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Resumen: Objetivo: Se han reportado factores de riesgo anatómicos que predisponen a rotura del ligamento cruzado anterior (LCA) y/o fracturas avulsivas de espinas tibiales (FAET) en pacientes pediátricos con resultados controversiales. Nuestro objetivo es comparar parámetros morfométricos en resonancia magnética (RM) de pacientes con esqueleto inmaduro que presenten FAET o rotura del LCA versus controles sanos. Métodos: Estudio observacional de una cohorte transversal donde se recolectaron de forma consecutiva todos los pacientes con esqueleto inmaduro que presentaron una rotura del LCA o una FAET. Se agregó un grupo control de pacientes con fisis abierta y RM sin evidencia de lesión. Un observador entrenado midió en cada una de las RM con técnica previamente estandarizada: a) el ancho de la escotadura intercondílea femoral, y b) el ángulo de apertura de la escotadura intercondílea femoral. Resultados: La muestra se compuso de 11 pacientes con rotura del LCA, 11 pacientes con FAET y 11 controles normales. El ángulo de apertura de la escotadura intercondílea femoral, medido en cortes axiales y coronales, fue significativamente menor en los pacientes con rotura del LCA versus controles sanos (p = 0,0256 y p = 0,0097). El resto de las variables estudiadas no presentaron diferencias significativas entre grupos. Conclusión: En pacientes con esqueleto inmaduro una escotadura intercondílea femoral más estrecha se asocia a rotura del LCA, mientras que aquellos con una FAET no presentan una anatomía ósea distintiva versus los controles sanos. Estos hallazgos sugieren que parámetros morfométricos óseos se asocian a un patrón lesional u otro en rodillas con fisis abierta. Abstract: Objective: Anatomical risk factors predisposing to anterior cruciate ligament (ACL) and/or avulsion fractures of tibial spines (AFET) have been reported in paediatric patients with controversial results. Our aim is to compare morphometric parameters in magnetic resonance imaging (MRI) of patients with immature skeleton presenting AFET or ACL rupture versus healthy controls. Methods: Observational study of a transverse cohort where all those patients with immature skeleton presenting ACL rupture or AFET were collected consecutively. A control group of patients with open physis and MRI reported without lesions was added. A trained observer measured in each MRI with previously standardized technique: a) the width of the intercondylar femoral notch, and b) the opening angle of the intercondylar femoral notch. Results: The sample was composed of 11 patients with ACL rupture, 11 patients with TEA and 11 normal controls. The opening angle of the intercondylar femoral notch, measured in axial and coronal sections, was significantly lower in those patients with ACL rupture versus healthy controls (P = .0256 and P = .0097). The rest of the variables studied did not present significant differences between groups. Conclusion: In patients with an immature skeleton, a narrower femoral intercondylar notch is associated with ACL rupture, while those with an ETF do not present a distinctive bone anatomy versus healthy controls. These findings suggest that bone morphometric parameters are associated with a lesional or other pattern in open-knee.

Objective Anatomical risk factors predisposing to ACL (anterior cruciate ligament) and/or avulsion fractures of tibial spines (AFET) have been reported in paediatric patients with controversial results. Our aim is to compare morphometric parameters in magnetic resonance imaging (MRI) of patients with immature skeleton presenting AFET or ACL rupture versus healthy controls. Methods Observational study of a transverse cohort where all those patients with immature skeleton presenting ACL rupture or AFET were collected consecutively. A control group of patients with open physis and MRI reported without lesions was added. A trained observer measured in each MRI with previously standardized technique: (A) the width of the intercondylar femoral notch, (B) the opening angle of the intercondylar femoral notch. Results The sample was composed of 11 patients with ACL rupture, 11 patients with TEA and 11 normal controls. The opening angle of the intercondylar femoral notch, measured in axial and coronal sections, was significantly lower in those patients with ACL rupture versus healthy controls (p = .0256 and p = .0097). The rest of the variables studied did not present significant differences between groups. Conclusion In patients with an immature skeleton, a narrower femoral intercondylar notch is associated with ACL rupture, while those with an ETF do not present a distinctive bone anatomy versus healthy controls. These findings suggest that bone morphometric parameters are associated with a lesional or other pattern in open-knee.

