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The article discusses a study to explain the demographics of pediatric and adolescent patients with a first-time patellofemoral dislocation and to determine predictors of recurrent instability. The results of the study indicated that almost half of patients with recurrent instability required surgical intervention to gain stability.

Background: Lateral tibial hemiepiphysiodesis is an accepted surgical treatment for skeletally immature patients with adolescent tibia vara. However, the results of this procedure are unpredictable. This study was conducted to identify the risk factors associated with failure of herniepiphysiodesis. Methods: We studied patients with adolescent tibia vara who were at least ten years of age, had open physes, had been treated with a lateral hemiepiphysiodesis, and had been followed for at least two years. The mechanical axis deviation, medial proximal tibial angle, and lateral distal femoral angle were measured on radiographs preoperatively, at six months postoperatively, and at the time of final follow-up. Failure was defined as a residual varus deformity requiring osteotomy or a mechanical axis deviation exceeding 40 mm (moderate or severe varus) at the time of final follow-up. Results: Forty-nine patients (forty-six male) with a total of sixty-four involved extremities met the inclusion criteria. The average age was 13.4 years, the average body mass index was 40.7 kg/m2, and the average duration of follow-up was 3.3 years. The lateral hemiepiphysiodesis was unsuccessful in 66% of the patients. In a multivariate Cox proportional hazards regression analysis, the variables associated with a higher risk of failure included an age of fourteen years or more (hazard ratio = 3.9, p = 0.0009) and a body mass index of ⩾45 kg/m2 (hazard ratio = 2.8, p = 0.01). Greater deformity at baseline as indicated by a smaller medial proximal tibial angle was also found to be a significant factor in the multivariate analysis (p = 0.03). Conclusions: Lateral herniepiphysiodesis may be a valuable treatment option for non-morbidly obese patients with less severe adolescent tibia vara, but it is likely to fail in older adolescents with a high body mass index and greater deformity. [ABSTRACT FROM AUTHOR]

Background: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This study was developed to examine the outcome of patients managed with a metal-backed, bone-ingrowth glenoid component as an alternative to a cemented component. Methods: The study group included eighty-three total shoulder arthroplasties with a metal-backed, bone-ingrowth glenoid component performed between 1989 and 1994. Seventy-four shoulders had a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points. Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102° preoperatively to 135° postoperatively; the mean external rotation increased from 27° to 56°. Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component loosening was seen in fifteen shoulders. Revision procedures were performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9% (95% confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%). Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Isolated meniscal tears in the skeletally immature patient are infrequent but well-recognized injuries. Although few studies have evaluated the pediatric and adolescent population, arthroscopic surgical repair remains the standard of care for patients in this age group with unstable meniscal tears. Purpose: To review our results of arthroscopic repair of isolated meniscal tears in pediatric and adolescent patients to further define future management of these injuries. Study Design: Case series; Level of evidence, 4. Methods: The records of all patients 18 years old or younger who underwent isolated meniscal repair between 1990 and 2005 were retrospectively reviewed. Forty-four patients (6 girls, 38 boys) with an average age of 15.8 years (range, 9.9-18.7 years) were included in this study, for a total of 45 isolated meniscal tears. Clinical examinations were performed, International Knee Documentation Committee forms were administered, and Tegner scores were determined at an average of 5.8 years (range, 2.5 months-13.8 years) postoperative follow-up. Three patients were lost to follow-up. Results: The clinical success rate of arthroscopic meniscal repair was 80% for simple tears, 68% for displaced bucket-handle tears, and 13% for complex tears. Seventeen menisci (38% overall) failed initial repair at a mean of 17 months (range, 3-61 months) postoperatively and underwent repeat arthroscopic surgery (15 partial meniscectomies, 2 rerepair). The average Tegner and International Knee Documentation Committee scores were 8 (range, 5-9) and 89.4 (range, 79-99), respectively, at the time of final follow-up. Risk factors for failure included complex tears and rim width greater than 3 mm. Conclusion: Clinically successful repair of an isolated meniscal tear in patients 18 years or younger was variable depending on tear type, with complex tears and rim width 3 mm or greater being negative prognostic factors. [ABSTRACT FROM AUTHOR]

