Animal models used in meniscal repair research from ex vivo to in vivo: A systematic review.

This systematic review, registered with Prospero, aims to identify an optimal animal model for meniscus repair research, moving from ex vivo experimentation to in vivo studies. Data sources included PubMed, Medline, all Evidence-Based Medicine Reviews, Web of Science, and Embase searched in March 2023. Studies were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted data including animal model, type of experiment, type of tear, surgical techniques, and measured outcomes, were recorded, reviewed, and analyzed by four independent reviewers. The SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) Rob tool was used for critical appraisal and risk of bias assessment. Out of 11,719 studies, 72 manuscripts were included for data extraction and analysis; 41 ex vivo extra-articular studies, 20 ex vivo intra-articular studies, and only 11 in vivo studies. Six animal models were employed: porcine, bovine, lapine, caprine, canine, and ovine. Longitudinal lesions were the most frequently studied tear pattern and sutures the most common repair technique. Studied outcomes focused mainly on biomechanical assessments and gross observations. This systematic review can guide researchers in their choice of animal model for meniscus repair research; it highlighted the strengths of the porcine, caprine, and bovine models for ex vivo cadaveric studies, while the porcine and caprine models were found to be more suited to in vivo studies due to their similarities with human anatomy. Research teams should familiarize themselves with the advantages and disadvantages of various animal models before initiating protocols to improve standardization in the field.

Retroarticular drilling for osteochondritis dissecans of the talus: A systematic review.

BACKGROUND: Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage. PATIENTS AND METHODS: A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS). RESULTS: Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9. DISCUSSION: Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment. LEVEL OF EVIDENCE: IV.

Development and validation of a French-language cross-cultural adaptation of the Pedi-IKDC Questionnaire.

BACKGROUND: The Pedi-IKDC is an English-language, knee-specific, paediatric questionnaire used by orthopaedic surgeons around the world as a valuable patient-reported outcome measure (PROM). The objective of this study was thus to extend the applicability of the Pedi-IKDC to French-speaking Canadian patients, for both clinical practice and research, by developing a French-language cross-cultural adaptation of the original version. HYPOTHESIS: The French adaptation of the Pedi-IKDC is valid and reliable for evaluating French-speaking children with knee conditions. PATIENTS AND METHODS: The Pedi-IKDC was translated to French by a panel of orthopaedic surgeons then back-translated by a professional translator. The original English version and the back-translation were compared to assess their similarity and confirm the faithfulness of the French translation. The validity of the French version was then tested at a major paediatric hospital in French-speaking Canada, in 203 children, including 163 with knee pain and 40 without knee symptoms. Internal consistency, construct validity, and discriminant capacity of the French version were assessed. RESULTS: Internal consistency of the Pedi-IKDC adaptation was excellent (Cronbach's alpha, 0.934 in the knee-pain group). Construct validity was robust, with all nine hypotheses adapted from the original Pedi-IKDC article demonstrating strong (n=7) or moderate (n=2) correlations (p<0.001). The evaluation of discriminant capacity identified no statistically significant score differences according to most of the respondent characteristics (body mass index, age group, type of diagnosis, and type of treatment). However, scores differed significantly between females and males. DISCUSSION: The French-language cross-cultural adaptation of the Pedi-IKDC obtained using a universally recognized method for translating PROMs demonstrated good performance, with psychometric properties similar to those of the original Pedi-IKDC and of its Danish, Italian, and Russian adaptations. LEVEL OF EVIDENCE: II.

Are outdoor playgrounds the real culprit for elbow fractures in children? A lesson learned from COVID-19 sanitary measures.

