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Objectives: This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR. Methods: A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT)techniques were used depending on patients' skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS)data and second surgeries were also obtained. Results: Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study. Conclusions: The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. [ABSTRACT FROM AUTHOR]

In 2006, the Centers for Disease Control and Prevention updated its recommendations for HIV testing of 4 population groups in health care settings: adults, adolescents, pregnant women, and newborns. Important components of the revised recommendations included opt-out routine HIV screening; eliminating prevention counseling for opt-out routine HIV screening; repeat HIV testing in the third trimester for all women at high risk for acquiring HIV and for women receiving health care in facilities and/or jurisdictions with high HIV burden; testing during labor and delivery for women with undocumented HIV status; and testing the newborn when the mother's HIV status is unknown. To assess the integration of these testing recommendations into state laws and to inform future recommendations, we researched and assessed statutes and regulations that addressed HIV testing in the 4 population groups in all 50 states and the District of Columbia in 2018. We then classified the laws, based on their consistency with the recommendations for each of the 4 population groups. Of 31 states and the District of Columbia that had relevant laws, all addressed at least 1 component of the recommendations. Although no state had laws that incorporated all the recommendations for all the population groups, 5 states (Delaware, Illinois, Louisiana, Maryland, and New Hampshire) had incorporated all the recommendations for adults and adolescents, and 4 states (Connecticut, Nevada, North Carolina, and West Virginia) had incorporated all the recommendations for pregnant women and newborns. [ABSTRACT FROM AUTHOR]