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In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions., Competing Interests: Competing interests: MC is a paid consultant for Arthrex. LE is the Head of Scientific Activities in the Medical and Scientific Department of the International Olympic Committee, has received fees for speaking from Smith & Nephew, has received research funding from Biomet and Smith & Nephew, has received funds for an employee from Arthrex and Smith & Nephew, has received royalties or fees for consulting from Arthrex and is an Editor of BJSM. MSK is a paid consultant for Best Doctors, OrthoPediatrics, Össur and Smith & Nephew, receives royalties, financial or material support from OrthoPediatrics, Össur, Saunders/Mosby-Elsevier and Wolters Kluwer Health–Lippincott Williams & Wilkins, is a paid member of the Steadman Philippon Research Institute, Scientific Advisory Committee, and is an unpaid board or committee member of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Harvard Medical School, Harvard School of Public Health, Herodicus Society, Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine. RLaP receives royalties from Össur, Arthrex and Smith & Nephew. BR receives royalties from Elsevier, salary from American Journal of Sports Medicine and Orthopaedic Journal of Sports Medicine, and holds stock in Merck and Johnson and Johnson. RSe is an unpaid board member and President of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA). TS works as Scientific Manager in the Medical and Scientific Department of the International Olympic Committee., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: Athletes can have pain derived from fractures or alternate pathology. Skeletal scintigraphy may detect abnormalities before anatomic imaging and provides a practical tool for whole-body imaging. However, study interpretation in children can be challenging. This pictorial essay describes a technique for pediatric skeletal scintigraphy and reviews findings commonly encountered in athletes., Conclusion: Skeletal scintigraphy complements anatomic findings in pediatric athletes. Familiarity with imaging technique and study interpretation can improve diagnosis.

The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

Objective: To determine the evidence base for recommendations regarding autologous chondryocyte implantation in adolescent athletes., Materials and Methods: All literature on articular cartilage repair from MEDLINE search dated 1990 to 2006 was reviewed. The majority of articles describe surgical technique and indications. Three techniques for secondary articular cartilage repair have been identified: autologous chondrocyte implantation, autologous osteochondral implants, and marrow stimulation techniques. The initial literature search identified 4 studies that reported the effectiveness and durability of autologous chondrocyte implantation in adults and 2 studies that reported the outcomes of autologous chondrocyte implantation in adolescent athletes. No results of osteochondral implantation or marrow stimulation techniques in adolescent athletes have been published., Results: Acceptable repair rates with all 3 techniques have been reported in adult athletes. Two studies reported high success using autolgous chondrocyte implantation (ACI) in children., Conclusions: Articular cartilage injury in young athletes remains a difficult problem. The ideal situation is early diagnosis and primary repair, particularly with lesions of the knee, elbow, and ankle. In cases where primary repair is not possible or has been unsuccessful and the lesion is large or symptomatic, secondary repair with either marrow stimulation, microfracture, autologous chondrocyte implantation, or autologous osteochondral grafting may be used. However, at present only the results of ACI repair have been reported for adolescent athletes.

Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.

With the explosion of the number of youth participating in sports activities has come an epidemic of injuries. Myriad factors make their prevention a great challenge for society. This article presents an overview of statistics, factors contributing to sports injuries, a review of significant prevention efforts, barriers to prevention, and recommendations for the future.

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Objective: To study risk factors for injury in karate and to establish safety recommendations., Design: Cross-sectional survey of karate injuries., Setting: Shotokan karate clubs in Boston, Massachusetts, Dallas, Texas, and Winnipeg, Manitoba, Canada., Participants: All athletes training at each club received surveys. A total of 114 surveys were analyzed (74% response rate)., Main Outcome Measures: Presence of injuries (requiring any time off from practice), major injuries (requiring at least 7 days off), and multiple injuries (3 or more injuries)., Results: No statistically significant differences were found with respect to sex. For all outcomes, karateka younger than 18 years of age had fewer injuries. The number of karateka with injuries and with multiple injuries increased with belt rank until brown belt, then reached a plateau. Brown and black belts had a greater frequency of major injuries than the lower ranks. Training more than 3 hours per week correlated with an increase in injuries, major injuries, and multiple injuries., Conclusion: Shotokan karate appears to be a safe sport, especially for those younger than 18 years of age. Risk of injury increases significantly when younger karateka of any rank or older karateka of lower ranks train more than 3 hours per week; therefore, to reduce the risk of injury to less than 50%, weekly training should be limited to a maximum of 3 hours in these groups.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

