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Osteochondritis dissecans of the knee is a disease that typically affects skeletally immature patients. Clinically manifested with knee pain, limping, and joint disfunction, this condition has remained misunderstood and undervalued for a long period. Although being a rare condition, its awareness is of utmost clinical interest because of the possible severe consequences it can bring when misrecognized or inadequately treated. Its etiology remains unclear and is still debated. Many theories have been proposed, including inflammation, local ischemia, subchondral ossification abnormalities, genetic factors, and repetitive mechanical microtrauma, with a likely interplay of the same. This review article aims to deliver and discuss current and up-to-date concepts on epidemiology, etiology, and natural history of this pediatric condition. Level of evidence: level V.

Osteochondritis dissecans of the knee is an idiopathic, focal, subchondral-bone abnormality that can cause instability or detachment of a bone fragment and overlying articular cartilage, with subsequent progression to osteoarthritis. The degree of lesion instability is best assessed by magnetic resonance imaging. Unstable lesions require operative management with fragment fixation. Level of evidence: V.

Background: Anterior cruciate ligament injury in the child and adolescent patient remains a controversial topic when considering management, especially regarding surgical choices. Treatment variations are seen not just when comparing different countries but also within nations. This arises partly as contemporary treatment is mostly inferred from the adult population who physiologically and in terms of outcomes differ significantly from children. There is an increasing body of evidence for this cohort of patients who have specific challenges and difficulties when determining the optimum treatment. Methods: Within this article, we will summarize the current evidence for surgical management of anterior cruciate ligament injury for the pediatric patient. Results and Conclusions: There remain many controversies and gaps inthe treatment of Paediatric Anterior cruciate ligament reconstruction and this high risk cohort continues to cause difficulty in identifying the best mode of surgical management. Level of evidence: level IV.

Background: Patellofemoral instability is a frequent cause of referral in pediatric sports medicine. Isolated medial patellofemoral ligament reconstruction is widely used and provides satisfactory outcomes with a low failure rate. Given the success of this surgical technique, the literature on medial patellofemoral ligament reconstruction failures in the pediatric population is limited. Moreover, given the multifactorial nature of patellofemoral instability, the heterogeneity of the current literature, and the paucity of pediatric studies, medial patellofemoral ligament reconstruction failures are often difficult to analyze. Methods: The purpose of this study was to retrospectively review the associated risk factors, surgical management, and the clinical outcomes at 2-year follow-up of skeletally immature patients that presented to our clinic with a failed medial patellofemoral ligament reconstruction. Results: Of the 181 cases in 155 patients included in this study, treatment failed in 12 (7%). All 12 patients presented with at least one risk factor for patellofemoral instability, the most common being trochlear dysplasia and a high-grade J sign. Conclusions: We conclude that isolated medial patellofemoral ligament reconstruction for patellofemoral instability in children has a low failure rate. Clinicians must assess pre-operative risk factors before surgical treatment is considered. A high-grade J sign and high-grade trochlear dysplasia were associated with medial patellofemoral ligament reconstruction failure in this cohort. Tailoring treatment to patients’ associated risk factors selection may improve outcomes.

Background: Motorized lengthening nails are the treatment standard for bone lengthening of the lower limbs. However, bony changes namely osteolysis and periosteal hypertrophy have been described after certain type of magnetically driven lengthening nails. The aim of this study was to estimate the proportion rate of radiological bone abnormalities of Fitbone TAA femoral or tibial lengthening nails with a minimum follow-up time of 1 year. Hypothesis: The bone surrounding the telescopic junction of Fitbone lengthening nails does not exhibit osteolysis or periosteal reactions. The bone surrounding the locking screws exhibits cortical hypertrophy. Patients and methods: Single-centre retrospective case series of patients treated with a Fitbone nails with a minimum follow-up of 1 year after implantation. Standard orthogonal radiographs were obtained postoperatively, weekly during the distraction phase, and then monthly for 6 months, and before removal of the equipment. We looked for bone abnormalities at the telescoping junction of the nail and at the locking screws before removal. Results: In total, 101 patients (58 males, 43 females) with a mean age of 21 years (range: 11.8–53.5) had 128 (101 femoral and 27 tibial) limb lengthening nails implanted between 2010 and 2021. The mean follow-up period was 925 days (range: 371–3587). The mean lengthening was 4.7 cm (range: 1.5–8.0). No bones exhibited focal osteolysis or periosteal reactions at the telescopic junction of the lengthening nail. Cortical hypertrophy at the locking screws was observed in significantly more Fitbone nails than previously reported, i.e., 101/128 (79%). Discussion: Neither focal osteolysis, nor periosteal reactions were observed at the bone surrounding the telescopic junction of 128 Fitbone lengthening nails. Cortical hypertrophy around the single diaphyseal locking screw was observed in 101/128 (79%) of the cases. These absences of osteolytic changes after long term observation are reassuring for both surgeons and patients alike. Level of evidence: IV.

Purpose: Calcaneonavicular coalition accounts for more than half of all tarsal coalitions. Resection of calcaneonavicular coalition by an open approach is the standard treatment. Treatment of calcaneonavicular coalition by an arthroscopic approach appears promising. The objective of our study was to compare the clinical outcomes of calcaneonavicular coalition resection by open approach versus arthroscopic approach. Methods: A retrospective cohort study was conducted to evaluate 127 patients who underwent a resection of calcaneonavicular coalition from 2009 to 2017. Patients were divided into two groups according to whether an arthroscopic approach or an open approach was used. Demographics, operative parameters, and clinical outcomes (foot and ankle ability measure score, subjective score, and global ankle estimation) were assessed. Results: Arthroscopic approach was used for 81 patients and open approach for 46 patients. Treatment with arthroscopic approach resulted in a shorter hospital stay (2.6 ± 0.6 days vs 3.0 ± 0.7; p = 0.02) and a longer operative time (24.5 ± 8.1 min vs 20.5 ± 4.2; p Conclusions: Arthroscopic treatment of calcaneonavicular coalition is associated with a higher revision rate than the open approach. Level of evidence: Level III—retrospective comparative study.

