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Background: Although anterior cruciate ligament (ACL) injury rates have been studied extensively, it is unclear whether levels of functional and psychological readiness for return-to-sport after primary ACL reconstruction (ACLR) differ based on an athlete's primary sport. Hypothesis: Youth athletes in different primary sports will demonstrate differences in short-term functional recovery, as well as patient-reported psychological and functional recovery after primary ACLR. Study Design: Retrospective cohort study of consecutive patients treated for ACL injury in pediatric sports medicine clinics. Level of Evidence: Level 3. Methods: Patients included underwent primary ACLR between December 1, 2015 and December 31, 2019 and reported sports participation at the time of injury. Demographic data, sports participation, surgical data, functional testing scores (Y-Balance Test [YBT]), functional and psychological patient-reported outcome measures (PROMs), and timing of return-to-play clearance were reviewed. YBT scores were the primary metric for clearance. Four groups were studied: soccer, football, basketball, and other. Results: A total of 220 male and 223 female athletes were included; 65.28% of soccer players were female and 100% of football players were male (P < 0.01). At initial postoperative YBT testing (6-9 months), soccer players had higher operative (P < 0.01) and nonoperative (P < 0.01) leg composite scores when compared with basketball players. No significant differences were found between sports in functional or psychological PROMs at presurgical baseline or 6 months postoperatively. When compared with football, soccer players completed functional clearance in a shorter time from surgery (P = 0.02). Multivariate analysis showed level of competition as a significant independent variable for clearance in female athletes. Conclusion: After primary ACLR, athletes, especially female athletes, demonstrated short-term sport-specific differences in YBT scores. Soccer players attained clearance sooner than football players. Level of competition influenced YBT composite scores in all athletes and time to clearance in female athletes. Clinical Relevance: Sport-specific differences in reinjury should be investigated to determine whether changes in return-to-play evaluation should be implemented. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. Purpose: To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). Results: In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P <.001), peripheral rim instability (P =.005), and longitudinal tears (P =.015) and require a meniscal repair (P <.001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P =.015) and require additional debridement beyond the physiologic rim (P =.003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. Conclusion: To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years. [ABSTRACT FROM AUTHOR]

Background Encephalopathy due to hyperammonemia is most often found in a setting of cirrhosis. However, it can also result from increased hepatic venous pressures, which can damage zone three hepatocytes and result in elevated serum ammonia. Case summary This report focuses on the unique case of a 43-year-old woman, who presented with confusion in the setting of hyperammonemia due to congestive hepatopathy from an iatrogenic aorto-right ventricular fistula. The patient underwent percutaneous repair of the fistula with resolution of encephalopathy and notable improvement in symptoms. The patient attended all follow-up appointments and was contacted five and eight months after admittance for updates regarding her recovery and permission to publish this case. Discussion This exceedingly rare case has not been reported in the literature and highlights the historically narrow differential for hyperammonemic encephalopathy given the prevalence of cirrhosis and potential reversibility of such a case. [ABSTRACT FROM AUTHOR]