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6. What are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures?

Author

Patel, Neeraj, Leska, Tomasina, Ganley, Theodore J., Aoyama, Julien, Cruz, Aristides I., Ellis, Henry Bone, Fabricant, Peter D., Green, Daniel W., Jagodzinski, Jason E., Johnson, Benjamin, Kushare, Indranil, Lee, R. Jay, McKay, Scott D., Rhodes, Jason, Sachleben, Brant, Sargent, Mary Catherine, Schmale, Gregory A., Yen, Yi-Meng, and Mistovich, R. Justin

Published
2021
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14. Evaluation of Tibial Slope on Radiographs in Pediatric Patients With Tibial Spine Fractures: An Age- and Sex-Matched Study.

Author

Shin, Chang Ho, Syed, Akbar N., Swanson, Morgan E., Kushare, Indranil V., Shea, Kevin G., Ganley, Theodore J., Baghdadi, Soroush, Cruz Jr, Aristides I., Ellis Jr, Henry B., Fabricant, Peter D., Green, Daniel W., Kerrigan, Alicia, Kirby, Julia, Kocher, Mininder, Jay Lee, R., MacDonald, James P., McKay, Scott D., Parikh, Shital N., Patel, Neeraj M., and Yen, Yi-Meng

Published
2024
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15. Anterior Displacement of Tibial Spine Fractures: Does Anatomic Reduction Matter?

Author

McGurty, Shannon A., primary, Ganley, Theodore J., additional, Kushare, Indranil, additional, Leska, Tomasina M., additional, Aoyama, Julian T., additional, Ellis, Henry B., additional, Johnson, Ben, additional, Baghdadi, Soroush, additional, Cruz, Aristides I., additional, Fabricant, Peter D., additional, Green, Daniel W., additional, Lee, R. Jay, additional, McKay, Scott D., additional, Milbrandt, Todd A., additional, Patel, Neeraj M., additional, Rhodes, Jason T., additional, Sachleben, Brant, additional, Traver, Jessica L., additional, Mistovich, R. Justin, additional, Schmale, Gregory A., additional, Cook, Danielle L., additional, and Yen, Yi-Meng, additional

Published
2023
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16. Tibial Spine Fractures in the Child and Adolescent Athlete: A Systematic Review and Meta-analysis.

Author

Orellana, Kevin J., Houlihan, Nathan V., Carter, Michael V., Baghdadi, Soroush, Baldwin, Keith, Stevens, Alexandra C., Cruz Jr, Aristides I., Ellis Jr, Henry B., Green, Daniel W., Kushare, Indranil, Johnson, Benjamin, Kerrigan, Alicia, Kirby, Julia C., MacDonald, James P., McKay, Scott D., Milbrandt, Todd A., Justin Mistovich, R., Parikh, Shital, Patel, Neeraj, and Schmale, Gregory

Subjects
MEDICAL information storage & retrieval systems, SPORTS medicine, FRACTURE fixation, ARTHROSCOPY, EVALUATION of medical care, META-analysis, DESCRIPTIVE statistics, ATHLETES, SYSTEMATIC reviews, MEDLINE, TIBIA injuries, MEDICAL databases, ONLINE information services, HEALTH outcome assessment, RANGE of motion of joints, DISEASE complications, ADOLESCENCE, CHILDREN
Abstract