Purpose: The use of isolated semitendinosus tendon for Anterior Cruciate Ligament Reconstruction bears several advantages and is popular worldwide. It assumes that the gracilis tendon is spared. The aim of the study was to measure the surface area of the gracilis tendon in children who had undergone arthroscopic reconstruction of the anterior cruciate ligament using a semitendinosus tendon graft. Our hypothesis was that the gracilis tendon may be unintentionally and iatrogenically sectioned due to the anatomical proximity and the small size of the patients. Methods: Fifty patients who had undergone a magnetic resonance imaging preoperatively and postoperatively at 1 year from the surgery and who had been operated between January 2017 and March 2019 were included in this prospective series. The surface area of the gracilis tendon was measured on fat-saturated T2-weighted axial views at the widest point of the medial epicondyle of the femur. Age, sex, body weight, and height were documented. Results: One hundred magnetic resonance imaging of 50 knees were reviewed, from 34 boys (68%) and 16 girls (32%). The mean age was 14.5 years (10–18). The gracilis was visualized in all cases at 1 year postoperatively. The average tendinous surface area of the gracilis before the surgical procedure was 7.13 mm2 versus 8.73 mm2 at 1 year, representing an increase of 1.6 mm2 (p = 0.0003). Conclusions: This study demonstrated that harvesting of the semitendinosus for the purpose of Anterior Cruciate Ligament Reconstruction was a safe technique that preserves the gracilis. Level of evidence: III.

Congenital pseudarthrosis of the clavicle (CPC) is a rare congenital malformation. We describe the outcomes of surgical treatment of CPC in a series of 10 patients. The hypothesis was that surgical treatment is an acceptable solution that will lead to satisfactory healing in asymptomatic patients. The aims were to determine if 1) surgical treatment of CPC will produce a satisfactory union rate, 2) surgical treatment causes complications and impacts the postoperative outcomes and 3) risk factors can be identified that affect the success of the surgical care.Ten patients with CPC who were treated by resection and bone grafting were included in this case series. The CPC was always in the right clavicle. All patients except one were asymptomatic preoperatively. The mean age at the time of the procedure was 5.1 years (range, 1.7-13.4). The initial fixation consisted of a K-wire in 9 patients and a plate in 1 patient. Iliac crest autograft was harvested in all patients. The mean length of postoperative immobilization was 10 weeks (range, 6-18 weeks).At a mean follow-up of 29 months (range, 3-129 months), all patients were pain-free and had full range of motion. Bone union was achieved in 70% (7/10) after revision at a mean of 3.8 months (range, 1.1-13.3). Three clavicles did not heal, two of which had been revised surgically. Four patients suffered a complication: three cases of K-wire migration and one case of infection. Among them, two patients had the fixation changed to a plate while preserving the graft, while the fixation device was removed in two patients, one of whom was undergoing revision for infection. The patients who had complications were all under 5 years of age at the time of surgery (mean 3.7 years, range 1.7-5 years).Surgical treatment of CPC generates a moderate union rate with a complication risk that is not insignificant. Age at the time of surgery appears to affect the outcomes. Thus, we propose waiting until the patient is at least 5 years of age before implementing surgical treatment.IV, Retrospective study.

Background Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role. Methods A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords “discoid meniscus”, “embryology”, “fetus”, “neonatal”. Search yielded 1013 studies, on which we performed a primary evaluation. Results Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week. Conclusion Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.

Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Depending on the study, the prevalence of ramp lesions is inconsistent. Purpose: To describe the prevalence of ramp lesions in children and adolescents and to investigate the sensitivity of magnetic resonance imaging (MRI) for diagnosing such lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We analyzed videos from arthroscopic ACL reconstruction (ACLR) in children. During these procedures, we systematically looked for potential ramp lesions. To do so, an arthroscope was passed through the intercondylar notch to visualize the posteromedial compartment. A needle was introduced at the site of a posteromedial portal to unfold the meniscocapsular junction to reveal any hidden meniscal tear. Surgical procedures were performed by 2 senior surgeons. Videos were blindly analyzed by a third surgeon. Preoperative MRIs were screened by 2 blinded, independent senior radiologists to look specifically for ramp lesions. Results: Videos of 50 consecutive arthroscopic ACLRs concerning 32 boys and 18 girls were analyzed. Mean age at surgery was 14.2 years (range, 8.5-17.6 years). A total of 14 ramp lesions (28%) in 8 boys and 6 girls were identified. In addition, there were 22 tears of the meniscal body in 20 patients (40%). Arthroscopic and MRI findings did not correlate. Among 14 arthroscopically diagnosed ramp lesions, only 8 were detected on the MRI. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. The sensitivity of MRI was 57% and the positive predictive value was 40%. Conclusion: A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. MRI has a low sensitivity for diagnosis of ramp lesions in children. Careful exploration of the posteromedial compartment is strongly recommended. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients.

Study design This is retrospective comparative study. Summary or background data Numerous studies have focused on the efficacy, safety, and restoration of thoracic kyphosis in adolescent idiopathic scoliosis surgery using posteromedial translation method with sublaminar bands and hook claws at the top. The relevance of exchanging the penultimate anchor, that is, the pedicle hook with a pedicle screw in a hybrid construction has not yet been assessed. Objective Our objective was to assess, in adolescent scoliosis Lenke 1 and 3 operated by posteromedial translation using sublaminar bands, the proximal fixation claw influence (transverse-pedicular hook vs. transverse hook-pedicular screw) for postoperative correction and the proximal junctional kyphosis (PJK) at 2 years follow-up. Materials and methods A comparative monocentric retrospective study included adolescent idiopathic scoliosis thoracic requiring surgery, between 2015 and 2017, with 2 years follow-up. Clinical (complications, revision surgery, and scoliosis research society-30) and radiographic (coronal and sagittal parameters) assessment were reported. Radiologic PJK was defined by a proximal junctional angle increase of 10 degrees or more between postoperative period and the last follow-up. Results Sixty patients (age at surgery=16±2 y; mean Cobb angle=58.2±12 degrees) were divided into 2 similar groups according to upper fixation: transverse-pedicular hook (H-H) and transverse hook-pedicle screw (S-H). No statistical differences were found for correction parameters (P>0.05). We reported 2 cases of PJK in H-H group (N=2/30=6.6%) and none in S-H group (N=0/30) (P=0.1) none requiring revision. No infectious or neurological events were reported. Mean scoliosis research society-30 was 126±12.7 in H-H group whereas 129.3±10 in S-H group (P=0.4). Conclusions No differences in postoperative correction and clinical results at 2 years follow-up were found. A claw with transverse-pedicular hook increase proximal junctional angle without significant increase on radiographic PJK incidence compared with a claw with transverse hook and pedicle screws.