BACKGROUND: The association between elbow fractures and outdoor playgrounds has always been anecdotal. We sought to determine the impact of closing outdoor playgrounds and other play areas during the COVID-19 lockdown on elbow fractures in a pediatric population. METHODS: We conducted a retrospective cohort study of all elbow fractures from a single pediatric referral hospital between 2016 and 2020 for the months of April and May. The months chosen corresponded to the COVID-19 lockdown during which outdoor playgrounds were closed. Inclusion criteria were elbow fracture diagnosis based on radiography and age younger than 18 years. Fracture type, where the injury occurred and the mechanism of injury were recorded. RESULTS: A total of 370 fractures were reported, with an average of 83 (95% confidence interval [CI] 83-84) per year for 2016-19 and only 36 recorded in 2020. The average annual number of fractures before 2020 was 17 (95% CI 16-17) for schools, and 33 (95% CI 31-34) for outdoor playgrounds, including 22 (95% CI 21-24) falls from playground structures. No fracture was reported in schools in 2020, and only 3 were reported from outdoor playgrounds (including 1 associated with falling from playground structures). CONCLUSION: We found an association between elbow fractures in a pediatric population and outdoor playground accessibility, but also with indoor public locations. Our findings emphasize the importance of safety measures in those facilities.

Medial Discoid Meniscus in Children: A Multicenter Case Series of Clinical Features and Operative Results.

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.

What is the J-sign and why is it important?

PURPOSE OF REVIEW: Recurrent lateral patellofemoral instability is a complex condition that requires a thorough evaluation to optimize treatment. The J-sign test is classically part of the physical examination, but its significance and importance remain unclear. This review aims to describe how to perform the test and classify the observation as well as to analyze the most recent literature on its clinical applications. RECENT FINDINGS: The J-sign test has been described as positive (present) or negative (absent), and classified using the quadrant method and the Donnell classification. Suboptimal inter-rater reliability has been shown for both classifications, making comparison between clinicians and studies challenging. The J-sign is most predominantly associated with patella alta, trochlear dysplasia, lateral force vector, and rotational abnormalities. A growing number of studies have shown a correlation between a positive J-sign and lower clinical outcome scores and higher rate of surgical failure. SUMMARY: The J-sign is an important aspect of the physical examination in patients with recurrent lateral patellofemoral instability. Although there is no consensus on how to perform or classify the test, it can be used as a marker of severity of patellofemoral instability and is one of the tools available to guide the treatment plan.

The Radiographic Femoroepiphyseal Acetabular Roof Index Is a Reliable and Reproducible Diagnostic Tool in Patients Undergoing Hip-Preservation Surgery: A Systematic Review.

PURPOSE: To assess the utility of the femoroepiphyseal acetabular roof (FEAR) index as a diagnostic tool in hip-preservation surgery. METHODS: MEDLINE, EMBASE, and PubMed were searched from database inception until May 2022 for literature addressing the utility of the FEAR index in patients undergoing hip-preservation surgery, and the results are presented descriptively. RESULTS: Overall, there were a total of 11 studies comprising 1,458 patients included in this review. The intraobserver agreement for the FEAR index was reported by 3 of 11 studies (intraclass correlation coefficient range = 0.86-0.99), whereas the interobserver agreement was reported by 8 of 11 studies (intraclass correlation coefficient range = 0.776-1). Among the 5 studies that differentiated between hip instability and hip impingement, the mean FEAR index in 319 patients in the instability group ranged from 3.01 to 13.3°, whereas the mean FEAR index in 239 patients in the impingement group ranged from -10 to -0.77° and the mean FEAR index in 105 patients in the control group ranged from -13 to -7.7°. Three studies defined a specific cutoff value for the FEAR index, with 1 study defining a cutoff value of 5°, which correctly predicted treatment decision between periacetabular osteotomy versus osteochondroplasty 79% of the time with an AUC of 0.89, whereas another defined a cutoff of 2°, which correctly predicted treatment 90% of the time and the last study set a threshold of 3°, which provided an AUC of 0.86 for correctly predicting treatment decision. CONCLUSIONS: This review demonstrates that the FEAR index has a high agreement and consistent application, making it a useful diagnostic tool in hip-preservation surgery particularly in patients with borderline dysplastic hips. However, given the variability in FEAR index cutoff values across studies, there is no absolute consensus value that dictates treatment decision. LEVEL OF EVIDENCE: Level IV; Systematic Review of Level II-IV studies.

Subchondroplasty in the treatment of bone Marrow lesion in early Knee Osteoarthritis: A systematic review of clinical and radiological outcomes.

