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  • 1
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    Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Clinical Orthopaedics & Related Research Vol. 475, No. 6 ( 2017-06), p. 1583-1591
    Details
    In: Clinical Orthopaedics & Related Research, Ovid Technologies (Wolters Kluwer Health), Vol. 475, No. 6 ( 2017-06), p. 1583-1591
    Type of Medium: Online Resource
    ISSN: 0009-921X
    URL: Article
    DOI: 10.1007/s11999-016-5123-6
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2018318-5
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  • 2
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    All-Epiphyseal Anterior Cruciate Ligament Femoral Tunnel Drilling: Avoiding Injury to the Physis, Lateral Collateral Ligament, Anterolateral Ligament, and Popliteus—A 3-Dimensional Computed Tomography Study
    Elsevier BV ; 2018
    In:  Arthroscopy: The Journal of Arthroscopic & Related Surgery Vol. 34, No. 5 ( 2018-05), p. 1570-1578
    Details
    In: Arthroscopy: The Journal of Arthroscopic & Related Surgery, Elsevier BV, Vol. 34, No. 5 ( 2018-05), p. 1570-1578
    Type of Medium: Online Resource
    ISSN: 0749-8063
    URL: Article
    DOI: 10.1016/j.arthro.2017.12.007
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 1491233-8
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  • 3
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    Variation in the Medial Patellofemoral Ligament Origin in the Skeletally Immature Knee: An Anatomic Study
    SAGE Publications ; 2018
    In:  The American Journal of Sports Medicine Vol. 46, No. 2 ( 2018-02), p. 363-369
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 46, No. 2 ( 2018-02), p. 363-369
    Abstract: The medial patellofemoral ligament (MPFL) is frequently reconstructed to treat recurrent patellar instability. The femoral origin of the MPFL is well described in adults but not in the skeletally immature knee. Purpose: To identify a radiographic landmark for the femoral MPFL attachment in the skeletally immature knee and study its relationship to the distal femoral physis. Study Design: Descriptive laboratory study. Methods: Thirty-six cadaveric specimens between 2 and 11 years old were dissected and examined (29 male and 7 female). Metallic markers were placed at the proximal and distal borders of the MPFL femoral origin footprint. Computed tomography scans with 0.625-mm slices in the axial, coronal, and sagittal planes were used to measure the maximum ossified height and ossified depth. The measurements were used to describe the position of the midpoint MPFL attachment with respect to the posterior-anterior and distal-proximal dimensions of the femoral condyle on the sagittal view and to describe the distance from the physis to the femoral origin of the MPFL. Results: In 23 of 36 specimens, the femoral origin of the MPFL was distal to the physis. Thirteen of the 36 specimens had an MPFL origin at or proximal to the physis, with a more proximal MPFL origin consistently seen in older specimens. The distance of the MPFL origin to the physis ranged from 15.1 mm distal to the physis to 8.3 mm proximal to the physis. The mean midpoint of the MPFL femoral origin was located 3.0 ± 5.5 mm distal to the physis for all specimens. For specimens aged 〈 7 years, the mean MPFL origin was 4.7 mm distal to the physis, and for specimens aged ≥7 years, the mean MPFL origin was 0.8 mm proximal to the femoral physis. The MPFL origin was more proximal and anterior for those aged ≥7 years and more distal and posterior for those aged 〈 7 years. Conclusion: Surgical reconstruction of the MPFL is a common treatment to restore patellar stability. There appears to be significant variability in the origin of the MPFL in skeletally immature specimens. This study demonstrated that the MPFL origin was more proximal and anterior with respect to the physis in the older age group. The MPFL origin footprint may be customized for different age groups. Clinical Relevance: This information shows anatomic variation of the MPFL origin with age, with older specimens having a footprint that was more proximal and anterior than younger specimens. Customization of the surgical technique might be considered based on patient age.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546517738002
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2063945-4
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  • 4
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    Lateral Radiographic Landmarks for ACL and LCL Footprint Origins During All-Epiphyseal Femoral Drilling in Skeletally Immature Knees
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Bone and Joint Surgery Vol. 99, No. 6 ( 2017-3-15), p. 506-511
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 99, No. 6 ( 2017-3-15), p. 506-511