Purpose The pediatric Simple Knee Value (pedi-SKV) is an outcome score in which paediatric patients are asked ‘How would you rate your knee today as a percentage of normal (0% to 100% scale with 100% being normal)?’. The primary aim of this study was to validate the pedi-SKV by measuring its correlation with validated knee function scores used most often in paediatric orthopaedics. Methods This prospective study was conducted at a teaching hospital to evaluate the pedi-SKV's validity. A total of 44 paediatric patients (ten to 15 years old), were enrolled prior to anterior cruciate ligament reconstruction as well as 17 healthy controls. A survey form consisting of the Lysholm, International Knee Documentation Committee Pediatric Form (Pedi-IKDC) and pedi-SKV was given to subjects twice (enrolment and six months postoperatively). The criterion validity of the pedi-SKV was determined by correlating it to existing knee functional scores. Responsiveness to change was evaluated by comparing the pedi-SKV scores before and after surgery (enrolment visit and six-month postoperative visit). Discriminative ability was evaluated by comparing the pedi-SKV distribution in patients versus controls. Results There was a strong and significant correlation between the pedi-SKV and the Lysholm and Pedi-IKDC (p < 0.0001). The pedi-SKV had a good responsiveness to change (p < 0.0001 for the pedi-SKV before versus six months postoperatively). Like the other knee-specific functional sores (p < 0.0001), the pedi-SKV was able to distinguish between patients and controls (p < 0.0001). Conclusion The pedi-SKV is a valid outcome measure that is strongly correlated with the Lysholm and Pedi-IKDC. This is a novel simple score that can be used by physicians in their daily practice. Level of evidence II

The aim of the study was to evaluate flexible flatfoot (FFF) diagnostic and current therapeutic modalities, as well as treatment expectations, among members of the European Paediatric Orthopaedic Society (EPOS). A 59-questions survey on FFF diagnosis and treatment preferences was distributed to EPOS members. The survey consisted of six sections (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; and (6) management options. Descriptive statistics were performed. A total of 93 responses were analysed. In general, clinical parameters, age (91.4% of cases), laxity (81.7%), diffuse pain (84.9%), and pain at the ankle joint (81.7%) were rated as 'average' and 'crucial importance' by the vast majority of respondents. Meary's angle (47.3% of cases), talonavicular coverage (35.5%), and lateral talocalcaneal angle (35.5%) were assessed as main radiological tools in the FFF evaluation. Among respondents, 61.3% rated 'improved ability to walk longer without symptoms' as of 'crucial importance'. Eighty-two percent of the respondents felt less than 10% of patients with FFF are candidates for corrective surgery. Arthroereisis (29.3%) was the most common surgical procedure (16.4% for subtalar and 12.9% for extra-articular arthroereisis, respectively), followed by lateral column lengthening (17.9%) and medializing calcaneal osteotomy (12.3%). There is great variation among respondents in diagnostic and treatment preferences in the management of children with FFF. The results of the EPOS 2019 FFF survey clearly show that large-scale, multicentric, international studies are necessary to elucidate which diagnostic and treatment practices lead to the best outcomes.

Resume Introduction La densite optimale de vis pediculaires pour le traitement des scolioses idiopathiques de l’adolescent (SIA) reste inconnue. L’augmentation de la densite d’implants n’est pas systematiquement associee a de meilleurs resultats cliniques. Une large variabilite de densite d’implants existe selon les montages par vis pediculaires ou hybrides. Une heterogeneite significative existe entre le nombre de bandes sous-lamaires (BSL) utilisees et l’influence de la densite des BSL sur la correction des deformations des SIA. Hypothese L’augmentation de la densite de BSL n’ameliore pas les corrections des courbes dans les plans sagittal et coronal. Methode Il s’agit d’une etude monocentrique retrospective portant sur 131 patients (118 filles) atteints d’une SIA Lenke 1 et operes entre 2012 et 2015 par deux chirurgiens realisant la meme technique chirurgicale avec le meme montage hybride avec BSL. La densite de BSL correspondait au nombre de BSL rapporte au nombre de vertebres instrumentees. Les mesures radiographiques comprenaient la flexibilite preoperatoire thoracique, l’index de reduction de Cincinnati (IRC) et les corrections postoperatoires des angles de cyphose (CPCyp) et de Cobb thoracique (CPCobb) a partir de radiographies realisees en postoperatoire immediat et a 2 ans. Resultats L’âge median des patients etait de 15,6 ans (EIQ, 12–18). La mediane de densite des BSL etait de 0,4 (EIQ, 0,4–0,5). Aucune correlation significative n’a ete identifiee entre la densite de BSL et l’IRC (p = 0,71), le CPCobb (p = 0,55), et le CPCyp (p = 0,61) a 2 ans postoperatoire. La flexibilite preoperatoire avait un effet significatif sur les corrections en postoperatoire immediat (r = −3,02, p Discussion Les BSL utilisees pour les montages hybrides chez les patients avec une SIA Lenke 1 flexible ont permis des corrections satisfaisantes des deformations quelle que soit la densite de BSL. Une faible densite de BSL est appropriee pour les patients avec une SIA Lenke 1 flexible.