Background: Tibial spine fractures (TSFs) are uncommon injuries that may result in substantial morbidity in children. A variety of open and arthroscopic techniques are used to treat these fractures, but no single standardized operative method has been identified. Purpose: To systematically review the literature on pediatric TSFs to determine the current treatment approaches, outcomes, and complications. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review of the literature was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines using PubMed, Embase, and Cochrane databases. Studies evaluating treatment and outcomes of patients <18 years old were included. Patient demographic characteristics, fracture characteristics, treatments, and outcomes were abstracted. Descriptive statistics were used to summarize categorical and quantitative variables, and a meta-analytic technique was used to compare observational studies with sufficient data. Results: A total of 47 studies were included, totaling 1922 TSFs in patients (66.4% male) with a mean age of 12 years (range, 3-18 years). The operative approach was open reduction and internal fixation in 291 cases and arthroscopic reduction and internal fixation in 1236 cases; screw fixation was used in 411 cases and suture fixation, in 586 cases. A total of 13 nonunions were reported, occurring most frequently in Meyers and McKeever type III fractures (n = 6) and in fractures that were treated nonoperatively (n = 10). Arthrofibrosis rates were reported in 33 studies (n = 1700), and arthrofibrosis was present in 190 patients (11.2%). Range of motion loss occurred significantly more frequently in patients with type III and IV fractures (P <.001), and secondary anterior cruciate ligament (ACL) injury occurred most frequently in patients with type I and II fractures (P =.008). No statistically significant differences were found with regard to rates of nonunion, arthrofibrosis, range of motion loss, laxity, or secondary ACL injury between fixation methods (screw vs suture). Conclusion: Despite variation in TSF treatment, good overall outcomes have been reported with low complication rates in both open and arthroscopic treatment and with both screw and suture fixation. Arthrofibrosis remains a concern after surgical treatment for TSF, but no significant difference in incidence was found between the analysis groups. Larger studies are necessary to compare outcomes and form a consensus on how to treat and manage patients with TSFs. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Poster 246: Epidemiology of Tibial Spine Fractures in Children: A National Multicenter Study

Author

Stevens, Alexandra, primary, Patel, Neeraj, additional, Cruz, Aristides, additional, Baghdadi, Soroush, additional, Ellis, Henry, additional, Green, Daniel, additional, Kushare, Indranil, additional, Johnson, Ben, additional, Kerrigan, Alicia, additional, Kirby, Julia, additional, MacDonald, James, additional, Milbrandt, Todd, additional, Mistovich, R. Justin, additional, Parikh, Shital, additional, Schmale, Gregory, additional, Traver, Jessica, additional, Yen, Yi-Meng, additional, and Ganley, Theodore, additional

Published
2023
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18. An assessment of the diagnosis, treatment, and outcomes of lower extremity stress fractures in pediatric and adolescent populations.

Author

Gremillion, Matthew J., Martinez, Armando, Ghanta, Ramesh B., Borici, Neritan, and Kushare, Indranil

Abstract

To present one of the first descriptive case series of pediatric and adolescent lower extremity stress injuries, their management, and outcomes in athletes and non-athletes. The IRB-approved retrospective study included patients under 18 years at a tertiary children's hospital who were diagnosed with a lower extremity stress fracture/reaction. Demographic data, mechanism of injury, physical exam, radiographic findings, treatment, & outcomes were collected. Descriptive statistical analysis was conducted. Ninety-seven patients with stress injuries on clinical exams and on radiographs or MRI were included. The average age when diagnosed was 11.7 years (range 1.1–18 years) and the most common injuries were to the tibia (n = 33, 28.4%) and the least common involved were the cuneiforms (n = 4, 3.4%). Patients under the age of 14 were more likely to experience cuboid and calcaneal stress injuries (mean age 5.5 and 8.3 years respectively). Nineteen patients (19.6%) had high-risk stress fractures, with the average age of 14.9 years versus 11.6 for those with low risk (p-value = 0.01) and return to activity time being 15 weeks compared to 10.5 (p-value = 0.027). The most common forms of treatment were controlled ankle motion (CAM), walker boots (58.6%), and physical therapy (PT) (38.1%). The mean Lower Extremity Function Score of the patient population was 73.8, indicating no clinically important difference from full functionality. Lower extremity stress injuries in this cohort were most seen in the tibia, although patients younger than 14 had a high number of cuboid and calcaneal stress injuries. Those with high-risk stress fractures were older and took longer to recover from when compared to low-risk injuries. Treatment is commonly conservative, with CAM boots and PT being the most frequently utilized interventions and serving as a successful approach to treatment, with patients returning to activity at an average of 11.4 weeks, which is comparable to similar studies. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Tibial Spine Fractures in Young Athletes

Author

Cruz, Aristides I., primary, Lee, Rushyuan Jay, additional, Kushare, Indranil, additional, Baghdadi, Soroush, additional, Green, Daniel W., additional, Ganley, Theodore J., additional, Ellis, Henry B., additional, and Mistovich, Ronald Justin, additional

Published
2022
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24. Paper 21: Anterior Displacement of Tibial Spine Fractures, Does Anatomic Reduction Matter?

