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Background: Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) is being used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR). However, the knee flexion angle at which fixation of ALLR or LET is performed during the procedure is quite variable based on existing technique descriptions., Purpose/hypothesis: The purpose of this study was to identify whether flexion angle at the time of ALLR/LET fixation affected postoperative outcomes in a clinical population. It was hypothesized that ALLR/LET fixation at low versus high flexion angles would lead to no statistically significant differences in patient-reported outcome measures and graft failure rates., Study Design: Systematic review; Level of evidence, 4., Methods: The PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify published clinical studies of ACLR with ALLR/LET in which the knee flexion angle at the time of ALLR/LET was reported. A priori, low flexion was defined as 0° to 30°, and high flexion was defined as 60° to 90°. Studies were excluded if the flexion angle was between 31° and 59° because these angles constituted neither low nor high flexion angles and including them in an analysis of high versus low flexion angle at fixation would have biased the study results toward the null. The overall risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled results of the studies were analyzed using the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores, along with reported graft failure rates., Results: A total of 32 clinical studies (5230 patients) met inclusion criteria: 22 studies (1999 patients) in the low-flexion group and 10 studies (3231 patients) in the high-flexion group. The median Newcastle-Ottawa Scale score was 6. Comparisons of patients with a low flexion angle versus a high flexion angle demonstrated no differences in the IKDC ( P = .84), Lysholm ( P = .67), or Tegner ( P = .44) scores or in graft failure (3.4% vs 4.1%, respectively; P = .69)., Conclusion: The results of this review indicated that ACLR performed in conjunction with ALLR/LET provides good to excellent patient-reported outcomes and low graft failure rates when ALLR/LET fixation is performed in either low or high knee flexion., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: P.D.F. has received consulting fees from WishBone Medical and stock options from Osso. B.E.H. has received financial or material support from AlloSource, Springer, and Vericel; education payments from Arthrex; nonconsulting fees from Arthrex; royalties from Springer; and stock options from Imagen Technologies. Y.M.Y. has received consulting fees from Smith & Nephew. D.E.K. has received financial or material support from Arthrex and consulting fees from Johnson & Johnson and Miach. M.S.K. has received financial or material support from Elsevier and Wolters Kluwer Health; consulting fees from Best Doctors, OrthoPediatrics, Ossur, and Smith & Nephew; and royalties from OrthoPediatrics, Ossur, Elsevier, and Wolters Kluwer Health. A.T.P. has received consulting fees from OrthoPediatrics. J.J.N. has received research support from Smith & Nephew and Zimmer Biomet Holdings, consulting fees from Responsive Arthroscopy and Smith & Nephew, nonconsulting fees from Smith & Nephew, and royalties from Responsive Arthroscopy. S.C.W. has received consulting fees from Smith & Nephew. P.L.W. has received research support from AlloSource and Ossur, financial or material support from Elsevier, and royalties from Elsevier. M.M. has received royalties from Elizur. J.E.V. has received consulting fees from Arthrex. D.D.S. has received financial or material support from Elsevier, research support from OrthoPediatrics, and royalties from Elsevier. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Objective: Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States., Study Design: Eighteen institutions from the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES) group retrospectively reviewed a minimum of 1 year of hospital data, reporting the total number of surgeons, total consultations, and MSKI-related consultations. Consultations were classified by the location of consultation (emergency department or inpatient). Culture positivity rate and pathogens were also reported., Results: 87,449 total orthopaedic consultations and 7,814 MSKI-related consultations performed by 229 pediatric orthopaedic surgeons were reviewed. There was an average of 13 orthopaedic surgeons per site each performing an average of 154 consultations per year. On average, 9% of consultations were MSKI related and 37% of these consults yielded positive cultures. Finally, a weak inverse monotonic relationship was noted between percent culture positivity and percent of total orthopedic consults for MSKI., Conclusion: At large, academic pediatric tertiary care centers, pediatric orthopaedic services consult on an average of ~3,000 'rule-out' MSKI cases annually. These patients account for nearly 1 in 10 orthopaedic consultations, of which 1 in 3 are culture positive. Considering that 2 in 3 consultations were culture negative, estimating resources required for pediatric orthopaedic consult services to work up and treat children based on culture positive administrative discharge data underestimates clinical need. Finally, ascertainment bias must be considered when comparing differences in culture rates from different institution's pediatric orthopaedics services, given the variability in when orthopaedic physicians become involved in a MSKI workup., Competing Interests: Funding for the creation of this database was provided by the Pediatric Orthopaedic Society of North America (POSNA) through a directed research. Many members of the CORTICES are likewise active members of POSNA. The CORTICES Group has no other competing interests.