The Simple Knee Value (SKV) is an outcome score in which patients are asked to grade their knee function as a percentage of that of a normal knee. The primary aim of this study was to validate the SKV by measuring its correlation with existing knee-related PROMs. This was a prospective study conducted at a teaching hospital to assess the SKV’s validity. The study enrolled 47 young patients (16–54 years old), 49 older patients (≥ 55 years) and 30 healthy controls. A paper questionnaire consisting of the Lysholm, IKDC, KOOS, WOMAC and SKV was given to subjects three times (enrolment, 1-month preoperative visit and 6 months postoperative visit). The criterion validity of the SKV was determined by correlating it to existing knee PROMs using the Spearman correlation coefficient (S). SKV test–retest reliability was assessed by the intraclass correlation coefficient (ICC) between two time points (initial consultation at enrolment and preoperative visit, reflecting the same clinical condition). Responsiveness to change was determined by comparing the SKV scores before and after surgery (enrolment consultation and 6 months postoperative). Discriminative ability was determined by comparing the SKV distribution in patients and controls. There was a strong and significant correlation between the SKV and the gold standard Lysholm, IKDC, KOOS and WOMAC in the younger patients and the older patients (p

Resume Introduction La rupture du ligament croise anterieur (LCA) est de plus en plus frequente chez l’enfant. L’objectif de notre etude etait d’evaluer les modifications de la marche des enfants avec une lesion du LCA, et surtout les adaptations de la cheville et du pied a l’instabilite du genou. Hypothese Les enfants compensent l’instabilite anterieure du genou pendant la marche par des adaptations au niveau de la cheville et du pied, car la compensation au niveau de la hanche et du bassin necessite une depense importante d’energie. Materiel et methode Quarante sept patients (14 filles, 33 garcons) âges de 9 a 17 ans (âge moyen 14,1) avec une lesion unilaterale du LCA ont ete analyses. La lesion du LCA etait confirmee par IRM et traitee initialement par immobilisation et reeducation. Tous les patients etaient symptomatiques, avec sensation d’instabilite du genou. Une analyse quantifiee de la marche (AQM) a ete realisee avec etude de la cinematique de la cheville (en appui et en phase oscillante) et de la progression plantaire. Les donnees des patients ont ete comparees a la reference de notre laboratoire et aux valeurs d’un groupe de 37 enfants sains (analyse statistique teste t). Resultats Par rapport a la reference du laboratoire : la cheville etait en flexion plantaire (FP) a l’attaque du pas pour 41 patients. La flexion dorsale (FD) du pied etait diminuee pour 39 patients en phase d’appui. La progression plantaire en rotation externe etait augmentee pour 23 patients en phase d’appui et pour 38 patients en phase oscillante. Par rapport au groupe des patients sains : les enfants avec lesion du LCA marchaient en FP de cheville a l’attaque du pas (3,43° ± 3,5 vs 0,74° ± 3,6, p Discussion Les enfants presentant une instabilite anterieure du genou ont developpe des compensations au niveau de la cheville et du pied qui permettent une meilleure stabilisation du genou. La comprehension de ces adaptations pourrait etre utile dans le traitement de cette pathologie. Niveau d’evidence III. Etude retrospective comparative.

Purpose: The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society. Methods: The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire. Results: The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of “crucial importance” for expected outcome of supracondylar humerus fractures treatment. Conclusion: Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated. Level of evidence: level II.

We are reporting on the x-ray and magnetic resonance imaging (MRI) follow-up of an 8-year-old boy who underwent transphyseal anterior cruciate ligament reconstruction with a 4-strand semitendinosus tendon graft. His graft was followed for 5 years by MRI, demonstrating a satisfactory but slow and gradual ligamentization process.The long-term MRI follow-up demonstrated the satisfactory outcome of the transphyseal reconstruction, although with a slower and more progressive ligamentization process than in adult patients.

Medial patello-femoral ligament (MPFL) reconstruction is one of the therapeutic options to treat patellofemoral instability. Classically, a "à la carte" treatment of skeletal and ligament abnormalities is described. This option is difficult to achieve in children because bony procedures can damage the femoral and / or tibial growth plate. The objective was to evaluate a strategy for isolated reconstruction of the MPFL in the treatment of objective patellar instabilities in children, in a large cohort. The return to sport, knee function and pain or discomfort were studied as secondary endpoints.This French multicenter retrospective study included 54 pediatric patients with objective patellofemoral instability. Patients were included if they had presented at least 2 episodes of objective patella dislocation. A Deie-like technique with gracilis tendon graft, soft tissue femoral fixation and patellar bone tunnels for patellar fixation was used. Recurrence of dislocation was studied as the primary endpoint, and the recurrence rate was compared with the literature. A comparison of functional scores (Kujala, Lille femoro-patellar instability score (LFPI Score) and Tegner) and NRS between pre- and postoperative was studied as a secondary objective.A recurrence of femoro-patellar instability was observed for five patients within 2 years follow up (9%). A significant improvement of the Kujala, LFPI score, Tegner and NRS scores was observed (p0.001).Isolated reconstruction of the MPFL presents a risk of recurrence of 9% at 2 years follow-up. This technique significantly improves the functional scores of the knee. This modified Deie technique provides good clinical and functional results, allowing return to sports with an acceptable risk of recurrence of patellar dislocation, similar to those observed in the literature. Isolated MPFL reconstruction as a first-line treatment appears to be a reliable and effective technique in terms of recurrence of dislocation and functional scores. It allows early recovery and rehabilitation and has lower morbidity than procedures requiring bone gestures.III, retrospective comparative study.

Introduction The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients has acutely increased over the last 20 years, yet there is no consensus on a single "best treatment". Selection of an optimal treatment is critical and based on individual circumstances; consequently, we propose a treatment-selection algorithm based on (i) skeletal development, (ii) ACL tear location, type, and quality, as well as (iii) parental perspective in order to facilitate the decision-making process. Evidence acquisition We combined our surgical group's extensive case histories of ACL tear management in Tanner Stage 1 and 2 patients with those in the literature to form a consolidated data base. For each case (i) the diagnostic phase, (ii) communication with patient and parents, (iii) treatment choice(s), (iv) selected surgical techniques and (v) rehabilitation schedule were critically analyzed and compared for patient outcomes. Evidence synthesis MRI-imaging and intraoperative tissue quality assessment were preeminent in importance for selection of the optimal treatment strategy. Considerations for selecting an optimal treatment included: (i) associated lesions, (ii) the child/patient and parent(s)' well-informed and counseled consent, (iii) biological potential, and (iv) the potential for successful ACL preservative surgery. Complete ACL tears were evaluated according to tear-location. In Type I and II ACL tears with remaining good tissue quality, we propose primary ACL repair. In Type III and IV ACL tears we propose physeal-sparing reconstruction with an iliotibial band graft. Finally, in the case of a Type V ACL tear, we propose that the best treatment be based on the Meyers-McKeever classification. Conclusions We present a facile decision-making algorithm for ACL management in pediatric patients based on specific elements of tissue damage and status.