BACKGROUND: Knee osteoarthritis (KOA) is increasingly prevalent in North American society. The significant societal burden it represents makes it essential to promote and target new treatments in earlier phases of the disease. Among others, subchondroplasty is a newly documented technique using calcium phosphate injection targeting the osteochondral lesions preceding KOA, also known as Bone Marrow Lesions (BMLs). This article aimed to review the existing literature on clinical and radiological outcomes of subchondroplasty in the treatment of BMLs in KOA. METHOD: A systematic review was performed using PubMed, Embase, Medline and Cochrane Database of Systematic Reviews. Studies on calcium phosphate injections into BMLs for KOA and its clinical and radiological outcomes were screened and reviewed by independent evaluators. RESULTS: After screening, ten articles were included, totaling 540 patients. Follow-up ranged from 6 months to 7 years. Overall, the procedure showed significant functional and quality of life improvement, as well as pain relief, as shown by Patients-Reported Outcomes Measures (PROMs). There were very few complications reported, the most important being leakage of calcium phosphate outside the targeted site. Conversion rate to total knee arthroplasty (TKA) ranged from 14 % to 30 % at 2 years post-procedure. Long term radiological outcomes have been poorly documented. CONCLUSIONS: Subchondroplasty is a promising avenue for the treatment of KOA. However, quality evidence is still required before any real conclusions and practical management guidelines can be drawn. Prospective, randomized studies with a control group and a rigorous assessment of long-term clinical and radiological outcomes are recommended.

Meniscus Repair in Pediatric Athletes.

Meniscus tears are common in the pediatric population, typically occur after noncontact injuries, and can be diagnosed clinically with MRI confirmation. Surgery should be offered to patients with loss of range of motion, persistent symptoms, or displaced/complex tears. Given poor long-term outcomes reported after meniscectomy, repair should be attempted when possible as pediatric menisci are well vascularized and have better outcomes after repair than their adult counterparts. The location of the tear is an important determining factor when deciding on the type of repair to use. Pediatric meniscus repair techniques will be discussed noting differences between pediatric and adult procedures. Further studies are needed to explore the role of biologics and define postoperative protocols.

Advanced practice physiotherapy in paediatrics: Implementation results.

Objectives: This study aimed to evaluate the implementation of an advanced practice physiotherapist (APP) clinic in our paediatric institution and assess APP and orthopaedic surgeon satisfaction. Methods: In this retrospective cohort study, all patient records from the APP clinic's second year (March 2017 to March 2018) at CHU Sainte-Justine were reviewed. These were compared with the records of patients seen by orthopaedic surgeons within the gait clinic the year before implementing the clinic. The following data were collected: demographic, professional issuing referral, reason for referral, consultation delay, clinical impression, investigation, and treatment plan. We also documented every subsequent follow-up to rule out any diagnostic change and identify surgical patients. Clinician satisfaction was assessed by the Minnesota Satisfaction and PROBES Questionnaires along with a short electronic survey. Results: Four hundred and eighteen patients were assessed by APPs and 202 by orthopaedic surgeons. APPs managed patients independently in 92.6% of cases. Nearly 86% of patients were discharged following the initial visit, and 7.4% were referred to a physiotherapist. Only 1% of APP patients eventually required surgery compared with nearly 6% in the orthopaedic group. The mean waiting time for consultation was greater in the APP group (513.7 versus 264 days). However, there was a significant reduction in mean waiting time over the last 3 months surveyed (106.5 days). Conclusions: The feedback from all clinicians involved was positive, with a greater mean score on the Minnesota Satisfaction and PROBES Questionnaire for APPs. The APP gait clinic appears to be an effective triage clinic. Level of evidence: III.

Reliability of a New Arthroscopic Discoid Lateral Meniscus Classification System: A Multicenter Video Analysis.

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.

Outcome of retroarticular drilling for osteochondritis dissecans of the talus in a pediatric population.

