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5. 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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7. 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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11. Fixation Strategy Does Not Affect Risk of Growth Disturbance After Surgical Treatment of Pediatric Tibial Spine Fracture

Author

O’Donnell, Ryan, primary, Lemme, Nicholas J., additional, Piana, Lauren, additional, Aoyama, Julien T., additional, Ganley, Theodore J., additional, Fabricant, Peter D., additional, Green, Daniel W., additional, McKay, Scott D., additional, Schmale, Gregory A., additional, Mistovich, R. Justin, additional, Baghdadi, Soroush, additional, Yen, Yi-Meng, additional, Ellis, Henry B., additional, Cruz, Aristides I., additional, Aoyama, Julien, additional, and McKay, Scott, additional

Published
2023
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12. 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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14. 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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20. 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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22. 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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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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27. 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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28. 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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31. sj-pdf-1-ajs-10.1177_03635465221142325 – Supplemental material for Effect of Delayed Anterior Cruciate Ligament Reconstruction on Repair of Concomitant Medial Meniscus Tears in Young Athletes

Author

Sorey, Woody, Hagen, Mia S., Mand, Simran, Sliepka, Joey, Chin, Kenneth, Schmale, Gregory A., Kweon, Christopher, Gee, Albert O., and Saper, Michael G.

Subjects
FOS: Clinical medicine, 110323 Surgery, 110604 Sports Medicine, FOS: Health sciences, 110314 Orthopaedics
Abstract

Supplemental material, sj-pdf-1-ajs-10.1177_03635465221142325 for Effect of Delayed Anterior Cruciate Ligament Reconstruction on Repair of Concomitant Medial Meniscus Tears in Young Athletes by Woody Sorey, Mia S. Hagen, Simran Mand, Joey Sliepka, Kenneth Chin, Gregory A. Schmale, Christopher Kweon, Albert O. Gee and Michael G. Saper in The American Journal of Sports Medicine

Published
2022
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32. Effect of Delayed Anterior Cruciate Ligament Reconstruction on Repair of Concomitant Medial Meniscus Tears in Young Athletes.

Author

Sorey, Woody, Hagen, Mia S., Mand, Simran, Sliepka, Joey, Chin, Kenneth, Schmale, Gregory A., Kweon, Christopher, Gee, Albert O., and Saper, Michael G.

Subjects
PSYCHOLOGY of athletes, ACADEMIC medical centers, CONFIDENCE intervals, CASE-control method, RETROSPECTIVE studies, TREATMENT delay (Medicine), DESCRIPTIVE statistics, ANTERIOR cruciate ligament surgery, LOGISTIC regression analysis, ODDS ratio, MENISCUS injuries
Abstract

Background: Delayed anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with an increased risk of meniscal injury. Limited data are available regarding the relationship between surgical delay and meniscal repairability in the setting of ACLR in young patients. Purpose: To determine whether time from ACL injury to primary ACLR was associated with the incidence of medial and/or lateral meniscal repair in young athletes who underwent meniscal treatment at the time of ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Records were retrospectively reviewed for patients aged 13 to 25 years who underwent primary ACLR between January 2017 and June 2020 by surgeons from a single academic orthopaedic surgery department. Demographic data were collected, and operative reports were reviewed to document all concomitant pathologies and procedures. Univariable and multivariable logistic regression analyses were used to determine factors associated with meniscal repair, including time elapsed from ACL injury to surgery. Results: Concomitant meniscal tears were identified and treated in 243 of 427 patients; their mean age was 17.9 ± 3.3 years, and approximately half (47.7%) of patients were female. There were 144 (59.3%) medial tears treated and 164 (67.5%) lateral tears treated; 65 (26.7%) patients had both medial and lateral tears treated. Median time from ACL injury to ACLR was 2.4 months (interquartile range, 1.4-4.7 months). Adjusted univariate analysis showed a statistically significant correlation between medial meniscal repair and time to surgery, with a 7% decreased incidence of medial meniscal repair per month elapsed between injury and surgery (odds ratio, 0.93 per month; 95% CI, 0.89-0.98; P =.006). No similar relationship was found between lateral meniscal repair and time to surgery (odds ratio, 1.02; 95% CI, 0.99-1.06; P =.24). Conclusion: In the setting of concomitant ACL and meniscal injuries, surgical delay decreased the incidence of medial meniscal repair in young athletes by 7% per month from time of injury. [ABSTRACT FROM AUTHOR]

