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Meniscus tears are common in the pediatric population, typically occur after noncontact injuries, and can be diagnosed clinically with MRI confirmation. Surgery should be offered to patients with loss of range of motion, persistent symptoms, or displaced/complex tears. Given poor long-term outcomes reported after meniscectomy, repair should be attempted when possible as pediatric menisci are well vascularized and have better outcomes after repair than their adult counterparts. The location of the tear is an important determining factor when deciding on the type of repair to use. Pediatric meniscus repair techniques will be discussed noting differences between pediatric and adult procedures. Further studies are needed to explore the role of biologics and define postoperative protocols.

In the treatment of native shoulder septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim to compare revision-free survival (RFS), complications, and resource utilization between these approaches.The National Readmission Database was queried from 2016 to 2019 to identify patients using International Classification of Diseases, 10th revision, diagnostic and procedure codes. Days to revision irrigation and débridement (ID) were calculated for patients during index admission or subsequent readmissions. Multivariate regression was used for healthcare utilization analysis. Survival analysis was done using Kaplan-Meier analysis and Cox proportional hazard regression.A total of 4,113 patients with native shoulder septic arthritis undergoing ID were identified, 2,775 arthroscopic (67.5%) and 1,338 open (32.5%). The median follow-up was 170 days (interquartile range 79 to 265). A total of 341 patients (8.3%) underwent revision ID at a median of 9 days. On multivariate analysis, arthroscopic ID was associated with a reduction in hospital costs of $4,154 ( P0.001) and length of stay of 0.78 days ( P = 0.030). Arthroscopic ID was associated with reduced blood transfusions (odds ratio 0.69, P = 0.001) and wound complications (odds ratio 0.30, P0.001). RFS was 96.4%, 94.9%, 93.3%, and 92.6% for arthroscopic ID and 94.1%, 92.6%, 90.4%, and 89.0% for open ID at 10, 30, 90 and 180 days, respectively ( P = 0.00043). On multivariate Cox modeling, arthroscopic ID was associated with improved survival (hazard ratio 0.67, P = 0.00035). On stratified analysis, arthroscopic ID was associated with improved RFS in patients aged 65 years or older ( P0.001), but RFS was similar in those younger than 65 years ( P = 0.17).Risk of revision ID was markedly lower after arthroscopic ID compared with open, although the protective benefit was limited to patients aged 65 years or older. Arthroscopy was also associated with decreased costs, length of stay, and complications. Although surgeons must consider specific patient factors, our results suggest that arthroscopic ID is superior to open ID.III.

In the treatment of native knee bacterial septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim to compare revision-free survival, complications, and resource utilization between these approaches.The National Readmission Database was queried from 2016 to 2019 to identify patients using International Classification of Diseases, 10th revision, diagnostic and procedure codes. Days to revision irrigation and débridement (ID), if any, were calculated for patients during index admission or subsequent readmissions. Multivariate regression was used for healthcare utilization analysis. Survival analysis was done using Kaplan-Meier analysis and Cox proportional hazard regression.A total of 14,365 patients with native knee septic arthritis undergoing ID were identified, 8,063 arthroscopic (56.1%) and 6,302 open (43.9%). The mean follow-up was 148 days (interquartile range 53 to 259). A total of 2,156 patients (15.0%) underwent revision ID. On multivariate analysis, arthroscopic ID was associated with a reduction in hospital costs of $5,674 and length of stay of 1.46 days (P0.001 for both). Arthroscopic ID was associated with lower overall complications (odds ratio [OR] 0.63, P0.001), need for blood transfusion (OR 0.58, P0.001), and wound complications (OR 0.32, P0.001). Revision-free survival after index ID was 95.3% at 3 days, 91.0% at 10 days, 88.3% at 30 days, 86.0% at 90 days, and 84.5% at 180 days. No statistically significant difference was observed between surgical approaches on Cox modeling.Risk of revision ID did not differ between arthroscopic and open ID; however, arthroscopy was associated with decreased costs, length of stay, and complications. Additional study is necessary to confirm these findings and characterize which patients require an open ID.III.