BACKGROUND: Outcomes of bone marrow stimulation for osteochondritis dissecans (OCD) of the talus in pediatric patients is not optimal. The objective was to evaluate the retroarticular drilling technique for talar OCD. METHODS: A retrospective case-series study of pediatric cases treated for talar OCD with retroarticular drilling was done. Clinical and radiological outcome scores were recorded as follows: the percentage of patients who had a successful treatment, the percentage for every category of the Berndt and Harty treatment result grading and the percentage for every radiographical outcome score were computed. RESULTS: Nineteen patients (18 girls; mean age: 14.6 ± 2.1 years) were included. The mean follow-up was 14.8 (±11.7) months. 26.3% required revision surgery. The Berndt and Harty scores were: 57.9% good, 10.5% fair, 31.6% poor. Radiological outcomes were: 21% healed, 47.4% partially healed, 31.6% no healing. The radiological outcome score was better for younger patients (P = 0.01) and those with an open physis (P = 0.001). CONCLUSION: 26.3% of patients needed revision surgery after talar OCD retroarticular drilling and 21% were healed radiographically. Skeletal immaturity and a younger age were associated to a better radiological outcome.

Complication rates following all-epiphyseal ACL reconstructions in skeletally immature patients: A retrospective case series study.

ABSTRACT: The aim was to evaluate the safety of a physeal-sparing anterior cruciate ligament reconstruction technique (ACLR), performed with Orthopediatrics (Warsaw, IN) equipment, by assessing complications.Skeletally immature patients who underwent all-epiphyseal ACLR between 2015 and 2017 with postoperative follow-up were included in this retrospective study. Complications, demographic, clinical, surgical, and imaging data was retrieved from an urban tertiary pediatric hospital database. Physeal status, limb-length discrepancies (LLD), and angular deformities were assessed on preoperative and postoperative radiographs, growth disturbances were reported, and initial and follow-up diameters of tunnels were compared.Nineteen ACLRs were included from 18 patients, 4 females and 14 males, with bone age at surgery of 13.3 ± 1.0 years. At a mean follow-up of 19.2 ±â€Š10.1 months, there were no symptomatic growth disorders requiring intervention. There were: 2 (11.1%) unilateral early physeal closures, 2 (10.5%) new angular deformities (5°-10°), 4 (22.2%) LLD (1-2 cm), 1 (5.6%) contralateral ACLR, 1 (5.6%) femoral screw removal, 2 (10.5%) graft ruptures, and 1 meniscal tear (5.3%). Mean tunnel widening was 1.7 mm and 1.5 mm on the femoral and tibial side, respectively, and no massive osteolysis was recorded at the polyetheretherketone implant site.The complication rates were comparable to those in similar studies, with no growth-related complications at 19.2 months.

Validation of the French version of the Self-Administered International Hip Outcome Tool-12 Questionnaire and determination of the Minimal Clinically Important Difference (MCID) in the French speaking population.

BACKGROUND: Patient-Reported Outcomes tools are becoming the gold standard in the evaluation of results in orthopaedic surgery. In 2012, the International Hip Outcome Tool-12 (iHOT-12) was developed. This self-administered questionnaire was designed to address the day-to-day clinical setting with faster completion and easier patient flow. In 2021, a French translation of the iHOT-33 questionnaire, from which the iHOT-12 is derived, proved to be valid. Since there is not data in French regarding iHOT-12, we performed a prospective study aiming to answer: (1) is this French version of the iHOT-12 questionnaire as valid, (2) can the minimal clinically important difference (MCID) value for patients undergoing hip arthroscopy for femoro-acetabular impingement (FAI) be defined? HYPOTHESIS: It is hypothesized that the iHOT-12-Fr would be valid and responsive to change in a cohort treated for FAI. PATIENTS AND METHODS: Using the COSMIN recommendations, a multicentric prospective cohort study was conducted to evaluate the reliability, validity, responsiveness and MCID of the iHOT-12-Fr. RESULTS: In total, 101 patients were recruited for participation in the project. The reliability of the iHOT-12-Fr questionnaire was assessed with the intraclass correlation coefficient (ICC=0.84) and the internal consistency with a Cronbach's alpha (α=0.86). The standard error of measurement (SEM=6.7) and the smallest detectable change (SDC=1.8) were calculated. Construct validity was evaluated with Pearson's correlation coefficients (r) by comparing the iHOT-12-Fr with the iHOT-33-Fr (r=0.96), the Hip disability and Osteoarthritis Outcome Score-Fr (r=0.68) and Nonarthritic Hip Score-Fr (r=0.82). Responsiveness was shown with a standardized effect size of 1.18, standardized response mean of 0.73, responsiveness ratio of 1.4 and an MCID of 11 points. DISCUSSION: Metrological qualities of the iHOT-12-Fr are comparable to the original version and other versions translated into different languages. This study proves that the French translation of the iHOT-12 is valid, reliable and compares to the original iHOT-12. LEVEL OF EVIDENCE: IV prospective study.