In the U.S., greater than half of boys and one quarter of girls in the 8- to 16-yr-old age range are engaged in some type of competitive, scholastic, organized sport during the school year. Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. Foot and ankle problems, in particular, are the second most common musculoskeletal problem facing primary care physicians in children under 10 yr of age next to acute injury. This report focuses on foot and ankle problems, trauma, and overuse in the young athletic population. Guidelines are given for both conservative and surgical management. Specific problems addressed include pes planus, tarsal coalition, adolescent bunion, os trigonum, accessory navicular, physeal fractures, sprains, peroneal tendon subluxation, metatarsal fractures, sesamoid fractures, turf toe, stress fractures, tendonitis, osteochondritis dissecans, ankle impingement, bursitis, Haglund's deformity, sesamoiditis, plantar fasciitis, apophysitis, osteochondroses, cuboid syndrome, and reflex sympathetic dystrophy. An extensive review of the literature is performed and presented in combination with the extensive experience of a well-established sports medicine clinic at the Boston Children's Hospital.

Objective: To evaluate trends in the frequency of anterior cruciate ligament (ACL) tears among adolescent soccer and basketball players resulting in reconstructive surgery, and to assess differences between female and male adolescent athletes., Design: A retrospective review of ACL reconstructive surgeries performed from 1992 through 1997 and annual statewide participation rates obtained from the National Federation of State High School Associations., Setting: Children's Hospital, Boston, Massachusetts, U.S.A., Patients: Adolescent athletes 13 to 19 years of age (78 girls, 31 boys) admitted for ACL reconstruction due to soccer or basketball injuries., Main Outcome Measures: Number of ACL reconstructive surgeries and number of Massachusetts participants in high school soccer and basketball., Results: A total of 69 soccer (49 girls, 20 males) and 40 basketball (29 girls, 11 males) players underwent ACL reconstruction. A greater proportion of girls underwent ACL surgery in both sports. The frequency increased over time for both sexes in both sports. Soccer-related surgeries increased at a faster rate among girls than boys. Basketball-related surgeries increased at a similar rate for both sexes, although in any given year more surgeries were performed on girls., Conclusion: The frequency of ACL surgery at our institution has increased among high school soccer and basketball players in a manner consistent with trends in sports participation. In our study, ACL surgery was more common among girls than boys.

Our experience in treating chronic lower-leg compartment syndrome suggests that women may be more susceptible to this injury than are men, an observation for which there is support in the literature. Furthermore, when we evaluated the 47 young female athletes (age range, 13 years 11 months to 21 years 10 months) from our practice on whom 78 separate surgeries were performed, we found a lower success rate than those generally reported in studies that combine male and female patients. We suspect, therefore, that for reasons as yet unclear, women may also respond less well than men to operative fasciotomy.

The youth soccer movement in the United States is developing at a tremendous rate. This article explores the epidemiology of youth soccer including trends in participation, injury data, and injury categories that are of specific concern to the young athlete. Finally, recommendations are made regarding possible future areas of study and research on youth soccer.

Stress fractures are a source of significant sports disability in the growing athlete. Early diagnosis and treatment are paramount in the management of these injuries to minimize the morbidity associated with them. In addition, the identification of potential host and/or environmental risk factors, and education of athletes, parents, coaches and physicians about these risk factors are key in the prevention of stress fractures and other overuse injuries in the pediatric athlete.