Resumen: Durante las últimas décadas, hemos visto un aumento exponencial de las lesiones traumáticas alrededor de la rodilla en niños y adolescentes. La rodilla pediátrica tiene características particulares, que la diferencian de los adultos, y la predisponen a lesiones distintivas que requieren un manejo acorde. El aumento de su incidencia obliga a los médicos a verse enfrentados con mayor frecuencia a patologías como la luxación patelar, la avulsión de espinas tibiales, la avulsión de la tuberosidad anterior de la tibia y la lesión meniscal en probable contexto de un menisco discoideo. Es fundamental conocer los diferentes diagnósticos diferenciales y su enfrentamiento inicial para realizar una derivación oportuna con el fin de que estos pacientes obtengan un tratamiento adecuado. Summary: Over the past few decades, we have seen an exponential increase in traumatic injuries around the knee in children and adolescents. The pediatric knee is different from the adult knee, with special characteristics that predispose it to certain types of injuries that require a specific management. The increase in its incidence has faced attendants more frequently with pathologies such as patellar dislocation, tibial eminence fracture, tibial tubercle fractures and meniscal injury in the setting of a discoid meniscus. It is essential to know the differential diagnoses of this age-group, how to obtain an adequate study for a prompt referral.

Resumen Objetivo Realizar la evaluación clínica, imagenológica y funcional de pacientes con fracturas avulsivas tibiales del ligamento cruzado posterior (FTALCPs) fijadas con tornillos canulados con técnica abierta. Métodos Los pacientes con FTALCP operados entre 2010 y 2017 fueron revisados retrospectivamente. Criterios de inclusión: fracturas agudas, desplazadas, test de cajón posterior grado III, lesiones combinadas de rodilla, seguimiento > 12 meses. Se excluyeron pacientes > 65 años, con FTALCPs bilaterales, lesiones del ligamento cruzado posterior (LCP) intrasustancia, test de cajón posterior grados I-II, fracturas expuestas, lesiones neurovasculares, y seguimientos < 12 meses. Objetivo primario: medir la estabilidad clínica mediante test de cajón posterior y radiografía de estrés arrodillada comparativa. Objetivos secundarios: nvaluar la consolidación en radiografías, complicaciones y funcionalidad con las escalas de Lysholm y Tegner. Resultados Se incluyeron 20 pacientes, con edad media de 41 años (rango: 32 a 61 años). El seguimiento promedio fue de 33,9 meses (rango: 12 a 82 meses). La estabilidad clínica mejoró en 93% (cajón posterior postoperatorio grados 0 y I) de los pacientes. La radiografía de estrés arrodillada mostró una diferencia promedio de 2,6 mm (rango: 0,1 mm a 6,8 mm) de traslación posterior al comparar con el lado sano. Todas las fracturas consolidaron. Siete pacientes presentaron complicaciones. El puntaje promedio de la escala de Lysholm al final del seguimiento fue de 85,17. El promedio preoperatorio del puntaje en la escala de Tegner no varió significativamente en comparación con el postoperatorio. Conclusiones La fijación de fracturas avulsivas tibiales del LCP con tornillos canulados con técnica abierta es efectiva en restaurar la estabilidad posterior y lograr la consolidación ósea. La funcionalidad clínica a mediano plazo es buena, a pesar del alto número de complicaciones y lesiones concomitantes.Nivel de evidencia tipo IV.

Resumen Objetivos Determinar el rendimiento de las clasificaciones de Outerbridge (OB) e International Cartilage Repair Society (ICRS). Método Estudio de test diagnóstico, diseño y recolección de datos prospectivo. Siete traumatólogos sub-especialistas observaron un mismo video donde se exponían 30 lesiones condrales bajo visión artroscópica, para luego clasificarlas según OB e ICRS y consignar el tratamiento de elección para cada una de las lesiones, eligiendo entre 6 alternativas: observación, debridamiento mecánico o térmico, microfractura, OATS o terapias biológicas. Tras 7 días, los evaluadores debían repetir el mismo procedimiento. Resultados La concordancia entre los observadores fue débil para clasificación de ICRS (k 0,25 p Conclusión Ambas clasificaciones mostraron una baja correlación inter-observador y una elevada concordancia intra-observador. En ambas categorías, Outerbridge fue más concordante que ICRS. En cuanto al tratamiento, ninguna de las dos clasificaciones logra unificar criterios quirúrgicos. Nivel de evidencia Nivel I (test diagnóstico).