Background: The majority of previous investigations on operative fixation of clavicle fractures have been related to the adult population, with occasional assessments of the younger, more commonly affected adolescent population. Despite limited prospective data for adolescents, the incidence of operative fixation of adolescent diaphyseal clavicle fractures has increased., Purpose: To detail the demographic features and descriptive epidemiology of a large pooled cohort of adolescent patients with diaphyseal clavicle fractures presenting to pediatric tertiary care centers in the United States through an observational, prospective, multicenter cohort study (Function after Adolescent Clavicle Trauma and Surgery [FACTS])., Study Design: Cross-sectional study; Level of evidence, 4., Methods: Patients aged 10 to 18 years who were treated for a diaphyseal clavicle fracture between August 2013 and February 2016 at 1 of 8 geographically diverse, high-volume, tertiary care pediatric centers were screened. Treatment was rendered by any of the pediatric orthopaedic providers at each of the 8 institutions, which totaled more than 50 different providers. Age, sex, race, ethnicity, fracture laterality, hand dominance, mechanism of injury, injury activity, athletic participation, fracture characteristics, and treatment decisions were prospectively recorded in those who were eligible and consented to enroll., Results: A total of 545 patients were included in the cohort. The mean age of the study population was 14.1 ± 2.1 years, and 79% were male. Fractures occurred on the nondominant side (56%) more frequently than the dominant side (44%). Sport was the predominant activity during which the injury occurred (66%), followed by horseplay (12%) and biking (6%). The primary mechanism of injury was a direct blow/hit to the shoulder (60%). Overall, 54% were completely displaced fractures, defined as fractures with no anatomic cortical contact between fragments. Mean shortening within the completely displaced group was 21.9 mm when measuring the distance between fragment ends (end to end) and 12.4 mm when measuring the distance between the fragment end to the corresponding cortical defect (cortex to corresponding cortex) on the other fragment (ie, true shortening). Comminution was present in 18% of all fractures. While 83% of all clavicle fractures were treated nonoperatively, 32% of completely displaced fractures underwent open reduction and internal fixation., Conclusion: Adolescent clavicle fractures occurred more commonly in male patients during sports, secondary to a direct blow to the shoulder, and on the nondominant side. Slightly more than half of these fractures were completely displaced, and approximately one-fifth were comminuted. Within this large cohort, approximately one-third of patients with completely displaced fractures underwent surgery, allowing for future prospective comparative analyses of radiographic, clinical, and functional outcomes., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study received funding from the Boston Children’s Hospital Program for Patient Safety and Quality (research grant; 2013), Boston Children’s Hospital Trust (private donation; 2015), and Pediatric Orthopaedic Society of North America (POSNA Directed Research Grant; 2015-2018). M.S.K., E.W.E., and B.E.H. have received research funding from AlloSource and Vericel for the Research in OsteoChondritis of the Knee (ROCK) Study Group. H.B.E. has received educational support from Pylant Medical, speaking fees from Smith & Nephew and Synthes, and hospitality payments from Arthrex. P.L.W. has received educational support from Pylant Medical. A.T.P. has received educational support from Sportstek Medical, speaking fees from Smith & Nephew, and consulting fees from OrthoPediatrics. J.J.N. has received educational support from Arthrex and Elite Orthopaedics; speaking fees from Smith & Nephew; and consulting fees from Ceterix Orthopaedics, Responsive Arthroscopy, and Smith & Nephew. S.C.W. has received speaking fees from Arthrex and Smith & Nephew and consulting fees from Smith & Nephew. D.D.S. has received educational support from Gentleman Orthopedics Solutions. N.K.P. has received educational support from Evolution Surgical and consulting fees from OrthoPediatrics. M.S.K. has received consulting fees from OrthoPediatrics, Ossur, and Smith & Nephew; speaking fees from Smith & Nephew; honoraria from Stryker; and royalties from OrthoPediatrics. E.W.E. has received research support from DePuy, consulting fees from OrthoPediatrics, and speaking fees from Arthrex and Ossur. D.M.K. has received speaking fees from Medtronic and consulting fees from WishBone Medical. M.T.B. has received educational support from Arthrex and United Orthopedics, speaking fees from Arthrex, and consulting fees from OrthoPediatrics. B.E.H. has received educational support from Kairos Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)