    Abstract: This study was conducted to evaluate the spatial relationship of the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) femoral footprint origins in knee specimens from skeletally immature donors as viewed on lateral radiographs. Methods: Fourteen cadaver specimens of skeletally immature knees from children between 7 and 11 years old at the time of death were examined through gross dissection. Metallic pins were placed at the center of the ACL and LCL femoral footprints, and computed tomography (CT) scans were performed. Sagittal plane CT images were merged to create a view analogous to an intraoperative C-arm image with overlaid ACL and LCL ligament footprints. Ligament origins were then measured as a percent of the epiphyseal depth (% P-A [posterior-anterior]) and height (% P-D [proximal-distal] ). Results: The ACL origin was centered at a point located 14% (14% P-A) of the total lateral femoral condyle (LFC) depth from the most posterior aspect of the LFC and 38% (38% P-D) of the LFC height from the most proximal aspect of the posterior physis. The LCL origin was centered at a point 27% P-A and 37% P-D. When viewed on a sagittal CT reconstruction analogous to a perfect lateral intraoperative fluoroscopic view, the ACL footprint origin is posterior and slightly inferior to the LCL origin. Both origins are distal to the distal femoral physis and are posterior to the origin of the popliteus. Conclusions: This study demonstrates a consistent relationship between the origin of the ACL and LCL, which may be useful in guiding safe tunnel placement during all-epiphyseal ACL reconstruction in skeletally immature knees. Clinical Relevance: This anatomic reference can be used intraoperatively to guide and radiographically evaluate ACL tunnel placement while avoiding the LCL origin in skeletally immature patients.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.16.00641
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 5
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    Anatomic Dissection and CT Imaging of the Anterior Cruciate and Medial Collateral Ligament Footprint Anatomy in Skeletally Immature Cadaver Knees
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Pediatric Orthopaedics Vol. 40, No. 2 ( 2020-02), p. e109-e114
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 2 ( 2020-02), p. e109-e114
    Abstract: Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in skeletally immature patients are increasingly recognized and surgically treated. However, the relationship between the footprint anatomy and the physes are not clearly defined. The purpose of this study was to identify the origin and insertion of the ACL and MCL, and define the footprint anatomy in relation to the physes in skeletally immature knees. Methods: Twenty-nine skeletally immature knees from 16 human cadaver specimens were dissected and divided into 2 groups: group A (aged 2 to 5 y), and group B (aged 7 to 11 y). Metallic markers were placed to mark the femoral and tibial attachments of the ACL and MCL. Computed tomography scans were obtained for each specimen used to measure the distance from the center of the ligament footprints to the respective distal femoral and proximal tibial physes. Results: The median distance from the ACL femoral epiphyseal origin to the distal femoral physis was 0.30 cm (interquartile range, 0.20 to 0.50 cm) and 0.70 cm (interquartile range, 0.45 to 0.90 cm) for groups A and B, respectively. The median distance from the ACL epiphyseal tibial insertion to the proximal tibial physis for groups A and B were 1.50 cm (interquartile range, 1.40 to 1.60 cm) and 1.80 cm (interquartile range, 1.60 to 1.85 cm), respectively. The median distance from the MCL femoral origin on the epiphysis to the distal femoral physis was 1.20 cm (interquartile range, 1.00 to 1.20 cm) and 0.85 cm (interquartile range, 0.63 to 1.00 cm) for groups A and B, respectively. The median distance from the MCL insertion on the tibial metaphysis to the tibial physis was 3.05 cm (interquartile range, 2.63 to 3.30 cm) and 4.80 cm (interquartile range, 3.90 to 5.10 cm) for groups A and B, respectively. Conclusion: Surgical reconstruction is a common treatment for ACL injury. Computed tomography scanning of pediatric tissue clearly defines the location of the ACL and MCL with respect to the femoral and tibial physes, and may guide surgeons for physeal respecting procedures. Clinical Relevance: In addition to ACL reconstruction, recent basic science and clinical research suggest that ACL repair may be more commonly performed in the future. MCL repair and reconstruction is also occasionally required in skeletally immature patients. This information may be useful to help surgeons avoid or minimize physeal injury during ACL/MCL reconstructions and/or repair in skeletally immature patients.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001398
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2049057-4
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  • 6