Fractures of the anterior tibial tuberosity during childhood are an infrequent pathology (around 3% of all proximal tibial fractures), but the incidence of this injury has risen over recent years, likely due to the increased involvement of this age group in sports activities. This fracture is more commonly seen in children 12–14 years old. It is vital to identify the anatomical structures associated with this type of fracture, along with the pathophysiological mechanisms involved. Treatment includes non-operative and operative options, with the goal of achieving articular congruency, restoring the extensor mechanism function, and avoiding damage to the proximal tibial physis. Understanding the management of this fracture, and the complications that might arise, is critical. The provision of an appropriate clinical management plan and the avoidance of complications are vital in the prevention of disability.Cite this article: EFORT Open Rev 2020;5:260-267. DOI: 10.1302/2058-5241.5.190026

Background Juvenile osteochondritis dissecans (JOCD) lesions are rarely located in the trochlea and few studies have focused on the causes and outcomes of JOCD lesions in this part of the knee. The purpose of this study is to (1) evaluate the clinical characteristics and outcomes of patients who undergo surgery for JOCD in this unusual location as well as (2) assess the association between trochlear JOCD and participation in sporting activities that load the patellofemoral joint. Methods We conducted a retrospective cohort study of 34 trochlear JOCD lesions in 30 patients. Cases that involved traumatic cartilage shear or patella instability were excluded. Preoperative and postoperative magnetic resonance images and x-rays were evaluated and demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from medical records. A case-control cohort of 102 femoral condyle lesions was used to assess the correlation between sports played and lesion location. Results The cohort comprised 34 consecutive trochlear JOCD lesions in 30 patients (26 males, 4 females). Average age at surgery was 13.8 years (9.3 to 18.0 y). In total, 27 (90%) patients were active, and of these active patients, soccer and basketball were the most common sports played. In the case-control comparison, the correlation between playing either basketball or soccer and the presence of a trochlear JOCD lesion was statistically significant (P=0.017). In total, 21 knees (62%) received operative treatment. Sixteen of the surgical patients underwent repair and fixation with bioabsorbable nails. The average length of clinical and radiographic follow-up was 21.1 months. All patients who underwent fixation showed radiographic and/or clinical indications of healing at most recent follow-up. Thirteen of the patients who underwent fixation were active, and all of these patients reported successful return to sports. Thirteen knees underwent nonoperative treatment, and the majority of these patients had limited follow-up. Conclusions We report a significant association between pediatric athletes who play basketball and soccer and the development of trochlear JOCD, suggesting that repetitive loading of the patellofemoral joint may play a role in the development of JOCD lesions. Patients with trochlear JOCD lesions were likely to undergo surgery, and repair and fixation of the lesions produced good outcomes at short-term follow-up. Level of evidence Level III-case-control study.

Multiligament injuries in below-knee amputation patients are a severe condition, and its treatment is controversial. Its incidence is unknown, and it is highly underdiagnosed, representing a challenge for the physician. The case presented is about a patient with a left transtibial amputation secondary to a severe crushing of the ipsilateral lower limb to which during the process of physiotherapy, a multiligament injury was diagnosed. The patient underwent a tibiofibular fixation with a multiligament reconstruction with good functional results. In this complex situation, delay in diagnosis is frequent, ligament instability should always be suspected and explored further, allowing for proper rehabilitation and early treatment.

Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population. The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears. Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined. Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus. Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears. Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus.Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023

In patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch. Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as defined by Stephen. A 20-mm-depth drilling was simulated, starting from the insertion point at every possible angle within a 90° cone using 5-, 6- and 7-mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student’s t test and one-way ANOVA. Maximum physeal damage (5.35% [4.47–6.24]) was obtained with the 7-mm drill when drilling 3° cephalic and 15° posterior from insertion without differences between sexes (n.s.). Minimal physeal damage (0.22% [0.07–0.37]) was obtained using the 5-mm drill aimed 45° distal and 0° anteroposterior, not affected by sex (n.s.). Considering intra-articular drilling avoidance, the safest zone was obtained when aiming 30°–40° distal and 5°–35° anterior, regardless of sex. Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30°–40° distal and 5°–35° anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.

