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The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents.

Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures.

1. Brian G. Smith, MD* 1. *Associate Professor, Department of Orthopaedics, Yale University, New Haven, CT After completing this article, readers should be able to: 1. Recognize and distinguish congenital clubfoot from metatarsus adductus. 2. Understand treatments and approaches to pes planovalgus or flatfoot. 3. Describe the natural history of torsional lower extremity deformities in children. 4. Discuss the differential diagnosis of idiopathic toe walking in children. Congenital talipes equinovarus or clubfoot is one of the oldest known congenital deformities, and its diagnosis and treatment date back to the time of Hippocrates. With a personal experience of clubfoot treatment over the past 50 years, Ignacio Ponseti from the University of Iowa has maintained that careful serial manipulation and casting followed by a percutaneous heel cord release yields better outcomes than the more extensive posteromedial release performed commonly in the past 2 decades. ### Epidemiology Clubfoot occurs in about 1 in 1,000 live births and is more common in certain races or ethnic groups. For example, among South Pacific natives, the incidence of clubfoot is 7 per 1,000. Involvement is bilateral in about 50% of patients, and there is a male predominance of 2:1. ### Pathogenesis The precise pathogenesis of congenital clubfoot remains unclear. This complex disorder possibly involves genetic, neurologic, muscular, and intrauterine compression influences. A genetic predisposition exists, but a specific genetic cause has not been identified at this time. ### Physical Findings and Presentation Clubfoot may be identified by prenatal ultrasonography as early as 12 weeks of gestational age. Definitive diagnosis is by clinical examination after birth and is characterized by the four components of clubfoot: equinus positioning, cavus positioning, metatarsus adductus, and hindfoot varus (Fig. 1). Figure 1. Congenital club foot, demonstrating equinus (A) and cavus positioning (B), metatarsus adductus (C), and hindfoot varus (D). On physical examination, the foot is resistant to passive correction of the fixed hindfoot varus and typically maintains a rigid equinus position. The hindfoot involvement separates clubfoot from metatarsus adductus. Also in …