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    The Incidence of Surgery in Osteochondritis Dissecans in Children and Adolescents
    SAGE Publications ; 2016
    In:  Orthopaedic Journal of Sports Medicine Vol. 4, No. 3 ( 2016-03-01), p. 232596711663551-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 4, No. 3 ( 2016-03-01), p. 232596711663551-
    Abstract: The frequency of osteochondritis dissecans (OCD), a disorder of the subchondral bone and articular cartilage, is not well described. Purpose: To assess the frequency of pediatric OCD lesions that progress to surgery based on sex, joint involvement, and age. Study Design: Descriptive epidemiology study. Methods: A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years. Exclusion criteria included traumatic osteochondral fractures or coexistence of non-OCD intra-articular lesions. Differences in progression toward surgery were compared between age groups, sex, and joint location. Logistical regression analysis was performed by sex, age, and ethnicity. Results: Overall, 317 patients with a total of 334 OCD lesions were found. The majority of lesions (61.7%) were in the knee, with ankle, elbow, shoulder, and foot lesions representing 25.4%, 12.0%, 0.6%, and 0.3% of all lesions, respectively. The majority of joints needing surgery were in the knee (58.5%), with ankle and elbow lesions representing 22.9% and 18.6% of surgeries performed, respectively. The percentage of all OCD lesions progressing to surgery was 35.3%; surgical progression for knee, ankle, and elbow joints was 33.5%, 31.8%, and 55.0%, respectively. Logistic regression analysis found no statistically significant different risk of progressing to surgery for OCD of the knee, elbow, and ankle between sexes. Patients aged 12 to 19 years had a 7.4-times greater risk of progression to surgery for knee OCD lesions than 6- to 11-year-olds. Patients aged 12 to 19 years were 8.2 times more likely to progress to surgery for all OCD lesions than patients aged 6 to 11 years. Progression to surgery of ankle OCD did not significantly differ based on location. Three of 4 trochlear lesions progressed to surgery, along with 1 of 1 tibial, 1 of 3 patellar, 40.3% of lateral femoral condylar, and 28.2% of medial femoral condylar lesions. Conclusion: In this large cohort study of pediatric OCD patients, 35% progressed to surgery. Progression to surgery did not differ significantly between sexes with OCD of any joint. Progression to surgery for OCD of the knee, elbow, and ankle strongly correlated with patient age at the time of diagnosis. Clinical Relevance: The knowledge of likelihood of progression to surgery of OCD by location, sex, and age is useful in counseling patients and in planning treatment. This study confirms a worse prognosis in the nonoperative treatment of older patients with OCD.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967116635515
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2706251-X
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  • 7
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    Incidence of Osteochondritis Dissecans in Adults
    SAGE Publications ; 2018
    In:  The American Journal of Sports Medicine Vol. 46, No. 7 ( 2018-06), p. 1592-1595
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 46, No. 7 ( 2018-06), p. 1592-1595
    Abstract: Osteochondritis dissecans (OCD) has frequently been described in children and adolescents, but cases of OCD in adults are certainly encountered. Little has been published on the epidemiology of OCD in adult patients. Purpose: To assess the frequency of OCD lesions in adults and assess the risk by age, sex, and ethnicity. Study Design: Descriptive epidemiology study. Methods: The authors assessed all patients aged 20 to 45 years from the entire database of patients enrolled as members of Kaiser Permanente Southern California from January 2011 until December 2013. Kaiser Southern California is an integrated health care system serving a racially, ethnically, and socioeconomically diverse population of 〉 3.5 million patients. A retrospective chart review was done on OCD during this period. Inclusion criteria included OCD of any joint. Exclusion criteria included traumatic osteochondral fractures and coexistence of intra-articular lesions other than OCD. Joint involvement/location, laterality, and all patient demographics were recorded. Results: Among 122 patients, a total of 124 OCD lesions were found. The majority of lesions were in the ankle (n = 76) and knee (n = 43), with 3 foot lesions and 2 elbow lesions identified. OCD lesions were identified in 75 men (62%) and 47 women (38%). Overall incidence rates per 100,000 person-years were 3.42 for all OCD, 2.08 for ankle OCD, and 1.21 for knee OCD. The relative risk of adult OCD for men was twice that of women. The relative risk of adult OCD for white patients was 2.3 that of Asians and 1.7 that of Hispanics. Risk of knee OCD was 3.6 times higher for men than women. As compared with women, men had a higher risk for lateral femoral condyle OCD lesions versus the medial femoral condyle ( P = .05; odds ratio [OR], 5.19). Conclusion: This large cohort study of Southern California adults with OCD demonstrated an increased OR for men (vs women) of OCD in all joints. The majority of symptomatic lesions were present in the ankle rather than the knee, as previously found in children. White and black patients had the highest OR of OCD; men had a significantly greater OR of lateral femoral condyle knee lesions as compared with women.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546518764676