Objectives: The number of anterior cruciate ligament (ACL) injuries and reconstructions observed in the adolescent population continues to rise. While the use of quadriceps tendon autograft has increased in popularity in this population, there remains no consensus on the ideal graft for pediatric ACL reconstruction. The objective of this study was to compare three commonly used ACL graft types with respect to i) performance on return to sport assessments and ii) timing to clearance for return to sports in an adolescent population. Methods: All patients, less than or equal to 19 years of age, who underwent reconstruction for ACL tears between 2016 and 2020 at a large, urban, academic institution were identified. Graft choice was made in a shared decision-making model with patient, parents, and surgeon. Patient demographics, laterality, graft type, time from surgery to clearance, number of physical therapy (PT) visits, and presence of concomitant meniscus injuries were collected from the electronic medical record. At a minimum of 6 months postoperatively, patients completed a formal return to sport test (RTS) including isometric strength assessments, Y- balance testing, and hop testing. Treatment cohorts based on graft type were compared with respect to RTS performance and timing to clearance. Associations between patient demographics and return to sport timing and performance were also assessed. Clearance for return to sport was determined by the treating surgeon with limb symmetry index of 90% on RTS as the goal for clearance. Results: A total of 110 adolescents, 44 female (40%), with a mean age of 16.3 years (SD, 1.7; range, 10-19) met our inclusion criteria (Table 1). Average time to first RTS assessment was 280 days (9.3 months) and average time to clearance was 371 days (12.2 months) after surgery. ACL grafts included 58 (52.7%) hamstring autografts, 26 (23.6%) bone-patellar tendon-bone (BPTB) autografts, 21 (19.1%) bone quadriceps (BQT) autografts, and 5 (4.6%) iliotibial band (ITB) autografts. ITB patients were younger on average (12.5 years old) than those receiving hamstring, BPTB or BQT grafts. There were no significant differences between groups with respect to laterality, number of physical therapy visits, or rate of concurrent meniscus surgery. Patients receiving BQT grafts were more likely to be cleared within 1 year of surgery compared to hamstring graft patients (82.4% vs. 39.6%, p=0.002) and had similar rates of clearance within 1 year compared to BPTB patients (82.4% vs. 65.2%, p=0.230). Patients with BQT and BPTB grafts both demonstrated significantly better hamstring strength symmetry compared to hamstring graft patients (5.8% strength deficit compared to healthy side vs. 1.3% vs. 29.3%, pConclusions: In this study of 110 adolescent ACL reconstruction patients who underwent return to sport evaluations, we found no significant difference between BPTB and BQT autografts with respect to RTS performance and time to clearance. Hamstring autograft was associated with significantly worse hamstring strength asymmetry and significantly lower rates of clearance within 1 year. Concurrent meniscus surgery, age, gender, and number of PT sessions completed prior to RTS evaluation were not significantly associated with timing of clearance or performance on the RTS assessment. [Table: see text][Table: see text]

Objectives: The spread of the coronavirus disease 2019 (COVID-19) in February and March of 2020 led to the delay or cancellation of major sporting leagues and events across the globe. Collegiate athletic competitions were postponed until the end of the 2020 calendar year and organized collegiate athletic practices and training camps throughout 2020 were either cancelled or significantly reduced in frequency. The impact of the COVID-19 pandemic on injury epidemiology in collegiate athletics has not yet been investigated. We aim to describe the types of athletic injuries sustained by high level collegiate athletes before and after the COVID-19 pandemic. Methods: The Pacific 12 (Pac-12) Health Analytics Program contains all injuries sustained by intercollegiate athletes in the Pac-12 conference. This database was queried for injuries that occurred across all sports from January 2019 to June 2021. For all sports, timing of injury onset (acute versus overuse), severity of injury, rate of procedural intervention, injury mechanism (contact versus non-contact), and likelihood of injury during the 4th quarter of competition (final 25% of competition) was compared between the season immediately preceding the COVID-19 pandemic and the season immediately after. In this database, injury timing is defined as overuse if symptom onset occurred more than 24 hours after the precipitating incident. Results were stratified by upper and lower extremity as well as sport. Sub group analyses were also performed on knee and shoulder injuries among athletes competing in sports with historically high rates of knee and shoulder injuries. Multivariate analysis including gender was performed. Results: A total of 12,319 sport-related injuries across 23 sports were identified. The overall proportion of injuries sustained during the 4th quarter of competition was higher in the post-pandemic season (28.5% vs. 25.9%, p=0.015) and the overall proportion of non-contact injury was higher in the post-pandemic season (46.1% vs. 39.8%, pConclusions: Compared with the season immediately preceding the COVID-19 pandemic, athletes competing in the post-pandemic season were at higher risk of non-contact injury and injury near the end of a competition. There was a higher risk of overuse knee injuries and non-contact knee and shoulder injuries in the post-pandemic season. These findings are the first to describe the effect of a global pandemic on an athlete’s injury risk profile upon return to sport and may be used to guide decisions regarding athlete workload and training. [Table: see text][Table: see text][Table: see text]