Author

Ganley, Theodore, primary, Ellis, Henry, additional, Shimberg, Jilan, additional, Cruz, Aristides, additional, Aoyama, Julien, additional, Fabricant, Peter, additional, Green, Daniel, additional, Johnson, Benjamin, additional, Kushare, Indranil, additional, Lee, R. Jay, additional, McKay, Scott, additional, Milbrandt, Todd, additional, Patel, Neeraj, additional, Rhodes, Jason, additional, Sachleben, Brant, additional, Traver, Jessica, additional, Mistovich, Justin, additional, Schmale, Gregory, additional, Leska, Tomasina, additional, Cook, Danielle, additional, Yen, Yi-Meng, additional, and McGurty, Shannon, additional

Published
2022
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25. What are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures?

Author

Patel, Neeraj M., primary, Leska, Tomasina M., additional, Ganley, Theodore J., additional, Aoyama, Julien T., additional, Cruz, Aristides I., additional, Ellis, Henry B., additional, Fabricant, Peter D., additional, Green, Daniel W., additional, Jagodzinski, Jason E., additional, Johnson, Benjamin, additional, Kushare, Indranil, additional, Lee, Rushyuan J., additional, McKay, Scott D., additional, Rhodes, Jason T., additional, Sachleben, Brant C., additional, Sargent, M. Catherine, additional, Schmale, Gregory A., additional, Yen, Yi-Meng, additional, and Mistovich, R. Justin, additional

Published
2022
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26. A Multicenter Comparison of Open Versus Arthroscopic Fixation for Pediatric Tibial Spine Fractures

Author

Shimberg, Jilan L, primary, Leska, Tomasina M, additional, Cruz, Aristides I, additional, Patel, Neeraj M, additional, Ellis, Henry B, additional, Ganley, Theodore J, additional, Johnson, Ben, additional, Milbrandt, Todd A, additional, Aoyama, Julien T., additional, Fabricant, Peter D., additional, Green, Daniel W., additional, Kushare, Indranil, additional, Lee, R. Jay, additional, McKay, Scott, additional, Rhodes, Jason, additional, Sachleben, Brant, additional, Schmale, Gregory A, additional, Traver, Jessica L., additional, Yen, Yi-Meng, additional, and Mistovich, R Justin, additional

Published
2022
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27. Type I Tibial Spine Fractures: Not So Simple to Classify, Not So Easy to Treat; A Multicenter Study

Author

Shimberg, Jilan L, primary, Leska, Tomasina M, additional, Aoyama, Julien T., additional, Cruz, Aristides I., additional, Ellis, Henry B., additional, Fabricant, Peter D., additional, Ganley, Theodore J., additional, Green, Daniel W., additional, Johnson, Benjamin, additional, Kushare, Indranil, additional, Lee, R. Jay, additional, McKay, Scott, additional, Milbrandt, Todd A., additional, Patel, Neeraj M., additional, Rhodes, Jason, additional, Sachleben, Brant, additional, Traver, Jessica L., additional, Yen, Yi-Meng, additional, Schmale, Gregory A, additional, and Mistovich, R Justin, additional

Published
2022
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29. Interobserver and Intraobserver Agreement are Unsatisfactory When Determining Abstract Study Design and Level of Evidence

Author

Patel, Neeraj M., primary, Schmitz, Matthew R., additional, Bastrom, Tracey P., additional, Ghag, Ravi, additional, Janicki, Joseph A., additional, Kushare, Indranil V., additional, Lewis, Ronald, additional, Mistovich, Ronald Justin, additional, Nelson, Susan E., additional, Sawyer, Jeffrey R., additional, Vanderhave, Kelly L., additional, Wallace, Maegen J., additional, and McKay, Scott D., additional