Specific elbow and wrist injuries are predictable in the skeletally immature athlete based on the biomechanics of the sport and the age of the patient. The physician must be aware of the potential for overuse injuries. Modification in training regimens is essential for recovery. A greater emphasis must be placed on the prevention of these injuries. As a general rule, the young athlete should not progress more than 10% per week in the amount and frequency of training. Correction of muscle-tendon imbalances is accomplished by maintaining strength and flexibility of susceptible tissues. In throwers, a triceps-strengthening program of progressive resisted extension exercises and a forearm flexor/extensor-strengthening program using the French curl technique are helpful. Careful attention to throwing technique and proper coaching are essential. The goal for the young athlete is early recognition of the injury and thereby prevention of a long-term disability.

Overuse injuries in the young athlete now are seen more frequently. Using an adult model of these injuries with respect to diagnosis and treatment and applying it to the young athlete does not address many of the unique characteristics that contribute to these injuries. An overview of causative factors that contribute to overuse injuries in young athletes is presented. Examples of specific injuries seen only in this age group and the treatment of these injuries are presented.

Back pain in children and young athletes is very different from back pain in adults. Macrotrauma must be carefully evaluated and managed, even in the absence of definitive radiographic findings. Microtrauma must be suspected in at-risk athletes. These athletes require persistent diagnostic evaluation and may require SPECT bone scan to uncover a posterior element stress reaction. Atraumatic back pain requires the elimination of neoplastic, infectious, rheumatologic, or congenital causes.

Certain topics and controversies involving young athletes are addressed, including unclear criteria for volume and intensity of training and acute and overuse injuries of the knee. Osteochondritis dissecans, tibial spine avulsions, peri-pelvic apophyseal avulsions, and back injuries are discussed.

We report 11 cases of symptomatic medial malleolar ossification centers (MMOC). Symptoms in six of the 10 patients responded to diminished athletic activity. Four patients required short-leg walking casts, and two of these patients required repeat casting for symptom recurrence. Two groups of bilateral, three-view ankle roentgenograms of asymptomatic patients were reviewed to determine the incidence of MMOC. Group 1 (age 6 years 1 month to 12 years 11 months) had a 20% incidence, and group 2 (age 13 years 1 month to 17 years 11 months) had a 4% incidence. Symptoms may occur at these roentgenographic variants, and diminished activity, either volition or enforced by walking casts, produced resolution of symptoms in all patients.

Overuse injuries to tendons and apophyses are being seen with increasing frequency in children and adolescents as they increase their participation in organized sports, fitness, and dance activities. A retrospective review of 724 overuse tendon and apophyseal injuries seen in the Sports Medicine Clinic at the Boston Children's Hospital suggested that growth and maturation constitute additional risk factors for injury occurrence. Diagnosis and treatment of these injuries is discussed in the context of sports participation.

The authors reviewed 1 year of experience with planar and single photon emission computed tomographic (SPECT) bone scintigraphy in 162 young patients with symptoms of low-back pain possibly related to stress injury to the pars interarticularis or spondylolysis. Planar scintigraphy and SPECT revealed no abnormality in 91 patients (56%). All abnormalities detected on planar images were also detectable with SPECT. SPECT showed an abnormal focus of radiotracer uptake in the lumbar spine in 71 patients (44%). In 32 of these 71 patients, these findings were also evident with planar scintigraphy. In 39 of these 71 patients, use of SPECT. Correlation with contemporaneous radiographs was made in 72 cases (including computed tomography in 10 cases). SPECT can be used to detect stress injury not seen with planar bone imaging or radiography and is recommended in evaluation of low-back pain in young athletes.

A retrospective review was undertaken of 16 adolescent patients (20 feet) with tarsal coalitions. All patients were active in sports and were seen in the Sports Medicine Clinic. Ages ranged from 9 to 17 years (average, 13 years). Failing conservative therapy, 18 feet had resection of the tarsal bar; 1 patient (2 feet) had bilateral extraarticular subtalar arthrodeses. The patients were seen in followup an average of 5.1 years postoperatively (range, 2 to 10 years). An objective ankle/foot score was developed and all patients improved their score postoperatively, with the average score being improved 25%. Nineteen of 20 feet (95%) had excellent or good postoperative results by the ankle/foot score, while 17 of 20 (85%) had an excellent or good subjective result. Two bars in two feet (10%), both in the same patient, recurred. There were six patients with preoperative talar beaking, and all had an excellent or good followup result. All males returned to their previous level of competition in sports, while three female patients (three feet) gave up sports. Resection of tarsal coalitions, even in the presence of talar beaking without other degenerative changes, yields consistently good follow-up results.

