common in underweight patients compared with overweight patients (RR 0.45, 95% CI 0.20-0.90). Higher BMI z-score was a significant predictor of implant breakage, whereas preoperative major curve, kyphosis, and etiology were not. EOSQ-24 scores did not differ significantly among BMI groups, and changes in scores were comparable across groups during follow-up.</p><p><strong>Conclusion: </strong>BMI status did not influence curve correction, thoracic height increase, or EOSQ-24 outcomes in early-onset scoliosis patients. However, the higher incidence of implant breakage in overweight patients suggests that elevated BMI should be carefully considered when planning treatment.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"492-498"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging in Pediatric Pyogenic Musculoskeletal Infections: Comment on the Study by Hunter et al.","authors":"Sitanshu Barik, Vikash Raj, Vishal Kumar","doi":"10.1097/BPO.0000000000003019","DOIUrl":"10.1097/BPO.0000000000003019","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e752"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127895","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":"Age and Sex-based Frequency of Graft and Technique Used in Pediatric Anterior Cruciate Ligament Reconstruction: A Multicenter Study.","authors":"Emily L Niu, Matthew R Schmitz, V Claire Clark, Caroline C Podvin, Theodore J Ganley, Daniel W Green, Michael G Saper, Donna M Pacicca, Matthew D Ellington, Philip L Wilson, Kevin G Shea, Henry B Ellis","doi":"10.1097/BPO.0000000000002983","DOIUrl":"10.1097/BPO.0000000000002983","url":null,"abstract":"<p><strong>Objective: </strong>As the incidence of pediatric and adolescent anterior cruciate ligament (ACL) reconstruction rises, knowledge of contributing factors to decision-making regarding graft selection and technique is important. Variations in ACL reconstruction (ACLR) regarding graft choice, tunnel placement, and technique may depend on patient age, sex, and surgeon preference. The purpose of this study was to review technique and graft source of pediatric ACLR based on these factors.</p><p><strong>Methods: </strong>A prospective, surgeon-driven, multicenter quality/performance improvement registry was queried to evaluate graft selection and technique in primary ACLR. Data regarding ACLR in those 19 years or younger performed by 23 contributing surgeons was collected. Frequency of graft use and surgical technique were stratified by patient age and sex.</p><p><strong>Results: </strong>A total of 3968 ACLRs were included, with an average age of 15.1 years (range: 6 to 19 years), 53.7% males, with a majority using autograft (97.4%). Of ACLR, 82.9% of those under age 11 used iliotibial band (ITB) graft and extra-articular extraphyseal technique. ITB use was similar in females (80.0%) and males (83.5%). For ages 11 to 15, soft tissue quadriceps (STQT, 38.1%), hamstring (HS, 23.5%), and ITB (16.6%) were most frequently used. STQT use was 40.1% in females and 36.2% in males. ITB was used more in males than females (25.6% and 7.4%, respectively). After age 15, STQT (30.9%), bone patellar tendon bone (BTB, 27.8%), and HS (24.8%) were most common. STQT was the dominant graft in females (35.5%) in this group, while BTB (32.3%) was the most frequent in males. When comparing the early (2018 to 2020) to the late (2020 to 2022) portion of collection period, quadriceps tendon autograft use increased from 30.5% to 48.0%.</p><p><strong>Conclusions: </strong>Variation exists in graft selection and technique for pediatric and adolescent ACLR. ITB, extra-articular extraphyseal technique, is favored in patients under age 11. Quadriceps autograft use has increased in ACLR in this patient population in recent years.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e663-e670"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001264","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":"A Comparison Study of Major and Minor Complications After Inpatient Versus Outpatient Pediatric Brachial Plexus Surgery: A Preliminary Report.","authors":"Kirby W Bonvillain, Eliana B Saltzman, Julia C Mastracci, Katherine D Drexelius, Andrew C Herman, Kennedy K Gachigi, Bryan J Loeffler, Peter M Waters, Raymond Glenn Gaston","doi":"10.1097/BPO.0000000000002979","DOIUrl":"10.1097/BPO.0000000000002979","url":null,"abstract":"<p><strong>Background: </strong>Interest in outpatient surgery has grown secondary to emphasis on the delivery of efficient, high-quality care. This study sought to compare 90-day complications between pediatric patients undergoing outpatient versus inpatient brachial plexus nerve surgery.</p><p><strong>Methods: </strong>A single institution database was queried for primary exploration and treatment of brachial plexus birth injuries from 2011 to 2022. Standard demographic data and the American Society of Anesthesiologists (ASA) classification were recorded. Operative procedures included neurolysis, nerve transfers, and/or nerve grafting. Outcome measures included operative time, postoperative emergency department (ED) visits, unplanned readmissions, and reoperation within 90 days.</p><p><strong>Results: </strong>The query yielded 19 patients. The mean age in the outpatient cohort was 7.1 months, and 5.9 months in the inpatient cohort. All patients were ASA I or II. The nerve injury levels, based on physical examination and intraoperative findings, revealed more global injuries in the inpatient group ( P = 0.182). There was a significant difference ( P = 0.001) in procedure length, with an average of 174.9 minutes for the outpatient cohort compared with 279.3 minutes for the inpatient cohort. This represents more extensive reconstructive surgery with concomitant nerve transfers and nerve grafting required for the inpatient group. There were zero unplanned readmissions or reoperations. When comparing surgeries performed from 2011 to 2016 to those performed from 2017 to 2022, inpatient admission odds decreased by 92% (OR: 0.08, P = 0.045). Those who represented the ED had 3 times the odds of inpatient care compared with those with no ED representation (OR: 3.43, P = 0.33). There were 3 ED visits in the inpatient cohort. Two patients presented due to minor parental incisional concerns that required no further management. The ED visit in the outpatient cohort was due to an unrelated fever.