Validation of the French version of the self-administered international hip outcome tool-33 questionnaire.

INTRODUCTION: To evaluate the effectiveness of new treatments, whether conservative or surgical, a self-administered questionnaire for hip pain targeted at physically active patients 18 to 60 years of age, named the international Hip Outcome Tool-33 (iHOT-33), was developed and validated in 2012. Since there is no French version available and we are acutely aware of transcultural variations, we conducted a prospective study to: 1) translate, and then 2) validate this questionnaire into international French. HYPOTHESIS: The iHOT-33-Fr questionnaire is a valid and reliable tool for evaluating hip pain in a young, francophone population. MATERIALS AND METHODS: Translation of the questionnaire was done according to the standardized method described by Beaton and the final version of the iHOT-33-Fr was validated using the COSMIN methodology. The data were collected prospectively at multiple sites. The reliability of the iHOT-33-Fr questionnaire was evaluated using the intraclass correlation coefficient (ICC) and its internal consistency using Cronbach's alpha. The standard error of measurement and minimum detectable change were calculated. The construct validity was evaluated using Pearson's correlation coefficient by comparing the iHOT-33-Fr with the Hip disability and Osteoarthritis Outcome Score (HOOS-Fr) and Nonarthritic Hip Score (NAHS-Fr). RESULTS: In all, 101 patients filled out the questionnaires. The ICC was 0.87. The Cronbach alpha was 0.95. The standard error of measurement was 6.4 and the minimum detectable change was 1.8. The correlation between the iHOT-33-Fr and the HOOS-Fr was 0.86, while the correlation between the iHOT-33-Fr and the NAHS-Fr was 0.75. DISCUSSION: Our results show that the metrological qualities of the iHOT-33-Fr are comparable to those of the original version and the versions translated into other languages. This study demonstrates that the iHOT-33-Fr is valid, reproducible and comparable to the original iHOT-33. It can be used by francophone surgeons treating symptomatic hip disease in young, active patients. LEVEL OF EVIDENCE: IV.

A Predictive Model of Progression for Adolescent Idiopathic Scoliosis Based on 3D Spine Parameters at First Visit.

MINI: The aim of this prospective cohort study was to improve the prediction of curve progression in AIS. By adding the 3D morphology parameters at first visit, the predictive model explains 65% of the variability. It is one of the greatest advances in the understanding of scoliosis progression in the last 30 years. STUDY DESIGN: Prospective cohort study. OBJECTIVE: The objective of the present study was to design a model of AIS progression to predict Cobb angle at full skeletal maturity, based on curve type, skeletal maturation, and 3D spine parameters available at first visit. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) spinal deformity that affects 1% of adolescents. Curve severity is assessed using the Cobb angle. Prediction of scoliosis progression remains challenging for the treating physician and is currently based on curve type, severity, and maturity. The objective of this study was to develop a predictive model of final Cobb angle, based on 3D spine parameters at first visit, to optimize treatment. METHODS: A prospective cohort of AIS patients at first orthopedic visit was enrolled between 2006 and 2010, all with 3D reconstructions. Measurements of five types of descriptors were obtained: angle of plane of maximum curvature, Cobb angles, 3D wedging, rotation, and torsion. A general linear model analysis with backward selection was done with final Cobb angle (either just before surgery or at skeletal maturity) as outcome and 3D spine parameters and clinical parameters as predictors. RESULTS: Of 195 participants, 172 (88%) were analyzed; average age at presentation was 12.5 ±â€Š1.3 years and mean follow-up to outcome, 3.2 years. The final model includes significant predictors: initial skeletal maturation, curve type, frontal Cobb angle, angle of plane of maximal curvature, and 3D disk wedging (T3-T4, T8-T9) and achieved a determination coefficient (R) = 0.643. Positive and negative predictive values to identify a curve of 35 degrees are 79% and 94%. CONCLUSION: This study developed a predictive model of spinal curve progression in scoliosis based on first-visit information. The model will help the treating physician to initiate appropriate treatment at first visit. LEVEL OF EVIDENCE: 3.