Determining which spinal levels to instrument during surgical treatment of Lenke Type 1 adolescent idiopathic scoliosis (AIS) depends on the reducibility of the primary and secondary curve patterns. This reducibility can be evaluated in several ways, with the most popular being radiographs in bending for moderate thoracic and lumbar curvatures. Hypothesis Side-bending radiographs will alter the choice of the lowest instrumented vertebra (LIV) for the surgical treatment of AIS.Thirteen experienced French spine surgeons were invited to perform surgical planning on 23 patients based on stereoradiographs with and without (standing) side-bending views. The surgical planning was repeated a second time to assess the intra- and inter-rater reliability. Variations in the choice of LIV were analyzed for each evaluation.The intra-rater reliability was moderate to substantial. The inter-rater reliability was low to moderate. The study compared 879 surgical plans. Selective fusion was chosen in 0.3% of the plans. The median LIV was L2. The availability of side bending views changed the plan in 39% of cases. However, 36% of the plans were changed in the control (test-retest) condition. No significant difference was found between the variations with side-bending radiographs and "control" variations (p0.05).The use of radiographs in bending has no significant effect on the LIV choice in this study. This result is derived from statistically robust analysis made possible by one of the largest datasets available on this topic. Large inter-rater variability was observed and will be explored further in a future study.II; non-randomized controlled comparative study.

International audience; Purpose: The aims of the present study were to compare the biomechanical properties of tibial fixation in hamstring-graft ACL reconstruction using interference screw and a novel combination interference screw and dowel construct. Material and methods: We compared the fixation of 30 (2- and 4-stranded gracilis and semitendinosis tendons) in 15 fresh-frozen porcine tibiae with a biocomposite resorbable interference screw (Group 1) and a screw and dowel construct (Group 2). Each graft was subjected to load-to-failure testing (50 mm/min) to determine maximum load, displacement at failure and pullout strength.Results: There were no significant differences between the biomechanical properties of the constructs. Multivariate analysis demonstrated that combination constructs (β = 140.20, p = 0.043), screw diameter (β = 185, p = 0.006) and 4-strand grafts (β = 51, p = 0.050) were associated with a significant increase in load at failure. Larger screw diameter was associated with increased construct stiffness (β = 20.15, p = 0.020).Conclusion: The screw and dowel construct led to significantly increased fixation properties compared to interference screws alone in a porcine model. Increased screw diameter and utilization of 4-strand ACL grafts also led to improvement in load-to-failure of the construct. However, this is an in vitro study and additional investigations are needed to determine whether the results are reproducible in vivo.Level of evidence: Level V; Biomechanical study.

Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by obesity, hypotonia, feeding difficulties, obesity, musculoskeletal manifestations including scoliosis, and hip dysplasia (HD). The aim of this study was to characterize the clinical and radiographic evolution of HD in the pediatric PWS population.The authors performed a retrospective cohort study of 72 patients (147 anteroposterior pelvic radiographs) between January 2004 and December 2016. Center-edge angle (CEA) of Wiberg, acetabular index (AI), and neck-shaft angle (NSA) were measures in all hips. The relationship between radiographic and demographic parameters of age, sex, and body mass index z-score (BMIzs) were assessed.A total of 274 radiographic measurements were performed and analyzed in 72 patients. The mean CEA, AI, and NSA were 21.8±7.1 degrees (range, 5 to 35 degrees), 16.7±7 degrees (range, 5 to 45 degrees), and 142±8.5 degrees (range, 128 to 165 degrees), respectively. HD was diagnosed in 79 (29%) hip radiographs and varied significantly between the age groups (P0.01). A statistically significant association was identified between age and CEA [β coef, 0.80; 95% confidence interval (CI), 0.6-1; P0.01], AI (β coef, -0.90; 95% CI, -1.1 to -0.7; P0.01), and NSA (β coef, -1.11; 95% CI, -1.4 to -0.9; P0.01) angles. Sex and BMIzs were not identified as independent predictors of radiographic hip angles (P0.1).The present study demonstrated favorable evolution of hip radiographic parameters in the PWS population treated with growth hormone early in development. This finding should prompt orthopedists to consider observation alone in the management algorithm for HD in patients with PWS.Level III-a retrospective comparative study.

Resume Introduction L’incidence et la precocite des ruptures du ligament croise anterieur (LCA) dans la population pediatrique sont en augmentation. L’algorithme therapeutique reste controverse chez les patients avant maturite osseuse concernant l’indication, le moment de la chirurgie, le choix de la technique et le type de greffon. Des troubles de croissance ont ete rapportes et demeurent une preoccupation dans la decision therapeutique. L’objectif primaire etait d’observer les tendances actuelles sur la prise en charge des ruptures du LCA avant maturite osseuse aupres des membres de la Societe francophone d’arthroscopie (SFA). L’objectif secondaire etait de determiner l’incidence, le type et la severite des troubles de croissance apres reconstruction du LCA. Hypothese Les dernieres donnees de la litterature tendent au developpement des techniques transphysaires et a la reconstruction chirurgicale precoce y compris chez l’enfant prepubere. Materiel et methodes Une invitation par messagerie electronique a remplir un questionnaire de 52 questions a ete envoyee a tous les membres de la SFA. La participation etait volontaire et les reponses confidentielles. Les donnees etaient automatiquement collectees via le site SurveyMonkey. Des statistiques descriptives etaient appliquees. Resultats Cent quarante-deux chirurgiens membres de la SFA ont repondu au questionnaire, soit un taux de reponse de 11 %. A la question « quel traitement recommandez-vous pour une rupture du LCA chez un enfant pre-pubere », 14 % ont repondu « reconstruction du LCA dans les 3 mois ». A la meme question concernant un enfant pubere, 35 % recommandaient la reconstruction du LCA dans les 3 mois. Le tunnel tibial prefere etait transphysaire chez un enfant pre-pubere (44,4 %) et transphysaire chez un enfant pubere (97,7 %). Le tunnel femoral prefere etait epiphysaire chez un enfant pre-pubere (62,2 %) et transphysaire pour un enfant pubere (55,5 %). Sept pour cent des participants ont rapporte des troubles de croissance apres reconstruction du LCA. Conclusion L’etat actuel des pratiques demeure a ce jour non consensuel. La tendance est a la realisation de tunnels transphysaires y compris chez l’enfant prepubere. Les cas rapportes de troubles de croissance significatifs sont relativement rares mais doivent faire l’objet de precautions techniques. Niveau IV Etude epidemiologique descriptive.

