bluuebunny/crossref_metadata_2025_split huggingface dataset:
ANTERIOR CRUCIATE LIGAMENT TEAR FOLLOWING SURGICAL TREATMENT OF PEDIATRIC TIBIAL EMINENCE FRACTURE IN A MULTICENTER COHORT
Authors: O’Donnell Ryan , Bokshan Steven , Brown Kelsey , Aoyama Julien T , Ganley Theodore J , Fabricant Peter D , Patel Neeraj M. , Ellis Henry B , Green Daniel W , Jagodzinski Jason E , Kushare Indranil , Lee R Jay , McKay Scott , Rhodes Jason , Sachleben Brant , Sargent Catherine , Schmale Gregory A. , Yen Yi-Meng , Mistovich R Justin , Cruz Aristides I. 
Published: July 2021

Background: While operative treatment of displaced pediatric tibial eminence fractures has generally been shown to be safe, post-operative complications including arthrofibrosis, infection, fixation failure, and postoperative ipsilateral ACL injuries remain prevalent. The purpose of this study was to describe the prevalence of and risk factors for post-operative ACL tears in a cohort of patients surgically treated for tibial eminence fracture. Methods: We performed a retrospective review of children undergoing treatment of a tibial eminence fracture at 10 tertiary children’s hospitals.. The primary outcome was subsequent ACL rupture. Patients with 2 year follow up data and those that had met the primary outcome within the 2 year period, were analyzed for demographics, risk factors and survival analyses Results: 385 pediatric patients were reviewed. Overall, 46 patients had either 2 year follow up data or met the primary outcome measure of an ACL tear prior to the 2 year mark. Mean age was 11.2 years old (SD 2.8), and the median follow time was 36.4 months (SD 17.7 months) There was a 21.7% incidence of subsequent ACL tear in the cohort analyzed. Subsequent ACL tears occurred at a median of 10.2 months (SD 19.5 months) postoperatively. There was a statistically significant association with higher Myers & McKeever grade tibial spine fractures (Type III and IV) and subsequent ACL rupture ( p=0.006). Subsequent ACL tears occurred in patients who were older when they had their original tibial eminence fracture, 13.4 years old versus 11.3 years old ( p=0.035). There was no statistically significant relationship between ipsilateral ACL tear and body mass index, operative time, fixation method used, postoperative weight bearing status, type of postoperative immobilization, contact versus non-contact injury mechanism, type of post-operative physical therapy protocol based on chi-squared or t-test ( p>0.05). Conclusion: Subsequent ipsilateral ACL tears following operatively treated pediatric tibial eminence fractures in a large multicenter cohort occurred at a rate of 21.7%. They were associated with completely displaced (Type III or IV) tibial eminence fractures, and older patients. Clinicians should therefore continue to follow patients for at least 2 years after treatment of pediatric tibial eminence fractures in order to track this potential complication. [Table: see text]
PREOPERATIVE 3D MODELING AND PRINTING FOR GUIDING PERIACETABULAR OSTEOTOMY
Authors: Shelton Trevor J. , Shafagh Monazzam , Calafi Arash , Leshikar Holly B. , Haus Brian M. 
Published: July 2021

Background: Achieving adequate acetabular correction in multiple planes is essential to the success of Periacetabular Osteotomy (PAO). Three-dimensional (3D) modeling and printing has the potential to improve preoperative planning by accurately guiding intraoperative correction. Hypothesis/Purpose: We, therefore, asked the following questions: 1) For a patient undergoing a PAO, does 3D-modeling with intraoperative 3D-printed models create a reproducible surgical plan to obtain predetermined parameters of correction including lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), Tonnis angle, and femoral head extrusion index (FHEI), 2) Can 3D computer modeling accurately predict when a normalized FHEI can be achieved without the need for a concomitant femoral sided osteotomy? Methods: A retrospective review was conducted on forty-two (42) consecutive patients that underwent a PAO. 3D-modeling software was utilized to simulate a PAO in order to achieve normal LCEA, ACEA, Tonnis angle, and FHEI. If adequate FHEI was not achieved, a femoral osteotomy was simulated. 3D-models were printed as intraoperative guides. Preoperative, simulated, and postoperative ACEA, LCEA, Tonnis angle, and FHEI were measured and compared statistically. Results: 40 patients had a traditional PAO, and 2 had an anteverting-PAO. The simulated LCEA, ACEA, Tonnis angle, and FHEI were within a median difference of 3º, 1º, 1°, and 0% of postoperative values, respectively and showed no statistical difference. Of those that had a traditional PAO, all thirty-four (34) patients were correctly predicted to need a traditional acetabular sided correction alone and the other six (6) were correctly predicted to need a concomitant femoral osteotomy for a correct prediction in 100% of patients. Conclusion: This study demonstrated that in PAO, 3D-modeling and printing allow the surgeon to accurately create a reproducible surgical plan to obtain predetermined postoperative hip coverage parameters. This new technology has the potential to improve preoperative/intra-operative decision making for hip dysplasia and other complex disorders of the hip.
INTER-RATER RELIABILITY OF THE PRONE APPREHENSION RELOCATION TEST (PART)
Authors: Watchmaker Lauren E. , Hetzel Scott J. , Sink Ernest L. , Spiker Andrea M. 
Published: July 2021

