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  • 1
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    Online Resource
    Fixation Strategy Does Not Affect Risk of Growth Disturbance After Surgical Treatment of Pediatric Tibial Spine Fracture
    Elsevier BV ; 2023
    In:  Arthroscopy, Sports Medicine, and Rehabilitation Vol. 5, No. 4 ( 2023-08), p. 100739-
    Details
    In: Arthroscopy, Sports Medicine, and Rehabilitation, Elsevier BV, Vol. 5, No. 4 ( 2023-08), p. 100739-
    Type of Medium: Online Resource
    ISSN: 2666-061X
    URL: Article
    DOI: 10.1016/j.asmr.2023.04.022
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 3003188-6
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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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    Anatomic all-epiphysial tibial tunnels for anterior cruciate ligament reconstruction in skeletally immature knees may be placed without damaging the anterior meniscus root
    Elsevier BV ; 2018
    In:  Journal of ISAKOS Vol. 3, No. 1 ( 2018-01), p. 3-7
    Details
    In: Journal of ISAKOS, Elsevier BV, Vol. 3, No. 1 ( 2018-01), p. 3-7
    Type of Medium: Online Resource
    ISSN: 2059-7754
    URL: Article
    DOI: 10.1136/jisakos-2017-000177
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2845311-6
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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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    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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  • 6
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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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  • 7
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    ANATOMICAL DISSECTION AND CT IMAGING OF THE ANTERIOR CRUCIATE AND MEDIAL COLLATERAL LIGAMENT FOOTPRINT ANATOMY IN SKELETALLY IMMATURE CADAVER KNEES
    SAGE Publications ; 2019
    In:  Orthopaedic Journal of Sports Medicine Vol. 7, No. 3_suppl ( 2019-03-01), p. 2325967119S0014-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 7, No. 3_suppl ( 2019-03-01), p. 2325967119S0014-
    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 two groups: Group A (ages 2-5 years), and Group B (ages 7-11 years). Metallic markers were placed to mark the femoral and tibial attachments of the ACL and MCL. CT 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: Median distance from the ACL femoral epiphyseal origin to the distal femoral physis was 0.30 cm (interquartile range, 0.20 cm to 0.50 cm) and 0.70 cm (interquartile range, 0.45 cm 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 cm to 1.60 cm) and 1.80 cm (interquartile range, 1.60 cm to 1.85 cm), respectively. Median distance from the MCL femoral origin on the epiphysis to the distal femoral physis was 1.20 cm (interquartile range, 1.00 cm to 1.20 cm) and 0.85 cm (interquartile range, 0.63 cm to 1.00 cm) for Groups A and B, respectively. Median distance from the MCL insertion on the tibial metaphysis to the tibial physis was 3.05 cm (interquartile range, 2.63 cm to 3.30 cm) and 4.80 cm (interquartile range, 3.90 cm to 5.10 cm) for Groups A and B, respectively. Conclusion: Surgical reconstruction is a common treatment for ACL injury, and occasionally MCL reconstruction or repair is also required. Cadaveric dissection and CT scanning of exceptionally rare 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 for both ACL reconstruction, and ACL repair 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. [Figure: see text][Figure: see text] [Figure: see text][Figure: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967119S00148
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 8
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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
    SSG: 31
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  • 9
    Online Resource
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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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  • 10
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    Osteochondritis Dissecans of the Knee: An Interrater Reliability Study of Magnetic Resonance Imaging Characteristics
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 9 ( 2020-07), p. 2221-2229
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 9 ( 2020-07), p. 2221-2229
    Abstract: Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented. Purpose: To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children. Study Design: Cohort study (diagnosis); Level of evidence, 3 Methods: A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable. Results: Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, –0.02 to 0.65), with reliability being moderate at best for these measurements. Conclusion: This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520930427
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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