Purpose of review To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications. Recent findings Although TTAFs amount to fewer than 1% of all physeal injuries in children, the incidence is increasing, likely because of greater participation in high-level athletics. Summary TTAFs tend to occur in adolescents nearing skeletal maturity who engage in sports with repetitive jumping. The most popular classification system was proposed by Ogden, which defines five fracture types based on the fracture pattern and extent of fragment displacement. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Arthroscopic approaches can reveal associated soft tissue injuries, such as meniscal tears, and confirm articular reduction. The most common postoperative complication is irritation because of hardware. With proper treatment, both nonsurgical and surgical outcomes are excellent. TTAFs have high rates of union and patients typically return to sports.

Tibial spine fractures (TSFs) are graded according to the Meyers and McKever (MM) classification system, which is based on a qualitative evaluation of plain radiographs. However, although MRI images can provide important information about these fractures, there is no MRI-based classification system. This study aims to (1) establish the intra- and inter-rater reliability of the MM system for use with radiographs, (2) propose a quantitative, MRI-based system and compare its reliability to the MM system, and (3) assess how often using the MRI-based system changes the classification and potential treatment plan as previously determined using MM. The MRI-based system was designed with three grades based on quantitative displacement patterns of the fractured fragment and tissue entrapment. Four raters from a tertiary care center evaluated 20 fractures according to the MM and MRI-based systems. Observers graded images at two time points at least 2 weeks apart, after which we compared the intra- and inter-rater reliability of each system (using Fleiss’ kappa and weighted kappa, respectively) and assessed how often using the MRI-based system changed the fracture grade. Both the MM and MRI-based systems exhibit fair to moderate intra- and inter-rater reliability (average kappa values ranged from 0.38 to 0.66). Use of the MRI-based system changed the fracture grade and as a result modified the treatment recommendations in 32.5% of cases: 6.9% were previously unnoticed fractures, 13.1% underwent a raise in grade, and 12.5% were graded as lower than before. The MRI-based system is as reliable as the MM system and provides specific, quantitative criteria for classifying fractures according to fragment displacement and tissue entrapment. The new MRI-based system potentially clarifies treatment indications for TSFs. Diagnostic Study, Level II.

Objetivo Reportar la experiencia, después de 1 año de seguimiento, de una serie de 30 pacientes sometidos a reconstrucción de la esquina posteromedial (EPM) con la técnica descrita por La Prade. Método Cohorte retrospectiva de 30 pacientes con lesión de EPM operados por el mismo equipo quirúrgico. Criterios de inclusión: diagnóstico clínico, radiografía con estrés y resonancia magnética compatibles con lesión de EPM, inestabilidad grado III luego de 3 meses de tratamiento ortopédico, técnica de reconstrucción de La Prade, al menos 12 meses de seguimiento. Criterios de exclusión: discordancia entre clínica e imagenología, inestabilidad grado I o II, y otra técnica quirúrgica. Evaluación con IKDC y Lysholm antes de la cirugía, a los 6 y 12 meses de seguimiento postcirugía. Resultados 30 pacientes cumplieron los criterios de inclusión. Promedio de edad 43 años (24–69). Veintiocho pacientes presentaron lesiones de alta energía, 20 pacientes fueron diagnosticados en agudo, mientras que 10 fueron diagnosticados luego de malos resultados en reconstrucción de otros ligamentos. Veintiocho presentaron lesiones asociadas: 11 casos asociados a lesión de ligamento cruzado anterior, 3 casos asociados a lesión de ligamento cruzado posterior, 3 casos en asociación con lesiones meniscales, 9 casos con lesión asociada de ligamento cruzado anterior y posterior, y 2 casos en asociación con ligamento cruzado anterior, posterior y ligamento colateral lateral. Promedio de tiempo hasta la reconstrucción de EPM fue de 5 meses (rango 2–32). Puntuación en Lysholm e IKDC (preoperatorio 18,2 y 24,3 respectivamente), mejoraron a 76,7 y 70,7 después de 1 año de seguimiento. Al fin del seguimiento, el rango articular promedio era 113° (90–140), la mayoría de los pacientes (24) tuvieron estabilidad tipo A según IKDC. Conclusión La reconstrucción de lesiones de EPM mejora los resultados clínicos en pacientes con inestabilidad crónica posteromedial de rodilla. Se observó mejoría en la estabilidad y scores funcionales de todos los pacientes.