Background: Hip dysplasia and related instability can cause pain, limit hip function, and ultimately result in osteoarthritis. The Prone Apprehension Relocation Test (PART) augments existing radiographic markers and clinical provocative maneuvers in diagnosing hip dysplasia. Reproducibility of the PART between examiners has not been previously studied. Hypothesis/Purpose: One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. The purpose of this study is to determine the inter-rater reliability of the PART between health care professionals. Methods: We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by two health care professionals who were blinded to the other’s results. Inter-rater reliability was assessed using the Cohen 𝜅, with a value of 𝜅 ≥ 0.75 considered excellent inter-rater reliability, between 0.75 and 0.40 moderate, and ≤ 0.40 poor. Results: 96 patients (190 hips) were included, with 63 females and 35 males, average age 32 ± 12.1 years. 23 hips had a positive PART from both examiners. Inter-rater reliability was excellent between health care professionals for the PART when evaluating the right hip (𝜅 = 0.80), left hip (𝜅 = 0.82), and when combining the results for left and right (𝜅 = 0.81). A sub-analysis of patients who had a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center edge angle > 25°. Conclusion: Our study demonstrates that the PART is a reliable physical exam maneuver in the evaluation of hip pain.
THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES
Authors: Smith Haley E. , Lyons Madeline M. , Patel Neeraj M. 
Published: July 2021

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.
NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL
Authors: Lindsay Eduardo A. , Olivella Gerardo , Rodríguez Manuel , Burgos-Rossy Edwin , Torres-Acevedo Natalia , Ramírez-Roggio Daniela , Iriarte Iván , Ramírez Norman 
Published: July 2021

Background & Objectives: Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain. Methodology: After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting > 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded. Results: A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P<0.03) and three times more likely of having an abnormal neurological examination (P<0.05). See table 1. Conclusion: Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients. Summary [Table: see text]
CLEARANCE BASED ON STANDARDIZED RETURN TO SPORTS ASSESSMENT FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS
Authors: Bergman Rachel , Kent Robert , Kellum Jessica , Crawford Eileen 
Published: July 2021

Background: Return to sports (RTS) is often the primary concern of patients following anterior cruciate ligament reconstruction (ACLR). Unfortunately, RTS at the preinjury level is not commonplace in pediatric patients despite advances in rehabilitation and measures of recovery, and second injury rates are highest among the young adolescent population. RTS criteria have become more rigorous in recent years. The impact of these new RTS assessments (RTSA) is still unfolding, and their application in a mixed pediatric and adolescent population is unclear. Purpose: To assess whether adolescent patients who undergo standard ACLR pass a rigorous RTSA sooner than those undergoing pediatric ACLR. Methods: This study was a retrospective chart review of patients ages >5 and <18 with primary, unilateral ACL tear who underwent ACLR from January 2017 to December 2019. Subjects were identified using current procedural terminology codes from the hospital electronic medical record then grouped based on ACL reconstruction technique: Adolescent (transphyseal approach) and Pediatric (complete or partial physeal-sparing approach). All subjects underwent a rigorous and standardized RTSA used by the operating surgeons to guide clearance to RTS. The primary outcome measure was post-operative time to clearance for RTS, with secondary analyses controlling for sex, concomitant pathology at the time of ACLR, number of RTSAs prior to clearance, and physical therapy provider. Parametric and nonparametric statistical comparisons were respectively performed via unpaired Student t-tests and Mann-Whitney U tests (p<0.05). Results: Of 426 identified ACLR patients, 97 (84 Adolescent, 13 Pediatric) met the inclusion criteria for the final analysis (39 M, 58 F; Adolescent mean age 16.44 ± 1.7 years, Pediatric mean age 13.21 ± 1.4 years). There were no significant differences in gender distribution or concomitant pathology between the groups. Median post-operative time to clearance for RTS was 12.2 months in the Pediatric group (95% CI: 10.9-12.7) and 9.3 months in the Adolescent group (95% CI: 8.9-9.8) (p<0.001). This difference in time to RTS between groups remained statistically significant after adjusting for the secondary variables described above (all p≤0.002). Conclusions: When applying a rigorous and standardized RTSA to determine readiness for RTS, Pediatric subjects who underwent a partial or complete physeal-sparing technique took nearly 3 months longer to be cleared than Adolescent subjects who underwent a standard transphyseal approach. Notably, Adolescent subjects averaged more than 9 months of rehabilitation prior to RTS. These findings help inform patient expectations for a safe recovery period following ACLR.
MAGNETIC RESONANCE IMAGING OF LATERAL MENISCAL POSTERIOR ROOT TEARS IN THE ADOLESCENT KNEE: IS THE DIAGNOSIS MISSED, MENTIONED, OR MADE?
Authors: Schlechter John A. , Gornick Bryn , McDonald Edward J. , Pak Theresa 
Published: July 2021

