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Purpose: The purpose of this review was to systematically evaluate the literature on pediatric shoulder arthroscopy and outline its indications, outcomes, and complications. Methods: This systematic review was carried out in accordance with PRISMA guidelines. PubMed, Cochrane Library, ScienceDirect, and OVID Medline were searched for studies reporting the indications, outcomes, or complications in patients undergoing shoulder arthroscopy under the age of 18 years. Reviews, case reports, and letters to the editor were excluded. Data extracted included surgical techniques, indications, preoperative and postoperative functional and radiographic outcomes, and complications. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results: Eighteen studies, with a mean MINORS score of 11.4/16, were identified, including a total of 761 shoulders (754 patients). Weighted average age was 13.6 years (range, 0.83-18.8 years) with a mean follow-up time of 34.6 months (range, 6-115). As part of their inclusion criteria, 6 studies (230 patients) recruited patients with anterior shoulder instability and 3 studies recruited patients with posterior shoulder instability (80 patients). Other indications for shoulder arthroscopy included obstetric brachial plexus palsy (157 patients) and rotator cuff tears (30 patients). Studies reported a significant improvement in functional outcomes for arthroscopy indicated for shoulder instability and obstetric brachial plexus palsy. A significant improvement was also noted in radiographic outcomes and range of motion for obstetric brachial plexus palsy patients. The overall rate of complication ranged from 0% to 25%, with 2 studies reporting no complications. The most common complication was recurrent instability (38 patients of 228 [16.7%]). Fourteen of the 38 patients (36.8%) underwent reoperation. Conclusion: Among pediatric patients, shoulder arthroscopy was indicated most commonly for instability, followed by brachial plexus birth palsy, and partial rotator cuff tears. Its use resulted in good clinical and radiographic outcomes with limited complications. Level of Evidence: Systematic review of Level II to IV studies.

Purpose: The purpose of this study was to evaluate case volume and variability of hip arthroscopy exposure among graduating orthopaedic residents. Methods: The Accreditation Council for Graduate Medical Education (ACGME) surgical case log data from 2016 to 2020 for graduating United States orthopaedic surgery residents were assessed. Arthroscopy procedures of the pelvis/hip were identified. The average number of cases performed per resident was compared from 2016 to 2020 to determine the percent change in case volume. The 10th, 30th, 50th, and 90th percentiles of case volumes from 2016 to 2020 were presented to demonstrate case volume variability. Results: There was no change in the number of hip arthroscopy procedures between 2016 and 2020 [average: 8.4 ± 10 (range: 0 to 87) vs. 9.8 ± 12 (range: 0 to 101)] (P = .995). There was a wide variability in case volume among residents. The 90th percentile of residents performed 24 cases in 2020, compared to 2 cases in the 30th percentile and 0 cases amongst the 10th percentile of residents. Conclusions: Despite the growing popularity of hip arthroscopy, resident exposure to this highly technical procedure remains limited, with about one-third of residents performing 2 or less cases by graduation. Clinical Relevance: Understanding case volume and variability is important for orthopaedic surgery programs to ensure that graduating residents are gaining adequate exposure.

Purpose: The purpose of this study was to evaluate orthopaedic surgery resident case volume and variability for adult and pediatric knee arthroscopy from 2016 to 2020. Methods: The Accreditation Council for Graduate Medical Education surgical case log data from 2016 to 2020 for graduating United States orthopaedic surgery residents were analyzed. The average number of total (adult and pediatric), adult, and pediatric knee arthroscopy cases were compared from 2016 to 2020. The 10th and 90th percentiles of case volumes for adult and pediatric knee arthroscopy procedures were compared from 2016 to 2020 to determine caseload variability. Results: There was an 18% increase in pediatric knee arthroscopy cases between 2016 and 2020 (average: 13.9 ± 10 to 16.4 ± 13; P < .005), a 5.4% decrease in adult knee arthroscopy cases (100 ± 45 to 94.6 ± 47; P < .027), and a 2.6% decrease in total knee arthroscopy (113.9 ± 47 to 111 ± 51; P = .264) cases. There was an 11-fold difference in the number of pediatric knee arthroscopy cases performed between the 10th and 90th percentile of residents in 2020 (3 vs 33 cases, respectively), a 3.28-fold difference for adult knee arthroscopy (47 vs 154, respectively), and a 2.98-fold difference for total knee arthroscopy (59 vs 176, respectively). Conclusions: Pediatric knee arthroscopy comprises a small yet growing percentage of total knee arthroscopy case volume of graduating orthopaedic surgery residents. However, wide variability in resident exposure is present and likely masked by the abundance of adult cases performed each year. Clinical Relevance: The findings presented in this study may assist in optimizing arthroscopy resident education. Existing ACL reconstruction and knee arthroscopy case minimum requirements could be updated to include a set number of pediatric cases. These changes might help reduce case volume variability and discrepancies in resident education.