Published
2022
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30. What Are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures? A Multicenter Study

Author

Smith, Haley E., primary, Cruz, Aristides I., additional, Mistovich, R. Justin, additional, Leska, Tomasina M., additional, Ganley, Theodore J., additional, Aoyama, Julien T., additional, Ellis, Henry B., additional, Kushare, Indranil, additional, Lee, Rushyuan J., additional, McKay, Scott D., additional, Milbrandt, Todd A., additional, Rhodes, Jason T., additional, Sachleben, Brant C., additional, Schmale, Gregory A., additional, and Patel, Neeraj M., additional

Published
2022
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33. Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results.

Author

Anderson, Kathryn G., Carsen, Sasha, Stinson, Zachary, Kushare, Indranil, Finlayson, Craig J., Nault, Marie-Lyne, Lee, R. Jay, Haus, Brian M., and Schmale, Gregory A.

Subjects
INJURY risk factors, MENISCUS surgery, RESEARCH, KNEE joint, NONPARAMETRIC statistics, ARTHROSCOPY, CHILDREN'S hospitals, ORTHOPEDIC surgery, JOINT instability, RETROSPECTIVE studies, FISHER exact test, ACQUISITION of data, POSTOPERATIVE care, CASE studies, REOPERATION, DESCRIPTIVE statistics, MEDICAL records, SYMPTOMS, DATA analysis software, DISEASE risk factors, CHILDREN
Abstract

Background: The discoid medial meniscus is a rare congenital anomaly of the knee. The literature is limited to small case series. Purpose/Hypothesis: Our purpose is to report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America. We hypothesized that symptoms and signs, arthroscopic findings, surgical treatments, and outcomes are similar to those for symptomatic discoid lateral menisci. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review identified patients with a diagnosed discoid medial meniscus confirmed at surgery across 8 children's hospitals between January 2000 and June 2021. The literature on discoid lateral menisci was reviewed and summarized for comparison. Results: A total of 21 patients (9 female, 12 male) with 22 discoid medial menisci were identified. The mean ± SD age at the time of diagnosis was 12.8 ± 3.8 years. The most common symptoms and signs were locking and/or clunking, present in 12 of 22 knees (55%), similar to that reported in patients with discoid lateral menisci. Twelve discoid medial menisci were complete (55%); 8, incomplete (36%); and 2, indeterminate (9%). Tears were present in 13 knees, most commonly horizontal cleavage (54%). Five discoid medial menisci were unstable (23%): 3 for posterior tears and 2 for rim insufficiency. All 22 knees underwent arthroscopic saucerization, and of the 13 torn menisci, 7 (54%) were repaired. The median follow-up was 24 months (range, 2-82 months). Four knees underwent reoperation. All knees that required reoperation had undergone repair for a posteriorly located tear. There was a significant association between operative repair and need for reoperation (P =.0048). High rates of peripheral instability were also noted in case series of patients with discoid lateral menisci. Conclusion: Patient presentations and treatments for those with discoid medial menisci were similar to those reported for patients with discoid lateral menisci. Knees with discoid medial menisci also demonstrated instability attributed to peripheral insufficiency and posterior tears. Tears were present in over half of knees with discoid medial menisci, and reoperation was more common in knees that underwent repair of tears than those without repair. [ABSTRACT FROM AUTHOR]

Published
2023
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35. Uneven Playing Field: Insurance Status Adversely Affects Children with Tibial Spine Fractures (181)

Author

Patel, Neeraj, primary, Leska, Tomasina, additional, Ganley, Theodore, additional, Aoyama, Julien, additional, Cruz, Aristides, additional, Ellis, Henry, additional, Fabricant, Peter, additional, Green, Daniel, additional, Jagodzinski, Jason, additional, Johnson, Benjamin, additional, Kushare, Indranil, additional, Lee, R, additional, McKay, Scott, additional, Rhodes, Jason, additional, Sachleben, Brant, additional, Sargent, Catherine, additional, Schmale, Gregory, additional, Yen, Yi-Meng, additional, and Mistovich, Justin, additional