Background: The meniscal roots play a vital role in maintaining proper knee kinematics. Neglected meniscal root tears place excess stress on the articular cartilage and increase the risk of premature osteoarthritis. As opposed to medial meniscal root tears, lateral meniscal posterior root tears (LMPRTs) are more likely to be associated with anterior cruciate ligament (ACL) pathology. Failure to identify and address meniscal root tears may place undue loads on ACL grafts and lead to inferior post-surgical outcomes. Purpose: To examine preoperative knee magnetic resonance imaging (MRI) radiologist interpretations for the identification of lateral meniscal root pathology in children and adolescents. Methods: We performed a retrospective review of children and adolescents that underwnent knee arthroscopy between 3/1/2010 and 4/1/2020 and had an arthroscopically confirmed LMPRT. Arthroscopic findings were compared to the reading radiologist’s preoperative MRI interpretations. LMPRTs were graded using the LaPrade classification. ANOVA was performed to assess if body mass index (BMI), open physes, time from injury to MRI, time from MRI to surgery, MRI magnet field strength, musculoskeletal radiologist designation, insurance type and tear grade were associated with the preoperative MRI identification of a LMPRT. Results: During the study period, 1285 knee arthroscopies were performed. 607 of which were ACL reconstructions. 54 children were found to have a LMPRT arthroscopically and all were associated with an ACL tear 54/607 (9%). One patient had 2 preoperative MRIs for a total of 55 MRIs in 54 pateints. Average age was 16 years (range 14-21). Preoperative MRI diagnosis of a LMPRT was made in only 14/55 (25%) and missed in 22/55 (40%). In 19/55 (35%), pathology of the lateral meniscus nonspecific to the root was mentioned. Lateral joint line tenderness was present in 23/54 (46%). There was no statistical significance found in regards to patient BMI, skeletal maturity, time from injury to MRI, time from MRI to surgery, MRI magnet strength, if the radiologist was musculoskeletal fellowship-trained, or insurance type, with a reliable diagnosis. (Table) Conclusion: The final interpretation of preoperative MRIs did not provide a clear definitive diagnosis of a LMPRT in 75 % in patients. As the intraoperative management of LMPRTs can be involved and diverge from standard meniscal work, preoperative diagnosis would be advantageous. All LMPRTs in this study were associated with a concomitant ACL tear. Surgeons caring for ACL tears in children and adolescents should be prepared to treat a LMPRT regardless of a inconclusive MRI interpretation for meniscal root pathology. [Table: see text]
IS PERCUTANEOUS MEDIAL COLLATERAL LIGAMENT (MCL) RELAXATION DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION A SAFE OPTION FOR GAINING ACCESS TO THE MEDIAL KNEE COMPARTMENT IN CHILDREN?
Authors: Schlechter John A. , Harrah Tanner , Gornick Bryn , Sherman Benjamin 
Published: July 2021

Introduction: With participation in youth sports anterior cruciate ligament (ACL) injuries are a common occurrence. Nearly 70% of ACL tears in children and adolescents have an associated meniscus tear. Percutaneous medial collateral ligament (MCL) relaxation has been described as utilitarian in accessing the medial meniscus for diagnostic assessment and treatment in the adult population to increase medial compartment working space in arthroscopic surgery. The technique has not been evaluated in the pediatric population. The purpose of this study was to compare the outcomes of children and adolescents that underwent anterior cruciate ligament reconstruction (ACLR) with and without percutaneous relaxation of the medial collateral ligament (MCL) for meniscal tear management. Methods: A retrospective review was performed of patients aged 8 to 19 years old that had undergone knee arthroscopy for an (ACLR) with meniscus pathology. Those that underwent MCL relaxation were grouped together and compared to a matched cohort that did not have MCL relaxation performed. Preoperative, operative and postoperative data was analyzed. The primary measurement was obtained using a validated patient reported outcome score (Pedi-IKDC), secondary outcome measures were defined as superficial or deep infection, saphenous nerve dysesthesias, ACL graft failure and return to the operating room. Statistical analysis of the two cohorts was performed. Results: Fifty-four patients were included in the study (27 in each group) with average age 15 years (range 10-19). Average follow-up for the MCL relaxation group was 22.4 months versus 58 months for the non-MCL relaxation group. The average Pedi-IKDC score was 93.3 for the MCL relaxation group and 91.4 for the non-MCL relaxation group (p=0.34). There was no difference in patient demographics, return to the operating room (p=0.49), saphenous nerve dysesthesia (p=0.49), superficial or deep infection (p=0.32). Conclusion: ACL reconstruction in children and adolescents with MCL relaxation for the management of medial meniscal tears appears to be a safe option. Equivocal patient reported outcome scores as compared to the control group were found with no increase in post-operative complications. In children with ACL tears, appropriate diagnosis and management of medial meniscal pathology is important to maintain secondary restraint to anterior tibial translation and prevent premature graft failure. Pediatric knees can have tight medial compartments, making access difficult, potentially leading to poor visualization and iatrogenic chondral damage. Percutaneous medial collateral ligament (MCL) relaxation has been described in the adult population to increase medial compartment working space without long term sequela. We report similar findings in an all pediatric cohort.