</p><p><strong>Conclusions: </strong>Over time, criteria were established to guide decision-making as more surgeries were safely conducted outpatient with no difference in complications. In appropriately selected patients, such as those of ASA I and II status, outpatient brachial plexus surgery may be safe and considered value-based care.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort, nerve transfer, muscle transfer.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e733-e737"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675048","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":"Wait or Drill? Shared Decision-making in Adolescents With Stable Osteochondritis Dissecans of the Knee.","authors":"Magnolia Livingston, Sylvia Culpepper, R Carter Clement","doi":"10.1097/BPO.0000000000002989","DOIUrl":"10.1097/BPO.0000000000002989","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of stable juvenile osteochondritis dissecans (OCD) of the knee in adolescents is controversial. Traditionally, initial management has been nonoperative. However, early subchondral drilling is also a consideration to potentially reduce the recovery time because ∼50% of stable OCD lesions eventually require surgery after a period of failed nonoperative care. This study uses choice-based conjoint (CBC) analysis to explore patient and family preferences regarding initial nonoperative treatment versus early drilling.</p><p><strong>Methods: </strong>This study used a CBC survey using Sawtooth Software (Lighthouse Studio version 9.2.0) to collect demographic information and preferences on surgical scenarios. Anonymous participants were recruited through the Prolific crowdsourcing platform. Eligible participants were US residents over 18 years of age with children aged 12 to 17. Data were analyzed using Hierarchical Bayes and logistic regression to determine the importance of each attribute and correlate preferences with demographic variables.</p><p><strong>Results: </strong>Of the 474 participants, the highest importance was placed on minimizing treatment failure (46.3%), followed by the likelihood of needing surgery (22.4%), cost (11.8%), time on crutches (10.8%), and return to normal activities (8.7%). Simulation of surgical decision-making showed a strong preference for early surgery (90.8%) over conservative treatment (9.2%). Preferences varied slightly by demographics, with female participants valuing recovery time more and male participants prioritizing cost.</p><p><strong>Discussion: </strong>Our findings indicate a significant preference for early surgical intervention driven by concerns over treatment failure and the need for a future surgery with a second recovery period. Despite some demographic differences in attribute importance, no specific patient characteristic significantly influenced the overall treatment preference.</p><p><strong>Conclusion: </strong>Early drilling of stable OCD lesions of the knee is favored by most parents of adolescents, primarily to reduce the risk of future surgery/recovery. This preference underscores the importance of personalized treatment discussions and highlights the need for shared decision-making tools that incorporate individual patient values.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"451-457"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971215","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":"Intercondylar Notch Becomes Steeper After Transphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Knees.","authors":"Yoan Bourgeault-Gagnon, Leo A Pinczewski, Jefferson James Co, Lucy J Salmon, Justin P Roe","doi":"10.1097/BPO.0000000000002981","DOIUrl":"10.1097/BPO.0000000000002981","url":null,"abstract":"<p><strong>Background: </strong>Transphyseal anterior cruciate ligament (ACL) reconstruction can be a reliable and safe treatment for skeletally immature patients, with low reported rates of major growth disturbances. However, more subtle knee morphologic and radiologic characteristics, such as the α-angle (sagittal orientation of the notch roof) and posterior tibial slope, may theoretically be affected by this surgical technique and potentially represent risk factors for ACL graft tears. The objective of this study was to compare radiologic knee morphology characteristics between the operated knee and the paired contralateral knee in skeletally immature patients following transphyseal ACL reconstruction.</p><p><strong>Methods: </strong>This is a retrospective matched within-subject case-control study on 25 skeletally immature patients with a radiologic follow-up 9 or more months after a transphyseal anatomic ACL reconstruction. The α-angle, medial posterior tibial slope, mechanical hip-knee-ankle angle, and leg length were assessed with a biplane x-ray imaging system (EOS) with the nonoperative limb used as an internal control.</p><p><strong>Results: </strong>The mean chronological age of the cohort was 11.8 years (range: 8.3 to 15.0). The α-angle was a mean of 3.3 degrees (SD=5.1) smaller, or more vertical, on the surgical knee than on the contralateral knee at a median of 2.1 years [interquartile range (IQR)=0.3 to 4.0], with mean α-angles of 36.6 degrees (SD=6.6 degrees) and 39.9 degrees (SD=5.3), respectively ( P =0.002). Other radiologic parameters were not significantly different between sides. A post hoc analysis showed a median side-to-side difference in α-angles of -5.0 (IQR: -7.0 to -1.9) in males versus 0.6 (IQR: -4.3 to 3.8) in females ( P =0.009).</p><p><strong>Conclusion: </strong>Transphyseal anatomic single-bundle ACL reconstruction in skeletally immature patients is associated with a relative decrease in α-angle, or verticalization of the notch roof, after a median follow-up of 2 years. A greater impact in α-angle was observed in male patients.</p><p><strong>Level of evidence: </strong>Level III-prognostic case-control study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e671-e679"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159751","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}