Prospective cohort study. The objective of the present study was to design a model of AIS progression to predict Cobb angle at full skeletal maturity, based on curve type, skeletal maturation, and 3D spine parameters available at first visit. Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) spinal deformity that affects 1% of adolescents. Curve severity is assessed using the Cobb angle. Prediction of scoliosis progression remains challenging for the treating physician and is currently based on curve type, severity, and maturity. The objective of this study was to develop a predictive model of final Cobb angle, based on 3D spine parameters at first visit, to optimize treatment. A prospective cohort of AIS patients at first orthopedic visit was enrolled between 2006 and 2010, all with 3D reconstructions. Measurements of five types of descriptors were obtained: angle of plane of maximum curvature, Cobb angles, 3D wedging, rotation, and torsion. A general linear model analysis with backward selection was done with final Cobb angle (either just before surgery or at skeletal maturity) as outcome and 3D spine parameters and clinical parameters as predictors. Of 195 participants, 172 (88%) were analyzed; average age at presentation was 12.5 ±â€Š1.3 years and mean follow-up to outcome, 3.2 years. The final model includes significant predictors: initial skeletal maturation, curve type, frontal Cobb angle, angle of plane of maximal curvature, and 3D disk wedging (T3-T4, T8-T9) and achieved a determination coefficient (R2) = 0.643. Positive and negative predictive values to identify a curve of 35 degrees are 79% and 94%. This study developed a predictive model of spinal curve progression in scoliosis based on first-visit information. The model will help the treating physician to initiate appropriate treatment at first visit. Level of Evidence: 3.

Effect of a Controlled Ankle Motion Walking Boot on Syndesmotic Instability During Weightbearing: A Cadaveric Study.

BACKGROUND: Syndesmotic injuries can lead to long-term complications; hence, they require careful management. Conservative treatment is adequate when 1 syndesmotic ligament is injured, but surgery is often necessary to achieve articular congruity when 3 syndesmotic ligaments are ruptured. However, there is some controversy over the best treatment for 2-ligament injuries. PURPOSE: To evaluate the effect of a controlled ankle motion (CAM) walking boot on syndesmotic instability following iatrogenic isolated anterior inferior tibiofibular ligament (AiTFL) injury and combined AiTFL/interosseous ligament (IOL) injuries in a cadaveric simulated weightbearing model. STUDY DESIGN: Controlled laboratory study. METHODS: Ten cadaveric specimens were dissected to expose the tibial plateau and syndesmosis. The specimens were fitted to a custom-made device, and a reproducible axial load of 750 N was applied. Iatrogenic rupture of the syndesmotic ligaments (AiTFL + IOL) was done sequentially. Uninjured syndesmoses, isolated AiTFL rupture, and combined AiTFL/IOL rupture were compared with and without axial loading (AL) and CAM boot. The distal tibiofibular relationship was evaluated using a previously validated computed tomography scan measurement system. Wilcoxon tests for paired samples and nonparametric data were used. RESULTS: The only difference noted in the distal tibiofibular relationship during AL was an increase in the external rotation of the fibula when using the CAM boot. This was observed with AiTFL rupture (8.40° vs 11.17°; P = .009) and combined AiTFL/IOL rupture (8.81° vs 11.97°; P = .005). CONCLUSION: AL did not cause a significant displacement between the tibia and fibula, even when 2 ligaments were ruptured. However, the CAM boot produced a significant external rotation with 1 or 2 injured ligaments. CLINICAL RELEVANCE: Further studies are needed to assess the capacity of the CAM walking boot to prevent malreduction when external rotation forces are applied to the ankle. Moreover, special care should be taken during the fitting of the CAM boot to avoid overinflation of the cushions.

Epidemiology of syndesmotic fixations in a pediatric center: A 12-year retrospective review.