Background Anterior cruciate ligament (ACL) tears are becoming more common and occurring at earlier ages in the paediatric population. The surgical indications and the optimal time for surgery, technique, and graft type remain controversial in skeletally immature patients. Growth disturbances have been reported after ACL reconstruction, further complicating treatment decisions. The primary objective of this study was to describe current practices of French Arthroscopy Society (Societe Francophone d’Arthroscopie, SFA) members regarding ACL tear management in skeletally immature patients. The secondary objectives were to determine the incidence, type, and severity of growth disturbances after ACL reconstruction. Hypothesis Recent publications support early surgical reconstruction and the further development of transphyseal techniques, even in pre-pubertal patients. Material and methods An email invitation to complete a 52-item questionnaire was sent to all SFA members. Participation was voluntary and replies were kept confidential. The data were collected automatically via the SurveyMonkey® tool. Descriptive statistics were computed. Results Of 1280 invited SFA members, 142 replied, yielding a participation rate of 11%. Among respondents, 14% recommended ACL reconstruction within 3 months for pre-pubertal patients, compared to 35% for pubertal paediatric patients. The preferred tibial tunnel was transphyseal for both pre-pubertal patients (44.4% of respondents) and pubertal patients (97.7% of respondents). The preferred femoral tunnel was epiphyseal for pre-pubertal patients (62.2% of respondents) and transphyseal for pubertal patients (55.5% of respondents). Growth disturbances after ACL reconstruction were reported by 7% of respondents. Conclusion No consensus exists to date about the surgical management of ACL tears in skeletally immature patients. Transphyseal tunnels are gaining in popularity, even for pre-pubertal children. Reports of significant growth disturbances, although relatively rare, warrant the implementation of technical precautions. Level of evidence IV, descriptive epidemiological survey.

Resume Introduction La determination du pronostic articulaire des la phase de condensation dans la maladie de Legg-Perthes-Calve (MLPC) est precieuse afin de selectionner les patients pouvant beneficier d’une chirurgie precoce. Une correlation positive significative avait ete etablie entre le ratio du coefficient apparent de diffusion metaphysaire et la classification de Herring dans une serie preliminaire portant sur 49 IRM. La valeur seuil de ratio du coefficient apparent de diffusion (ADC) superieure a 1,63 etait associee a un mauvais pronostic. Hypothese Cette correlation pronostique se verifie a moyen terme sur l’evolution radiographique. Materiels et methode Etude prospective chez 27 enfants (âge moyen 13 ans ; 9,5 a 16) presentant une MLPC unilaterale. Quarante-neuf IRM ont ete realisees en phase de condensation ou de fragmentation. La quantification bilaterale de l’ADC de la tete et du col femoral a permis de mesurer le ratio d’ADC entre cote pathologique et cote sain. Les patients etaient revus regulierement jusqu’a un recul minimal de 5 ans. Le ratio d’ADC etait compare au grade de Stulberg au dernier recul. Resultat Au recul moyen de 6,8 ans (5,2–8,4) a partir de l’IRM initiale, 13 hanches etaient classees Stulberg 1 et 2, 13 Stulberg 3 et 4, et une Stulberg 5. Le ratio d’ADC metaphysaire augmentait significativement avec le grade de Stulberg (p Discussion/conclusion Non irradiante et non invasive, l’IRM de diffusion en complement des sequences morphologiques est utile pour la prise en charge de la MLPC. L’elevation de l’ADC dans le col apparait comme un element pronostique pejoratif statistiquement correle au grade de Herring au stade de fragmentation et au grade de Stulberg au stade de sequelle. L’elevation precoce de la diffusion dans le col pathologique permettrait de selectionner les enfants susceptibles de beneficier plus precocement d’un traitement chirurgical avant le stade de fragmentation necessaire a l’etablissement du grade de Herring. Niveau de preuve III, etude prospective non controlee.

The Fitbone® motorized nail system has been used to correct limb length discrepancies (LLD) for several years. This study focuses on its application in posttraumatic limb lengthening surgery, its outcome and challenges. Materials and methods: A prospective, single center study was conducted between 2010 and 2019 in patients treated with motorized lengthening nails. The inclusion criteria were symptomatic LLD of 20 mm or more. An imaging analysis was done using TraumaCad® software (Brainlab AG, Munich, Germany) to compare frontal alignment angles and limb length discrepancy (LLD) on preoperative and latest follow-up radiographs of the lower limbs. Results: Thirty-four patients were included with a mean age of 28.8 ± 9.7 years, a mean follow-up of 27.8 ± 13 months and a mean hospital stay of 4.4 ± 1.7 days. The mean LLD was 44 ± 18 mm in 29 femoral and 32 ± 8 mm in 4 tibial cases, which was reduced to less than 10 mm in 25/34 (74%) patients. The mean healing index was 84.6 ± 62.5 days/cm for femurs and 92 ± 38.6 days/cm for tibias. The mean time to resume full weight-bearing without walking aids was 226 days ± 133. There was no significant difference between preoperative and final follow-up alignment angles and range of motion. The mechanical lateral distal femoral angle (mLDFA) was corrected in the subgroup of 10 LLD patients with varus deformity of the femur (preoperative 95.7° (±5.0) vs. postoperative 91.5° (±3.4), p = 0.008). According to Paley’s classification, there were 14 problems, 10 obstacles and 2 complications. Discussion: Six instances of locking screw pull out, often requiring reoperation, raise the question of whether a more systematic use of blocking screws that provide greater stability might be indicated. Lack of compliance can lead to poor outcomes, patient selection in posttraumatic LLD patients is therefore important. Conclusion: Limb lengthening with a motorized lengthening nail for posttraumatic LLD is a relatively safe and reliable procedure. Full patient compliance is crucial. In-depth knowledge of lengthening and deformity correction techniques is essential to prevent and manage complications.