The traction apophysitises are one of the frequently encountered overuse injuries to children. Although known for many years and classed as osteochondroses, the traumatic origin of these disorders--from repetitive microtrauma--is now receiving wider acceptance. Discussion of the assessment, treatment, and prevention of these disorders is included.

Overuse injuries are now well known to sports enthusiasts at any age or level of competition. The seeming explosion of overuse stress fractures of lower extremity bones in high-profile professional basketball players has brought about widespread media attention and a better understanding of the phenomenon of "overuse syndrome" by the public. However, the spectrum of overuse injuries in the child or adolescent athlete has only recently been recognized. These injuries can range from the permanent disability of osteochondritis dissecans of the elbow to the completely nonspecific "growing pains" of active youngsters.

A study of radionuclide bone scintigraphy in adolescents was conducted to evaluate the pattern of stress-related abnormalities and their correlation with both symptoms and roentgenography. In 26 episodes of stress-related abnormal scintigraphy, 12 (46%) had a multifocal pattern of abnormalities. Forty foci were identified by scintigraphy, with 11 (28%) exhibiting abnormal roentgenograms. These multiple abnormalities were frequently unsuspected clinically, and studies limited to symptomatic areas would have failed to detect them. It is recommended that patients with stress-related symptoms be screened utilizing radionuclide bone scintigraphy to facilitate the early detection of abnormalities in bone prior to the development of cortical disruption, thereby preventing increased morbidity and possible disabling sequelae.

The Boston Brace System was developed to attain functional realignment of the scoliotic spine. This system uses prefabricated thermoplastic pelvic modules which can be rapidly fitted to an individual patient. These modules are available in 20 sizes and designed with a forward flexion of 30 degrees on the anterior margin and 15 degrees on the posterior surface. The resultant antilordotic straightening of the lumbar spine is important in correcting the scoliotic spine and has been found to be therapeutically effective in managing a number of other conditions of the spine, including back injuries in the young athlete. A review of the results of treatment of 31 young athletes for back injuries over the past 3 years with the brace, with an average followup of 15 months, reveals good or excellent results in 28 of the 31, or 90%. Best results were attained in spondylolysis. Therapy for discogenic back pain with the brace was effective in only 50%. Modifications of initial brace design included changing from a posterior opening to an anterior opening module and from polypropylene to polyethylene brace construction. Most patients have continued full athletic participation while in the brace.

Increased number of overuse injuries, particularly of the lower extremity, occurs in exercise. It is important for the physician who prescribes exercise to understand the mechanism of injury-repetitive microtrauma-and the risk factors for occurrence of these injuries. In the lower extremity, risk factors include inappropriate progression of the rate, intensity and duration of training; anatomic malalignment; muscle-tendon imbalances of strength, endurance, or flexibility; shoewear; surface; and pre-existent disease states. Specific recommendations for training progression, technique, and sports equipment may have to come from the physician, since the recreational athlete often does not have access to coach or athletic trainer. These are described.

Calcaneal apophysitis (Sever disease) is a common cause of heel pain, particularly in the athletically active child. Eighty-five children (137 heels) with calcaneal apophysitis were reviewed. Both heels were affected in 52 (61%) patients. The most common associated foot condition was pronation, occurring in 16 patients. Sixty-eight patients complained that pain was made worse by a specific sport, with soccer leading the list. All patients were treated with a physical therapy program of lower extremity stretching, especially of the heel cords, and ankle dorsiflexion strengthening. Soft Plastizote orthotics or heel cups were used in 98% of patients. Proper athletic shoewear was advised. All patients improved and were able to return to their sport of choice 2 months after the diagnosis. There were two recurrences.