Las lesiones meniscales en niños son cada día más frecuentes. La preservación meniscal es una prioridad en este grupo de pacientes, sin embargo, existen pocos artículos que muestran los resultados de suturas meniscales en niños. Objetivo El objetivo de este estudio es identificar factores de riesgo de falla en pacientes sometidos a una sutura meniscal en niños menores de 18 años. Método Estudio retrospectivo de 35 pacientes sometidos a una sutura meniscal, con una edad promedio de 16 años (13–18) y un seguimiento de 71 meses de media (16–115). Se evaluaron 6 variables: tipo, localización y tamaño de la lesión, edad, técnica quirúrgica y asociación a rotura de ligamento cruzado anterior (LCA). Los pacientes que presentaron falla de la sutura meniscal fueron identificados y sometidos a una regresión logística usando un modelo Stata V.14.0. Resultados 9 pacientes (24.3%) presentaron una falla en su cirugía durante el seguimiento. Lesiones iniciales mayores a 16 mm mostraron una tasa de re-rotura de un 73% independiente de la técnica quirúrgica. En lesiones menores a 16 mm, se obtuvo un 78% de reparaciones exitosas. No se encontró relación entre la re-rotura meniscal y lesión de LCA, tipo y localización de la lesión, técnica quirúrgica y edad de los pacientes. Conclusión Este estudio muestra que la reparación meniscal en niños tiene buenos resultados con una tasa de éxito promedio de un 75%. El riesgo de falla de sutura meniscal se correlacionó con el tamaño inicial de la lesión con un 73% de fallo en lesiones mayores a 16 mm independientemente del tipo de cirugía. Nivel de Evidencia 4, Serie de casos.

As anterior cruciate ligament (ACL) injury is becoming increasingly prevalent in the population of active children and young adolescents, it is crucial to be aware of both the modifiable and nonmodifiable factors that place this population at increased ACL injury risk. Historically, there has not been a definitive consensus on all of these risk factors-particularly the nonmodifiable ones.The present review has accumulated the most recent evidence for the nonmodifiable risk factors in ACL injury focusing particularly on female gender, generalized joint laxity, knee recurvatum, increased lateral tibial slope, decreased intercondylar notch width, structural lower extremity valgus, limb length discrepancy, family history, and history of contralateral knee ACL injury.Physicians should be aware of the nonmodifiable risk factors for ACL tears in active children and adolescents and should also encourage avoidance of modifiable risk factors in this population. Young athletes with nonmodifiable risk factors are at a particularly increased risk of recurrent injury following ACL reconstruction (ACLR). We believe that a primary extra-articular augmentation via iliotibial band tenodesis at the same time of ACLR may decrease the rate of reinjury for the high risk athlete with multiple nonmodifiable risk factors.

Purpose of review The purpose of this review is to summarize and clarify the current framework for treating tibial spine avulsion fractures (TSAFs). We will discuss how these fractures are classified both on plain radiographs and MRI as well as report the incidence of concomitant soft tissue injury, an important consideration that guides treatment. We will also compare guidelines for nonsurgical versus surgical treatment and summarize frequently used surgical techniques. Finally, we will review outcomes following treatment, including common complications. Recent findings Although TSAFs only constitute 2-5% of all pediatric knee injuries, the incidence is increasing. A recently developed MRI-based system for evaluating TSAFs is another tool that aids in the treatment of these injuries. Summary TSAFs can be classified using plain radiographs as well as MRI. Type I fractures are usually treated with immobilization whereas type II fractures typically undergo an initial attempt at closed reduction followed by arthroscopic or open reduction and fixation if needed. Type III fractures are indicated directly for arthroscopic surgery and both suture and screw fixation produce good clinical outcomes. All-epiphyseal or transphyseal approaches can minimize the risk of physeal injury in skeletally immature patients. Common complications following TSAF injury and treatment are residual laxity, knee stiffness, and nonunion or malunion.