Published
2021
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42. ANTERIOR CRUCIATE LIGAMENT TEAR FOLLOWING SURGICAL TREATMENT OF PEDIATRIC TIBIAL EMINENCE FRACTURE IN A MULTICENTER COHORT

Author

O’Donnell, Ryan, primary, Bokshan, Steven, additional, Brown, Kelsey, additional, Aoyama, Julien T, additional, Ganley, Theodore J, additional, Fabricant, Peter D, additional, Patel, Neeraj M., additional, Ellis, Henry B, additional, Green, Daniel W, additional, Jagodzinski, Jason E, additional, Kushare, Indranil, additional, Lee, R Jay, additional, McKay, Scott, additional, Rhodes, Jason, additional, Sachleben, Brant, additional, Sargent, Catherine, additional, Schmale, Gregory A., additional, Yen, Yi-Meng, additional, Mistovich, R Justin, additional, and Cruz, Aristides I., additional

Published
2021
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43. Levels of Evidence Are Not the Whole Story

Author

Nelson, Susan, primary, Narayanan, Unni, additional, Schmitz, Matthew, additional, McKay, Scott, additional, Bastrom, Tracey, additional, Ghag, Arvindera, additional, Janicki, Joseph, additional, Karlen, Judson, additional, Kushare, Indranil, additional, Lewis, Ronald, additional, Mistovich, Justin, additional, Patel, Neeraj, additional, Phillips, William, additional, Sawyer, Jeffrey, additional, Vanderhave, Kelly, additional, and Wallace, Maegen, additional

Published
2021
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45. Anterior Cruciate Ligament Tear Following Operative Treatment of Pediatric Tibial Eminence Fractures in a Multicenter Cohort

Author

O’Donnell, Ryan, primary, Bokshan, Steven, additional, Brown, Kelsey, additional, Aoyama, Julien T., additional, Ganley, Theodore J., additional, Fabricant, Peter D., additional, Patel, Neeraj M., additional, Ellis, Henry B., additional, Green, Daniel W., additional, Kushare, Indranil, additional, Lee, R. Jay, additional, McKay, Scott, additional, Rhodes, Jason, additional, Sachleben, Brant, additional, Sargent, Catherine, additional, Schmale, Gregory A., additional, Yen, Yi-Meng, additional, Mistovich, R. Justin, additional, and Cruz, Aristides I., additional

Published
2021
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46. Is Nonoperative Treatment Appropriate for All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study of the Tibial Spine Research Interest Group.

Author

Shimberg, Jilan L., Leska, Tomasina M., Cruz Jr, Aristides I., Ellis Jr, Henry B., Patel, Neeraj M., Yen, Yi-Meng, Schmale, Gregory A., Mistovich, R. Justin, Fabricant, Peter D., Ganley, Theodore J., Green, Daniel W., Johnson, Benjamin, Kushare, Indranil, Lee, R. Jay, McKay, Scott D., Milbrandt, Todd A., Rhodes, Jason, Sachleben, Brant, and Traver, Jessica L.

Published
2022
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49. Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study

Author

Bram, Joshua T., primary, Aoyama, Julien T., additional, Mistovich, R. Justin, additional, Ellis, Henry B., additional, Schmale, Gregory A., additional, Yen, Yi-Meng, additional, McKay, Scott D., additional, Fabricant, Peter D., additional, Green, Daniel W., additional, Lee, R. Jay, additional, Cruz, Aristides I., additional, Kushare, Indranil V., additional, Shea, Kevin G., additional, and Ganley, Theodore J., additional

Published
2020
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50. Tibial Spine Fracture Management - Technical Tips and Tricks from the Tibial Spine Fracture Research Interest Group

Author

Kushare, Indranil, primary, Lee, Rushyuan Jay, additional, Ellis, Henry B., additional, Fabricant, Peter D., additional, Ganley, Theodore J., additional, Green, Daniel W., additional, McKay, Scott, additional, Patel, Neeraj M., additional, Schmale, Gregory A., additional, Weber, Morgan, additional, and Mistovich, R. Justin, additional

Published
2020
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