Correlation between the Child Health Questionnaire and the International Knee Documentation Committee score in pediatric and adolescent patients with an anterior cruciate ligament tear.

BACKGROUND: The modified International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form has recently been shown to be valid, reliable, and responsive in a pediatric and adolescent population. The correlations between the Pedi-IKDC and quality-of-life-related health measures have not been studied in depth to determine how a knee injury affects patients in this age group. The purpose of this study was to examine the association between the Pedi-IKDC score and the Child Health Questionnaire (CHQ) in a group of pediatric patients with an anterior cruciate ligament (ACL) injury. METHODS: A prospectively collected registry of patients with ACL injuries was searched to indentify all patients who had completed both the Pedi-IKDC and CHQ (CHQ-CF87) questionnaires. These were analyzed to determine significant correlations between domains of the CHQ and the Pedi-IKDC. RESULTS: A total of 135 patients were included (80 male, 55 female) with a median age of 15.3 years (range, 13.1 to 17.2 y). The cohort included patients treated both operatively (120) and nonoperatively (15). The total Pedi-IKDC score was found to correlate with the majority of the CHQ including expected domains such as physical function (correlation coefficient = 0.64), bodily pain (0.7), and family activities (0.41), in addition to emotional role (0.45), mental health (0.46), self-esteem (0.45), and social limitations--physical (0.38) (P < 0.001 for all correlations). CONCLUSIONS: Seven of the 12 domains on the CHQ are significantly correlated with the IKDC in adolescent patients with an ACL tear. Self-esteem, mental health, emotional role, and social limitations categories are significantly correlated with knee function suggesting that quality-of-life in this population is affected in domains outside of physical function and pain. A greater understanding of the psychosocial impact of injury may be of utility in these patients. STUDY DESIGN: Level III cross-sectional study.

Risk Factors for Conversion to Total Hip Arthroplasty After Acetabular Fractures Involving the Posterior Wall.

OBJECTIVES: Identify risk factors for early conversion to total hip arthroplasty (THA) in an effort to aid in counseling patients and selecting the optimal treatment for patients who sustain a fracture involving the posterior wall of the acetabulum. DESIGN: Retrospective cohort analysis. SETTING: Level I trauma center. PATIENTS: Patients with acetabular fractures involving the posterior wall managed with open reduction internal fixation at least 4 years out from surgery. INTERVENTION: Preoperative and postoperative computed tomography scans were reviewed for injury characteristics and reduction quality. Participants were contacted by telephone to document reoperations and functional outcomes including the SF-8 and modified Merle d'Aubigne Hip Scale. MAIN OUTCOME MEASURE: Conversion to THA. RESULTS: The overall rate of conversion to THA was 5% at 2 years, 14% at 5 years, and 17% at 9 years. Presence of 5 specific radiographic features was associated with a 50% rate of conversion to THA in contrast to 11% if 4 or less features were present. Among cases with less than 1 mm of diastasis/step-off on postoperative computed tomography scan, there were no THA conversions, 10% conversion for 1-4 mm, and 54% if 4 mm or more of malreduction. There was no difference in SF-8 or modified Merle d'Aubigne scores comparing patients who underwent THA and those who did not. CONCLUSIONS: Acetabular fractures with posterior wall involvement are associated with a significantly higher rate of conversion to THA if reduction is not near-anatomic. A combination of clinical/radiographic findings is associated with poorer reductions and higher rate of conversion to THA. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.