Objectives: To analyze graft structure and signal with particular emphasis on the distal femoral socket aperture following all-epiphyseal ACLR using hamstring autografts with sequential MRI in skeletally immature athletes. Methods: Retrospective cohort study of 23 skeletally immature patients who underwent ACLR by the same surgical team at a tertiary center during 2011-2013. Athletes had at least two follow-up MRIs, the first MRI 6-12 months after surgery and the second MRI >18 months, were included. Exclusion criteria included those athletes with inMRI follow-up (6) or with a failure of their reconstructions (1). All athletes were treated with an arthroscopic all-inside, all-epiphyseal ACLR, using hamstring autograft, secured with adjustable loop cortical buttons on both tibia and femur. MRI images were analyzed independently and blinded by an orthopaedic surgery fellow and a musculoskeletal radiology fellow. Using a GE Functional Analysis Software, the signal intensity (SI) of the graft was measured in 5 different locations: 1) femoral tunnel, 2) intra-articular proximal turn, 3) midsubstance, 4) intra-articular distal turn, and 5) tibial tunnel. Values were normalized to cortical bone density. The amount of perigraft scarring and synovitis was analyzed. An intraclass correlation coefficient was used to quantify inter-rater reliability, non-parametric Wilcoxon test for perigraft scarring and synovitis, one-way ANOVA to test if significant differences of SI were seen between the different graft locations, and a 2-tailed student t-test for SI changes from 1st to 2nd MRI. Results: The study included 16 patients (5 girls and 11 boys), with an average age at surgery of 11.9 years (range 10-15). The first follow-up MRI was on average at 8.4 months (range 6-12 months), while the 2nd MRI was on average 30.7 months (range 18-40) after surgery. Intra-class correlation coefficients were above 0.7 for all measurements, indicating an excellent concordance between observers. Perigraft scarring tended to reduce with follow-up (p=0.057) though not significantly, while synovitis had a significant reduction over time (p=0.01). On average, normalized SI showed no significant differences between measurements taken in different regions of the graft (p=0.58). When comparing the graft SI from 1st to 2nd MRI, no significant differences were found in any of the locations: femoral tunnel (p=0.14), proximal turn (p=0.11), midsubstance (p=0,29), intra-articular distal (p=0.10), or tibial tunnel (p=0.15). All 16 athletes returned to their prior sport at the same level of performance without re-injury. Conclusion: ACL grafts in skeletally immature patients with all-epiphyseal reconstructions maintain a stable intensity signaling at long term MRI follow-up, with no significant signal reduction over time. Despite the sharp turn created at the distal femoral socket aperture in physeal-sparing reconstructions, no particular anatomic location of the graft presents significantly different signal intensity over others. This is the first sequential mri study in pediatric epiphyseal acl reconstructions demonstrating postoperative maintenance of graft integrity and graft signal.

Objectives To identify those clinical characteristic and arthroscopic findings in patients with knee arthrosis that are associated with worsening of the disease and subsequent total knee arthroplasty (TKA). Method A retrospective, descriptive study was conducted on 78 consecutive patients (88 knees) who underwent knee arthroscopy for arthrosis. The study included 44 women and 34 men, with a mean age of 58.9 years (range: 37–78 years). After a mean follow-up of 50.4 months (range: 12–96 months), those patients who progressed towards TKA were identified. A logistic regression model was applied to recognize the factors associated with deterioration of the arthrosis, with consequent progression towards a TKA. Results Twenty-four out of the 88 knees progressed towards a TKA (27.3%) within a mean time of 13.5 months after arthroscopy (range: 13–29 months). The clinical characteristics that showed a significant association with poor progression of the arthrosis were: female gender (0.02) and Ahlback 2 (P = .04). Arthroscopic finding that proved significant correlation with worsening of the arthrosis towards TKA were: meniscal tears of the posterior horn (P = .02), meniscectomies above 60% (P = .03), and 2nd degree chondral lesions in loading areas of the medial femoral condyle (P = .02). Conclusion The variables associated with a greater chance of progressing towards a TKA after a knee arthroscopy due to arthrosis in this study were, female gender, grade 2 radiographic arthrosis, posterior horn meniscal lesions, meniscectomies over 60%, and chondral lesions in loading area of the medial femoral condyle.