Resume Introduction La periode de confinement de 8 semaines, imposee en raison de l’epidemie liee au Covid-19, a entraine une restriction de la circulation, un arret de la scolarite et des activites sportives. Notre hypothese est que cette situation inedite a modifie temporairement l’epidemiologie des traumatismes chez l’enfant. Materiel et methode Il s’agit d’une etude prospective realisee pendant les 8 semaines de confinement. L’activite d’urgence traumatologique pediatrique a ete comparee a l’activite des 3 annees precedentes a la meme periode. Resultats Pendant le confinement, le taux de passage aux urgences a diminue de 50 %. Le taux de patients operes representait 86 % par rapport aux 3 annees precedentes. Les patients operes pendant le confinement avaient une moyenne d’âge de 7,6 ans (âge median 7,5) contre 9,3 ans (âge median 9,4) les annees precedentes. On notait une augmentation des accidents domestiques (59 % versus 23 %) et des accidents de trampoline (16 % versus 5 %), et une diminution des accidents de sport et des accidents de locomotion. Les plaies etaient plus frequentes en periode de confinement, representant 35 % des actes chirurgicaux contre 13 % les annees precedentes. Le nombre de patients operes pour fracture au membre superieur a diminue alors qu’il restait similaire pour le membre inferieur. Les fractures distales de l’avant-bras etaient moins frequentes, ainsi que les fractures distales de jambe. Discussion Notre etude a montre pendant le confinement une reduction de 50 % de l’activite de traumatologie aux urgences sans diminution de l’activite au bloc operatoire. En cas de nouvelle periode de confinement, nous recommanderions une reorganisation de l’accueil aux urgences permettant de liberer des equipes pour l’accueil des patients Covid-19; et le maintien d’un bloc operatoire pour les urgences chirurgicales. Une information pourrait etre proposee au public pour la prevention des accidents domestiques, ainsi que des risques lies aux activites de trampoline. Niveau de preuve III.

The aims of the present study were to compare the biomechanical properties of tibial fixation in hamstring-graft ACL reconstruction using interference screw and a novel combination interference screw and dowel construct.We compared the fixation of 30 (2- and 4-stranded gracilis and semitendinosis tendons) in 15 fresh-frozen porcine tibiae with a biocomposite resorbable interference screw (Group 1) and a screw and dowel construct (Group 2). Each graft was subjected to load-to-failure testing (50 mm/min) to determine maximum load, displacement at failure and pullout strength.There were no significant differences between the biomechanical properties of the constructs. Multivariate analysis demonstrated that combination constructs (β = 140.20, p = 0.043), screw diameter (β = 185, p = 0.006) and 4-strand grafts (β = 51, p = 0.050) were associated with a significant increase in load at failure. Larger screw diameter was associated with increased construct stiffness (β = 20.15, p = 0.020).The screw and dowel construct led to significantly increased fixation properties compared to interference screws alone in a porcine model. Increased screw diameter and utilization of 4-strand ACL grafts also led to improvement in load-to-failure of the construct. However, this is an in vitro study and additional investigations are needed to determine whether the results are reproducible in vivo.Level V; Biomechanical study.

Pectus excavatum is a common chest malformation, classically asymptomatic. The pectus excavatum surgical procedure allows aesthetic correction. Funnel chest is a malformation frequently associated with thoracic scoliosis, especially in Marfan syndrome. Scoliosis is treated with first-line nonsurgical treatment. Second-line treatment consists of a scoliosis operation. In this case report, we present an exceptional emergency indication of funnel chest correction with the Ravitch procedure for a 14-year-old girl who presented with postoperative acute compression of the inferior vena cava due to a surgical scoliosis correction.

Due to the danger of repeated exposure to X-rays for patients with Adolescent Idiopathic Scoliosis (AIS), reducing the number of radiographs is necessary. By using Surface Topography (ST), trunk asymmetry evaluation could be used. The number of radiographs required can be reduced by 30% when the radio is used only for patients with worsening ST. ST is a reliable technique for deformity monitoring in AIS. Observational prospective study. The risk of curve progression in AIS is high during a growth spurt and necessitates regular radiographic follow-up, despite the adverse effects of repeated exposure to X-rays. The aim of this study was to determine a simple and reproducible parameter for deformity monitoring using ST in AIS patients. Consecutive AIS patients with a Cobb angle between 10° and 40° were included. Every 6 months, X-ray and ST acquisitions were performed. Radiographic parameters and the ribs prominence curve calculated from ST were collected. This curve was deduced from the axial rotation of the 100 axial sections of the trunk. We analyzed correlations between the evolution of Cobb angle and the curve. 123 patients were included, 111 girls, 12 boys, mean age 12 years. The measurement of the curve had a good reproducibility (ICC: 0.816). ST differentiated patients with or without increased Cobb. (p = 0.0294). ST is useful for monitoring AIS. This device could reduce the number of radiographs by 30%. II.

International audience; The adolescent idiopathic scoliosis (AIS) is a 3D deformity of the spine whose origin is unknown and clinical evolution unpredictable. In this work, a mixed theoretical and numerical approach based on energetic considerations is proposed to study the global spine deformations. The introduced mechanical model aims at overcoming the limitations of computational cost and high variability in physical parameters. The model is constituted of rigid vertebral bodies associated with 3D effective stiffness tensors. The spine equilibrium is found using minimization methods of the mechanical total energy which circumvents forces and loading calculation. The values of the model parameters exhibited in the stiffness tensor are retrieved using a combination of clinical images post-processing and inverse algorithms implementation. Energy distribution patterns can then be evaluated at the global spine scale to investigate given time patient-specific features. To verify the reliability of the numerical methods, a simplified model of spine was implemented. The methodology was then applied to a clinical case of AIS (13-year-old girl, Lenke 1A). Comparisons of the numerical spine geometry with clinical data equilibria showed numerical calculations were performed with great accuracy. The patient follow-up allowed us to highlight the energetic role of the apical and junctional zones of the deformed spine, the repercussion of sagittal bending in sacro-illiac junctions and the significant role of torsion with scoliosis aggravation. Tangible comparisons of output measures with clinical pathology knowledge provided a reliable basis for further use of those numerical developments in AIS classification, scoliosis evolution prediction and potentially surgical planning.