The increasing participation in organized sports has been paralleled by an increasing number of sports injuries. An exact diagnosis of the injury and an understanding of the mechanisms of injury are essential for proper management, relief of pain, and restoration of function. The two mechanisms of injury are single-impact macrotrauma and repetitive microtrauma. Overuse injuries, which result from repetitive microtrauma, are caused by the interaction of a number of risk factors. Determining the etiological factors present in a given injury is essential for proper management and prevention of overuse injuries. The roles of non-narcotic analgesics, muscle relaxants, and nonsteroidal anti-inflammatory drugs (NSAIDs) in aiding recovery and restoration of function in sports injuries have been extensively studied. NSAIDs, in particular, have been demonstrated in clinical and laboratory studies to speed recovery from overuse sports injury. Their place in acute sports injuries due to single-impact macrotrauma, however, is more controversial.

Childhood participation in sports involves a complex interaction of many physical, psychological, and social factors. Some children and teenagers cope well with the stress of performance and competition and their participation leads to enhanced self-esteem and personal growth; others cope poorly, however, and are at a higher risk for injury. Based on clinical observations of patients seen through the sports and orthopedic services at a major children's hospital, this article has identified two groups of children and adolescents at risk for psychological complications following injury. Psychotherapeutic intervention is seen as a fundamental component in the overall treatment planning for patients manifesting a difficult recovery course, prolonged interference in athletic injury, and a tendency toward reinjury.

The complaint of low back pain in the adolescent must never be taken lightly. A high index of suspicion should be particularly entertained in a child participating in gymnastic training or competition. As noted in this article, steps can now be taken, particularly if a specific diagnosis is made early, to institute specific treatment with a high likelihood of success. Young gymnasts complaining of back pain must never be passed off as having sustained a back strain or "muscle spasms" and treated symptomatically. Persistent back pain beyond two weeks warrants, in our opinion, a complete evaluation, careful history and physical examination, a four-view radiographic assessment of the spine, and, if necessary, bone scans or other more advanced techniques to make a specific diagnosis of the cause of the pain.

Radiographs and bone scans of 40 young athletes with low back pain were reviewed retrospectively to correlate the imaging findings and assess the value of scintigraphy in the diagnosis of these patients. The radiographs were positive for spondylolysis with or without spondylolisthesis in 15 (38%), and scintigraphy showed focal disease in the posterior vertebral elements in 14 (35%). Five patients had positive radiographic studies but normal scans, indicating old injuries; four patients had positive scintigrams but normal radiographs, suggesting early or active injuries. The authors use radiography as the initial examination in the evaluation of patients with low back pain. Scintigraphy is most useful in early stages, when radiographs may be normal; and in cases in which the age and activity of a radiologic abnormality cannot otherwise be accurately determined before therapy.

This paper reviews 14 patients who underwent elbow arthrotomy for osteochondritis of the capitellum. The etiology in 7 of the 14 cases appears to be the result of repeated trauma from throwing sports. Five of the 14 described a singular significant traumatic episode, and in 2 of the 14, a clear etiology is uncertain. The diagnostic features including signs, symptoms, and elbow range of motion are examined. The operative findings are correlated with plain x-ray films of the elbow in all cases and with an elbow arthrogram in 11 out of 14 cases. The average length of followup was 24 months. The postoperative range of motion was increased an average of 18 degrees. Eighty-six percent (12 out of 14) patients returned to organized, competitive athletic activity without restrictions. The Little League background of those patients with apparent repetitive microtrauma to the elbow is examined in terms of length of pitching experience and types of pitches thrown. In addition, the throwing mechanism of these patients is evaluated with respect to the type of delivery at possible risk for the development of osteochondritis. We conclude that after a failure of conservative therapy, surgical treatment, including removal of the intraarticular loose bodies, excision of capitellar lesions, and curettage to bleeding bone can be expected to produce pain relief and improvement in joint motion. A return to organized competitive sport activities can be expected.