Resumen Objetivos Identificar los hallazgos artroscopicos y las caracteristicas clinicas de los pacientes con artrosis de rodilla sometidos a lavado articular artroscopico, que se correlacionaron con una mala evolucion de su enfermedad y su consecuente conversion a artroplastia total de rodilla (ATR). Metodo Estudio retrospectivo-descriptivo de una serie de 78 pacientes (88 rodillas) sometidos a artroscopia de rodilla por artrosis. Cuarenta y cuatro mujeres y 34 varones, con promedio de edad de 58,9 anos (rango: 37-78) en el momento de la artroscopia, ingresaron al estudio. Tras un seguimiento promedio de 50,4 meses (rango: 12-96) se identificaron aquellos pacientes que evolucionaron a una ATR. Para el analisis estadistico se utilizo un modelo de regresion logistica para identificar aquellos elementos asociados a la evolucion hacia una ATR. Resultados En el seguimiento, a 24 rodillas se les implanto una ATR (27,3%) a los 13,5 meses de promedio (rango: 13-29). Las caracteristicas clinicas de los pacientes que mostraron una asociacion estadisticamente significativa hacia una mala evolucion fueron: el genero femenino (0,02) y clasificacion de Ahlback 2 (p = 0,04). Los hallazgos artroscopicos asociados significativamente a evolucion hacia ATR fueron lesiones meniscales mediales y laterales en cuerno posterior (p = 0,02), cuando se realizo una meniscectomia mayor o igual a un 60% (p = 0,03) y la presencia de lesiones condrales grado 2 en la zona de carga de condilo femoral medial (p = 0,01). Conclusion En este grupo estudiado, las variables asociadas a una mayor posibilidad de terminar en una ATR tras una artroscopia de lavado articular fueron del genero femenino, artrosis radiologica grado 2, lesiones meniscales en cuerno posterior, meniscectomia mayor al 60% y lesiones condrales en condilo femoral medial grado 2 en zona de carga.

The purpose is to review and discuss the fundamentals, indications, surgical technique, controversies, and outcomes regarding meniscal transplantation, focusing on available evidence in pediatric populations.Recent studies have confirmed meniscal allograft transplantation as an effective procedure to improve symptoms, knee function, and quality of life following meniscectomy, particularly in symptomatic young patients. Associated procedures, such as osteotomies and cartilage-related surgeries, have expanded the indications for transplantation. Most patients return to sports following meniscal transplantation, and the procedure does not preclude the potential return to high-level athletic competition. The chondroprotective effect of transplantation has not been proven and as a result the role of prophylactic transplantation remains unclear.Meniscal allograft transplantation is indicated following symptomatic meniscal loss in young, active patients to relieve pain and improve knee function. The quality of the available evidence regarding meniscal transplantation is limited, and no published series to date has focused exclusively on a pediatric population. Further high-quality studies are needed to establish improved indications, timing, and outcomes in a pediatric population.