Background: In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not. Methods: All skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation. Results: Ninety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014). Conclusions: Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays. Trial registration: ClinicalTrials.gov—NCT02412137, initial registration date April 2015 Level of evidence: III [ABSTRACT FROM AUTHOR]

Abstract: Linear morphea of the limb primarily affects children, and extracutaneous manifestations are common. Orthopedic surgeons are often essential in the care of patients with linear morphea, yet there are few reports outlining specific orthopedic complications in this population. We sought to improve the understanding of orthopedic complications in linear morphea of the limb. Between 1999 and 2014, 51 children were evaluated for linear morphea of an extremity. Twenty‐six (51%) had documented orthopedic manifestations. Outcome measures included limb length discrepancy, angular malalignment, limb atrophy, and orthopedic surgical intervention. Joint contractures were most common, affecting 88% of patients, followed by limb atrophy, angular deformity, and limb length discrepancy; 14% required surgical intervention. Despite the use of systemic immunosuppressive therapy in many patients, approximately half of patients with linear morphea of an extremity have orthopedic disease. Early orthopedist involvement is crucial to improve limb alignment and preserve function. [ABSTRACT FROM AUTHOR]

The article discusses the connection between meniscal and chondrial injuries in pediatric patients and delayed Anterior Cruciate Ligament (ACL) reconstruction surgery. For this study, 130 patients with the median age of 14 years who had ACL reconstructions were analyzed. The report suggest that early reconstruction should be carried out on pediatric ACL patients.

STUDY DESIGN.: Case control study. OBJECTIVE.: To determine complications associated with pedicle screw use and screw accuracy in children 10 years or younger. SUMMARY OF BACKGROUND DATA.: Pedicle screws are frequently used for the treatment of spine deformity in children, but, for young patients, this is only by physician-directed use. Thus, we sought to determine the rates of screw-related complications and screw malposition in patients 10 years or younger compared with a series of matched controls greater than 10 years of age. METHODS.: From 2000-2011, 265 screws were placed in 33 consecutive patients undergoing a total of 35 procedures for a variety of spine deformities. Mean age at surgery was 7 years (range, 2-10) with a mean time to follow-up of 3.3 ± 2.4 years. Congenital spine deformity was the most common surgical indication. Primary outcome measures were screw-related complication or return to surgery for screw malposition. Patients were matched by diagnosis/fusion level to 66 control patients greater than 10 years of age. Available computed tomographic scans in young children were reviewed to assess screw accuracy. RESULTS.: In patients 10 years or younger, 2 out of 265 screws (0.75%) resulted in a screw-related complication. No patient required revision surgery due to screw malposition. No patients older than 10 years in the matched controls had a screw-related complication or revision surgery due to screw malposition. Computed tomograpic data was available for 10 young patients, which was compared with data from the larger cohort of 81 older children. No difference was found in the rates of severe asymptomatic screw malposition, but moderate screw malposition was more common in the younger cohort. CONCLUSION.: In this limited series, 265 pedicle screws were placed in 33 patients 10 years or younger with 0.75% of pedicle screws resulting in a complication. The rates of screw malposition revealed on computed tomographic scan were similar to those of adolescent children. These data support the use of pedicle screws in children 10 years or younger for the treatment of complex spinal deformity. [ABSTRACT FROM AUTHOR]

Background: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This study was developed to examine the outcome of patients managed with a metal-backed, bone-ingrowth glenoid component as an alternative to a cemented component.Methods: The study group included eighty-three total shoulder arthroplasties with a metal-backed, bone-ingrowth glenoid component performed between 1989 and 1994. Seventy-four shoulders had a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points.Results: The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102 degrees preoperatively to 135 degrees postoperatively; the mean external rotation increased from 27 degrees to 56 degrees . Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component loosening was seen in fifteen shoulders. Revision procedures were performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9% (95% confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%).Conclusions: The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations.Level Of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]