Published
2023
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34. 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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37. 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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38. HOW MANY PAIN PILLS DO WE PRESCRIBE: A SURVEY OF PARTICIPANTS IN SCORE: A QUALITY IMPROVEMENT INITIATIVE (204)

Author

Halloran, Kenny, primary, Ellis, Henry, additional, Wilson, Philip, additional, Beck, Jennifer, additional, Schmale, Gregory, additional, Latz, Kevin, additional, Fabricant, Peter, additional, Schmitz, Matthew, additional, Niu, Emily, additional, Heyworth, Benton, additional, Bowen, Richard, additional, Parikh, Shital, additional, McKay, Scott, additional, Edmonds, Eric, additional, Green, Daniel, additional, Saper, Michael, additional, Mansour, Alfred, additional, Milewski, Matthew, additional, Crepeau, Allison, additional, Ganley, Theodore, additional, and Shea, Kevin, 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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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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48. Reliability of a New Arthroscopic Discoid Lateral Meniscus Classification System: A Multicenter Video Analysis.

Author

Lee, R. Jay, Nepple, Jeffrey J., Schmale, Gregory A., Niu, Emily L., Beck, Jennifer J., Milewski, Matthew D., Finlayson, Craig J., Joughin, V. Elaine, Stinson, Zachary S., Pace, J. Lee, Albright, Jay, Carsen, Sasha, Chambers, Hank, Nault, Marie-Lyne, Schlechter, John A., Stavinoha, Tyler J., Tompkins, Marc, Wilson, Philip L., and Heyworth, Benton E.

Subjects
RESEARCH, MENISCUS (Anatomy), ACADEMIC medical centers, ARTHROSCOPY, INTER-observer reliability, DESCRIPTIVE statistics, SPORTS medicine, STATISTICAL correlation, WOUNDS & injuries, VIDEO recording, LONGITUDINAL method
Abstract

Background: The discoid lateral meniscus (DLM) is one of the most common congenital anomalies of the knee. The pathomorphology of DLM varies. Current classification systems are inadequate to describe the spectrum of abnormality. Purpose: A study group of pediatric orthopaedic surgeons from 20 academic North American institutions developed and tested the reliability of a new DLM classification system. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: After reviewing existing classifications, we developed a comprehensive DLM classification system. Four DLM features were evaluated: meniscal width, meniscal height, peripheral stability, and meniscal tear. Stepwise arthroscopic examination using anteromedial and anterolateral viewing portals was established for evaluating these features. Three senior authors who were not observers selected 50 of 119 submitted videos with the best clarity and stepwise examination for reading. Five observers performed assessments using the new classification system to assess interobserver reliability, and a second reading was performed by 3 of the 5 observers to assess intraobserver reliability using the Fleiss κ coefficient (fair, 0.21-0.40; moderate, 0.41-0.60; substantial, 0.61-0.80; excellent, 0.81-1.00). Results: Interobserver reliability was substantial for most rating factors: meniscal width, meniscal height, peripheral stability, tear presence, and tear type. Interobserver reliability was moderate for tear location. Intraobserver reliability was substantial for meniscal width and meniscal height and excellent for peripheral stability. Intraobserver agreement was moderate for tear presence, type, and location. Conclusion: This new arthroscopic DLM classification system demonstrated moderate to substantial agreement in most diagnostic categories analyzed. [ABSTRACT FROM AUTHOR]

Published
2022
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49. 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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