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 8
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    Childhood Obesity is Associated With Osteochondritis Dissecans of the Knee, Ankle, and Elbow in Children and Adolescents
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Pediatric Orthopaedics Vol. 38, No. 5 ( 2018-05), p. e296-e299
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 5 ( 2018-05), p. e296-e299
    Abstract: Osteochondritis dissecans (OCD) is a joint disorder of the subchondral bone and articular cartilage whose association with obesity in children is not clearly known. The purpose of this study was to assess the magnitude of the association between childhood obesity and the occurrence of OCD of the knee, ankle, and elbow in children. Methods: A retrospective chart review of an integrated health system was performed on OCD patients aged 2 to 19 from 2007 to 2011, with over 1 million patients in this cohort. Lesion location, laterality, and all patient demographics were recorded. The body mass index (BMI) for each patient in the cohort was used to stratify patients into 5 weight classes (underweight, normal weight, overweight, moderately obese, and extremely obese) based on BMI-for-age. The associations between the 5 weight classes and OCD of the ankle, knee, and elbow were assessed using multiple logistic regression models to estimate odds ratios (OR) and 95% confidence intervals using multivariate analysis to adjust for patient demographic variables. Results: In total, 269 patients fit the inclusion criteria. Mean BMI, both absolute and percentile, was significantly higher for patients with OCD of the knee, elbow, and ankle than patients without OCD. In the multivariate analysis, extremely obese patients were found to have an increased OR of OCD for all patients, with an 86% increased risk of any OCD compared with normal weight patients. In addition, assessment by different types of OCD revealed that extremely obese patients had an increased OR of OCD of the elbow and ankle individually, with a 3.1 times increased OCD elbow risk and 3.0 times increased risk of ankle OCD in extremely obese patients. Although extremely obese patients did not have a statistically significant increased risk of knee OCD, moderately obese patients did have a 1.8 times increased risk of knee OCD as compared with normal weight children. There were no significantly different risks of any type of OCD seen in overweight or underweight patients as compared with normal weight patients. Conclusions: In this population-based cohort study, extreme obesity is strongly associated with an increased risk of OCD overall and OCD of the elbow and ankle specifically. In addition, moderate obesity is associated with an increased risk of knee OCD. All types of OCD were also found to have a significantly greater average BMI when compared with patients without OCD. Level of Evidence: Level IV—descriptive epidemiology study.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001158
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2049057-4
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  • 9
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    Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents
    SAGE Publications ; 2018
    In:  Orthopaedic Journal of Sports Medicine Vol. 6, No. 12 ( 2018-12-01), p. 232596711881584-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 6, No. 12 ( 2018-12-01), p. 232596711881584-
    Abstract: Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known. Purpose: To assess the demographics and epidemiology of OCD of the elbow among children. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review of an integrated health system for the years 2007 through 2011 was performed for patients with elbow OCD aged 2 to 19 years. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole as well as by sex and age group (2-5, 6-11, 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and multivariable logistic regression models were used to assess the risk of elbow OCD by group. Results: A total of 37 patients with 40 OCD lesions fit the inclusion criteria. No lesion was found among 2- to 5-year-olds. A majority of lesions (n = 39, 97.5%) were in the capitellum, and 1 (2.5%) was in the trochlea. Twenty-five patients (67.6%) had right-sided lesions; 9 (24.3%), left-sided; and 3 (8.1%), bilateral. The incidence of elbow OCD for patients aged 6 to 19 years was 2.2 per 100,000 overall and 3.8 and 0.6 per 100,000 for males and females, respectively. The majority of OCD cases were seen in those aged 12 to 19 years, with an incidence of 3.4 per 100,000 versus 0.38 among 6- to 11-year-olds. Multivariable logistic regression analysis revealed a 21.7-times increased odds ratio of elbow OCD among patients aged 12 to 19 years versus 6 to 11 years, and males had a 6.8-times greater odds ratio of elbow OCD than females ( P 〈 .0001 for both). Based on race and ethnicity, non-Hispanic whites had the highest incidence of elbow OCD as compared with all other ethnic groups. Conclusion: In this population-based cohort study of pediatric elbow OCD, males had almost 7 times the risk of elbow OCD as compared with females, and 12- to 19-year-olds had nearly 22 times the risk of elbow OCD versus 6- to 11-year-olds. In keeping with many prior studies, the majority of patients had right-sided lesions.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967118815846
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2706251-X
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  • 10
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    Biomechanical Comparison of Epiphyseal Anterior Cruciate Ligament Fixation Using a Cortical Button Construct Versus an Interference Screw and Sheath Construct in Skeletally Immature Cadaveric Specimens
    SAGE Publications ; 2018
    In:  Orthopaedic Journal of Sports Medicine Vol. 6, No. 6 ( 2018-06-01), p. 232596711877695-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 6, No. 6 ( 2018-06-01), p. 232596711877695-
    Abstract: Anterior cruciate ligament (ACL) ruptures have become increasingly common in pediatric and adolescent athletes. While multiple methods exist, all-epiphyseal ACL reconstruction is a popular technique in the skeletally immature patient. Given the high rate of reruptures in this population and the increasing number of commercially available fixation devices, biomechanical testing is crucial to understand the performance of these devices in pediatric epiphyseal bone. To our knowledge, there has not been a biomechanical analysis of ACL fixation devices in skeletally immature bone. Purpose: To compare cortically based button fixation with interference screw and sheath fixation in skeletally immature femoral epiphyseal cadaveric bone. Our hypothesis was that there would be no difference in peak load to failure, stiffness, or cyclic displacement between these 2 fixation constructs. Study Design: Controlled laboratory study. Methods: Fresh-frozen matched-pair knees from 3 pediatric cadaveric specimens were obtained. A synthetic graft was fixed in an all-epiphyseal femoral tunnel. Both the lateral and medial condyles were utilized to increase the sample size. Specimens were randomized and assigned to receive either an interference screw and sheath construct designed for pediatric patients or an adjustable loop cortical button. Biomechanical testing was performed to obtain ultimate load to failure, stiffness, total displacement after 500 cycles, and the failure mode for each condyle. Results: Each medial and lateral condyle in 3 pairs of skeletally immature cadaveric knees (ages 7, 9, and 11 years) was utilized for testing. One specimen was excluded after it failed by having a transphyseal fracture. The median peak load to failure was 769.80 N (interquartile range [IQR], 628.50-930.41 N) for the screw and sheath group and 862.80 N (IQR, 692.34-872.65 N) for the button group ( P = .893). The median displacement after 500 cycles for the screw and sheath group was 0.65 mm (IQR, 0.47-1.03 mm) and 1.13 mm (IQR, 0.96-1.25 mm) for the button group ( P = .08). The median stiffness of the screw and sheath group was significantly higher than that of the button group (31.47 N/mm [IQR, 26.40-43.00 N/mm] vs 25.22 N/mm [IQR, 21.18-27.07 N/mm], respectively) ( P = .043). Conclusion: When comparing femoral fixation with a screw and sheath construct developed for pediatric patients to an adjustable loop cortical button in skeletally immature bone, our results showed that fixation did not significantly differ with respect to cyclic displacement or peak load to failure. While the screw and sheath construct was significantly stiffer, its effect on clinical outcomes is not yet known. Clinical Relevance: With regard to femoral fixation, there is no significant biomechanical difference between the use of cortically based button fixation or interference screw and sheath fixation in pediatric epiphyseal cadaveric bone.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967118776951
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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