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Purpose: Trochlear dysplasia (TD) is one of the several factors that predispose to recurrent instability and long-term morbidity. Subclassification can aid in risk stratification with surgery and comparing case-cohort outcomes. The inter- and intra-observer agreement of the Oswestry-Bristol Classification (OBC) for TD has previously been demonstrated in adults but not in children. We aim to assess the inter- and intra-observer reliability of the OBC in skeletally immature patients. Methodology: This was a retrospective review of magnetic resonance imaging scans performed in children presenting with patellofemoral instability or recurrent dislocation. A total of 34 scans were graded according to the OBC by seven orthopedic surgeons in two rounds 6 weeks apart. All reviewers were blinded and scans were randomized. The observations from both rounds were compared for inter- and intra-rater reliability. Results: First-round observations showed low–moderate agreement between raters (mean kappa = 0.39). Second-round observations showed moderate agreement (mean kappa = 0.42). However, subanalysis using S statistics found good reliability. There was no statistically significant difference between the two agreement values. Category-wise agreement was excellent for normal trochlea (OBC 1) and moderate to good for severe dysplasia (OBC 4). Reliability was low moderate to poor for mild (OBC 2) or moderate (OBC 3) dysplasia. Intra-observer reliability was good to excellent (mean kappa = 0.73). Conclusion: The OBC is reliable in categorizing a normal or severely dysplastic trochlear in skeletally immature children although it fails to adequately differentiate between mild and moderate dysplasia. [ABSTRACT FROM AUTHOR]

Objective: The objectives of our study were to assess the evidence for the diagnostic efficacy of 3-T MRI for meniscal and anterior cruciate ligament (ACL) injuries in the knee using arthroscopy as the reference standard and to compare these results with the results of a previous meta-analysis assessing 1.5-T MRI., Materials and Methods: The online Cochrane Library, MEDLINE, and PubMed databases were searched using the following terms: MRI AND ((3 OR three) AND (Tesla OR T)) AND knee AND arthroscopy AND (menisc* OR ligament). Patient demographics, patient characteristics, MRI scanning details, and diagnostic results were investigated. The methodologic quality of the included studies was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A meta-analysis of studies using 3-T MRI was performed, and the results were compared with a previous meta-analysis of studies using 1.5-T MRI., Results: One hundred one studies were identified by the search strategy, and 13 studies were included in our review. Twelve studies were considered to have level 1b evidence, and one study was considered to have level 2b evidence. All 13 studies had high methodologic integrity and low risk of bias using the QUADAS-2 tool. The studies included 1197 patients with a mean age of 41.9 years. Ten of the 13 studies were eligible for meta-analysis. The mean sensitivity and mean specificity of 3-T MRI for knee injuries by location were as follows: medial meniscus, 0.94 (95% CI, 0.91-0.96) and 0.79 (95% CI, 0.75-0.83), respectively; lateral meniscus, 0.81 (95% CI, 0.75-0.85) and 0.87 (95% CI, 0.84-0.89); and ACL, 0.92 (95% CI, 0.83-0.96) and 0.99 (95% CI, 0.96-1.00). The specificity of 3-T MRI for injuries of the lateral meniscus was significantly lower than that of 1.5-T MRI (p = 0.0013)., Conclusion: This study does not provide evidence that 3-T scanners have superior diagnostic efficacy for meniscal damage and ACL integrity when compared with previous studies of 1.5-T machines.

Purpose: To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc-sur-Tille, France) for posterior cruciate ligament (PCL) reconstruction., Methods: A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria., Results: Fifty-four studies were found from the database search, of which 5 were included in the final review (4 case series and 1 case-control study). One hundred twenty-nine PCL reconstructions with LARS were performed. The mean patient age was 32.2 years, with 89 male and 40 female patients included. The mean follow-up time ranged from 10.5 to 44 months. Lysholm scores improved from a mean of 64.8 preoperatively to 89.8 postoperatively. No patients had International Knee Documentation Committee grade 1 or 2 preoperatively, with 93.0% achieving this postoperatively. Only 1 case of synovitis and 1 case of graft rupture were reported., Conclusions: There is little evidence on the effectiveness of PCL reconstructions using LARS ligaments. What data there are show great promise, with short- and medium-term outcome data appearing favorable to autograft reconstruction. Complication rates are encouragingly low., Clinical Relevance: LARS has great potential for PCL reconstruction. Further studies are needed regarding the use of LARS ligaments during PCL reconstruction, including longer follow-up periods and investigation into the optimal timing for reconstruction. This may be best achieved by way of a multicenter study., (Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)