Patient: Male, 13-year-old Final Diagnosis: Meniscectomy Symptoms: Knee joint pain Medication: — Clinical Procedure: Arthroscopy Specialty: Orthopedics and Traumatology Objective: Unusual setting of medical care Background: Implantation of the Actifit® polyurethane meniscal scaffold is indicated for knee pain after partial meniscectomy in adults who are skeletally mature. This report is of a case of implantation of an Actifit® polyurethane meniscal scaffold 18 months after subtotal lateral meniscectomy in a 13-year-old male adolescent. Case Report: A 13-year-old male presented with right knee pain, localized to the lateral joint, 18 months after undergoing subtotal lateral meniscectomy. Magnetic resonance imaging (MRI) of the knee showed a complete amputation of the lateral meniscal middle segment with subchondral bone damage. Arthroscopic exploration of the knee joint showed a subtotal posterior and middle lateral meniscectomy and a 4 cm2 area of International Cartilage Repair Society (ICRS) grade 3 cartilage damage on the posterior aspect of the lateral tibial plateau. The antero-lateral portal was enlarged to introduce the Actifit® scaffold. The implant was secured using three all-inside Fast-Fix® sutures and three outside-in vertical sutures, which rapidly reduced the pain symptoms. At five-year follow-up, the patient reported no pain, and he had resumed sporting activities and recovered a full knee range of motion at 0/0/145°. MRI showed a type 2 meniscal implant shape and size, according to the Genovese MRI score. The ICRS MRI score was stable at grade 3b. Conclusions: This case showed that the use of the Actifit® polyurethane meniscal scaffold is an option for the treatment of knee pain after partial or subtotal meniscectomy in skeletally immature patients, resulting in a stable functional outcome at five-year follow-up.

We hypothesized that bracing alone was an adequate treatment for idiopathic EOS and was as effective as serial casting in most cases. This retrospective, single Institution series demonstrates this is a valid alternative under close monitoring.

Arthroscopy simulators offer safe and reproducible training to orthopaedic residents, thereby obviating the need for cadaver specimens. In addition, they collect data that can serve to investigate learning curves and evaluate training programmes with the goal of improving the quality of arthroscopy teaching. In this study, a cohort of surgeons was evaluated before and after a European theoretical and practical training programme that used a knee arthroscopy simulator. The primary objective was to assess whether the overall performance score was improved by the training programme. The secondary objectives were to determine which tasks and skills were improved by the programme, to compare a novice group to an experienced group, and to identify targets for improvement.A theoretical and practical training course improves the scores achieved on an arthroscopy simulator task.A prospective comparative study was performed in 34 surgeons during the advanced arthroscopy training course organised by the European Paediatric Orthopaedic Society (EPOS) in January 2018. All participants performed a diagnostic task on the VirtaMed ArthroS™ simulator before and after the programme. The participants were divided into two groups based on number of knee arthroscopies performed each year, i.e.,20 (experienced group) vs.≤20 (inexperienced group). The following parameters were compared between the two groups: overall score, operative time, percentage of iatrogenic injuries, camera and hook path lengths, and success in identifying anatomical structures.The overall score on the diagnostic task was 199 before and 203 after the training programme (p=0.02). The operative time decreased significantly, from 185 to 115.9seconds (p0.01). Camera path length decreased from 85.2 to 49.2cm and hook path length from 65.5 to 15.0cm (p0.05). The mean proportion of arthroscopies with iatrogenic tibial cartilage injuries diminished from 2.7%±1.7% (range, 0-6.7) to 1.8%±1.8% (range, 0-7) (p=0.03); no change occurred in femoral injuries. When each group was assessed separately, the only significant change found in the experienced group was a decrease in operative time, whereas in the inexperienced group all parameters improved significantly. However, visualisation of anatomical structures was unchanged.Participation in the training programme improved overall performance, and the gains were greatest in the inexperienced group. During the post-training evaluation, some of the major anatomical structures were classified by the simulator as incompletely visualised, raising concern about a risk of underdiagnosis during arthroscopic explorations.III, prospective comparative study.

Resume Introduction Les simulateurs d’arthroscopies permettent de proposer un entrainement sur et reproductible aux chirurgiens en formation en s’affranchissant de pieces anatomiques. Les donnees collectees par ces appareils permettent egalement de mieux comprendre la courbe de progression de ces chirurgiens, d’evaluer un programme de formation pour ameliorer la qualite pedagogique de l’enseignement en arthroscopie. L’hypothese de travail est qu’une periode de formation pratique et theorique permettrait une amelioration des scores obtenus par simulateur d’arthroscopie. Objectif Etudier le comportement d’une cohorte de chirurgiens avant et apres un cours theorique et pratique europeen en arthroscopie a l’aide d’un simulateur d’arthroscopie de genou. Identifier les tâches les aptitudes modifiees grâce a cet enseignement. L’objectif principal est d’objectiver une amelioration du score general obtenu avant et apres la periode de formation. Les objectifs secondaires sont d’etudier les differents parametres ameliores, comparer un groupe novice et confirme, identifier des points a ameliorer chez les participants a cette formation. Methode Trente-quatre chirurgiens ont ete inclus dans cette etude de niveau III, lors du cours avance d’arthroscopie de l’European Paediatric Orthopaedic Society (EPOS) en janvier 2018. Une premiere evaluation des participants a ete realisee a l’aide du ArthroS TM Arthroscopy Simulator lors d’un exercice diagnostic d’arthroscopie de genou avant le cours. Les participants ont ensuite ete evalues a l’issu du cours. Deux sous-groupes ont ete etudies : le groupe A (non debutant, realisant plus de 20 arthroscopies de genou par an) et le groupe B (debutant pratiquant moins de 20 arthroscopies par an). Les donnees collectees suivantes ont ete comparees : la note globale, la duree de realisation de l’exercice, le pourcentage de lesions iatrogenes, la distance parcourue par les instruments ainsi que l’identification des structures anatomiques. Resultats Avant la realisation du cours, la note globale a l’exercice diagnostic etait de 199, apres la periode de formation elle passe a 203 (p = 0,02). La duree de realisation de l’exercice etait significativement raccourcie de 185 a 115,9 secondes (p Conclusion La participation au cours a ameliore les resultats globaux. Cette amelioration etait particulierement profitable aux participants debutants en arthroscopie. Apres repetition de l’exercice certaines structures anatomiques importantes n’etaient pas completement considere par le simulateur comme correctement visualisees ce qui suggererai une tendance au sous-diagnostic. Niveau de preuve III, etude prospective cas-temoin.