Objective: Report the experience, after 1-year follow-up, of 30 patients who underwent anatomical knee reconstruction of posteromedial corner (PMC) injuries, using La Prade´s Technique. Methods: Retrospective cohort study of 30 consecutive patients with PMC injuries operated between November 2010 and May 2014 by the same surgical team. Inclusion criteria: patients with clinical presentation and images (stress radiographs and MRI) compatible with PMC injury, who maintained a grade III chronic instability in spite of at least 3 months of orthopedic treatment, who were reconstructed using La Prade’s anatomical technique, and completed at least 12 months of follow-up. Exclusion criteria: discordance between clinical and image studies, grade I or II medial instability, and surgery performed through a different technique. Data was collected by reviewing the electronic files and images. Functional scores (IKDC and Lysholm) were applied and registered in the preoperative evaluation, and then 6 and 12 months after surgery. Results: Thirty patients (28 men and 2 women) met the inclusion criteria. Mean age was 43 years (24-69). The vast majority (28 patients) had a high-energy mechanism of injury. Twenty patients were diagnosed in the acute setting, while 10 had a delayed diagnosis after poor results of concomitant ligament reconstructions. With the exception of 2 patients, who presented with isolated PMC injury, the majority had associated injuries as detailed: 11 cases had PMC + anterior cruciate ligament (ACL) injury, 3 patients had PMC + posterior cruciate ligament (PCL) injury, 3 patients had PMC + meniscal tears, 9 patients had PMC + ACL + PCL injuries, and there were 2 cases of PMC + ACL + PCL + lateral collateral ligament injuries. Mean time for PMC reconstruction surgery was 5 months (range 2-32). Lysholm and IKDC scores were 18,2 (2-69) and 24,3 (9,2-52,9) respectively in the preoperative setting, improving to 76,7 (44-94) and 70,7 (36,8-95,4) after 1-year follow-up. At the end of follow-up, average ROM was 113º (90-140) the majority (24 patients) had type A IKDC stability, and the remaining 6 patients type D IKDC stability. Conclusion: Acceptable results were achieved following reconstruction of PMC injuries in patients with chronic posteromedial knee instability. Improvement in stability and functional scores were observed in all the patients of this cohort after surgery.

Objectives: Describe the clinical characteristics, image findings, and outcomes of patients with juvenile osteochondritis dissecans (JOCD) of the knee. To our knowledge, this is the largest single-surgeon cohort of JOCD patients. Methods: Retrospective cohort study of knee JOCD patients assessed by a single pediatric orthopaedic surgeon at a tertiary care center between 2005-2015. All diagnoses were confirmed by magnetic resonance imaging (MRI). Patients with patellar dislocations or osteochondral fractures were excluded. Demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from charts. Images were analyzed to identify the location and size of lesions. Chi-square or Fisher’s exact tests were used to compare discrete variables, and Mann-Whitney U and Kruskal Wallis tests to compare continuous variables between groups. P-values of Results: Sample consisted of 180 patients (207 knees), 124 boys and 56 girls. Average age at diagnosis was 12.8 years (7.5-17.5). Majority were active in sports (80.8%), primary soccer (36.7%) and basketball (29.4%). JOCD was present bilaterally in 27 patients (15%), 14 knees had bifocal OCD (6.8%), and only 1 patient had bifocal lesions in both knees. Most common location was medial femoral condyle (56.3%) followed by lateral femoral condyle (23.1%), trochlea (11.4%), patella (9%), and tibia (0.5%). In the sagittal view, most common location was the middle third of the condyles (48.7%). Surgery was performed in 72 knees (34.8%), with an average age at surgery of 14.1 years (9.3-18.1). Bilateral JOCD was present in 13 surgical patients (18.8%), but only 3 patients had bilateral surgery. Two operative patients had bifocal JOCD (2.7%) and surgery on both lesions. Location distribution did not differ between surgical and non-surgical lesions. The average normalized area of non-surgical JOCD lesions was 6.8 (0.1-18), whereas surgical lesions averaged a significantly higher area of 7.7 (0.5-17) (p=0.023). Average BMI was 21.6 versus 20.2 for surgical and non-surgical patients, respectively, significantly higher for those who underwent surgery (p=0.002). Most common procedure was fixation with 1.6 mm bioabsorbable nails (54.2%), using an average of 4 nails (1-9). Only 2 cases were fixed using metallic headless screws. Other surgical treatments were drilling (13.9%), microfracture (13.9%), microfracture + fixation (6.9%), removal of loose body/chondroplasty (6.9%), and allograft transplantation (4.2%). Fixation was achieved all-arthroscopic in 43.1% of the cases, and 61.3% of the lesions that were fixed underwent curettage of the subchondral bone. Revision surgery was required in 14 knees (19.4%). The most common revision procedures were microfracture, removal of hardware, chondroplasty and allograft implantation, where some revisions had combined procedures. Most surgical patients had postoperative MRIs (55 knees), with an average radiological follow-up of 14.5 months (range 2.1-55.4). Conclusion: JOCD occurs more frequently in young adolescent athlete boys, affecting the middle third of the medial femoral condyle. In our cohort, 1/3 of the patients had surgery, where bigger lesions and higher BMI were risk factors for operative treatment. At short-term follow up, the success rate following surgery was above 80%.