Syndesmosis injuries need to be accurately diagnosed and managed to avoid chronic pain, early arthritis, and instability. To this end, the present study aimed to analyze the epidemiology of syndesmotic injuries in a pediatric ankle fracture cohort and identify patient and surgery-related characteristics.A retrospective review of all the ankle fractures during a 12-year period at a single pediatric referral center was conducted. Inclusion criteria were: a fractured ankle that underwent a surgical fixation, at least 1 radiograph available for review before fixation, available information regarding surgery, including operative report and fluoroscopic images, and younger than 18 years at the time of surgery. Demographic information, trauma, radiographs, surgical details, clinical examination, follow up, outcomes, and physeal status (skeletally immature, transitional, or mature) were recorded. Finally, patients were divided in 2 groups: with or without syndesmotic fixation. Statistical analysis included descriptive statistics, Mann-Whitney test for nonparametric data to compare continuous parameters, and χ test for categorical parameters.A total of 128 patients were included with a mean age of 14.1 years. There were 80 boys and 48 girls. There were 51 skeletally immature patients, 23 with transitional fractures, and 54 that were skeletally mature. The main finding of this study is that only 11 patients from the mature group underwent syndesmotic fixation. There were no cases of syndesmotic fixation in the skeletally immature and transitional groups.This is the first retrospective study to focus specifically on syndesmotic injuries in a pediatric population who underwent ankle fracture fixation. Only 11 skeletally mature patients underwent syndesmotic fixation out of 128 patients in this cohort. This result raises the question of whether there are accurate diagnostic tools to evaluate syndesmosis in children.

Validation of the French version of the KOOS-child questionnaire.

PURPOSE: The Knee Injury Osteoarthritis Outcome Score (KOOS) questionnaire is one of the frequently used outcome scores in pediatric studies. However, a recent study demonstrated that the pediatric population had a limited understanding of some of its questions. Therefore, the KOOS-Child questionnaire was developed specifically for this population. Our team produced a French adaptation based on the English version. The objective of the current study was to validate the French adaptation of the KOOS-Child questionnaire. METHODS: After ethic board approval, the questionnaire was translated from English to French by two French speaking orthopedic surgeons. Following consensus, the translated version was retranslated to English by a professional translator. A group of experts compared the original and back translated version and decided on a final adapted questionnaire version. Ninety-nine 8-16 year-old patients were prospectively recruited from our pediatric orthopedic surgery clinic. Twenty-one control participants and 78 patients suffering from knee pain were recruited. The participants were asked to answer the translated French version of the KOOS-Child questionnaire and two validated French pediatric quality of life surveys. RESULTS: Statistical analysis demonstrated no statistically significant demographic difference between the control population and the patients suffering from a knee pathology. The mean for the five different domains of the KOOS-Child questionnaire showed statistical differences (p < 0.001) between the two groups. Construct validity was demonstrated through testing of previously validated hypothesis of correlation. Internal consistency was also confirmed in injured patients. CONCLUSIONS: In conclusion, the current study results demonstrate good to excellent internal consistency, good construct validity and inconclusive discriminant capacity of the French adaptation of the KOOS-Child questionnaire. LEVEL OF EVIDENCE: II.

The heterogeneous management of pediatric ankle traumas: A retrospective descriptive study.

Frequent misdiagnosis of pediatric ankle traumas leads to inappropriate management, which may result in residual pain, instability, slower return to physical activity, and long-term degenerative changes. The purpose of this study was to evaluate the consistency of diagnosis, management, and the treatment of acute lateral pediatric ankle trauma in a tertiary care pediatric hospital. The hypothesis was that the initial diagnosis is often incorrect, and the treatment varies considerably amongst orthopedic surgeons.We conducted a retrospective study of all cases of ankle sprains and Salter-Harris one (SH1) fractures referred to our orthopedic surgery service between May and August 2014. Exclusion criteria included ankle fractures other than SH1 types, and cases where treatment was initially undertaken elsewhere before referral to our service. Primary outcome was the difference between initial and final diagnosis.Among 3047 cases reviewed, 31 matched our inclusion criteria. Initial diagnosis was 20 SH1 fractures, 8 acute ankle sprains, and 3 uncertain, with a change in diagnosis for 48.5% at follow-up.Accurate diagnosis can be difficult in pediatric ankle trauma, with case management and specific treatments varying considerably. This study reinforces the need to evaluate the safety of a general treatment algorithm for all lateral ankle trauma with normal radiographs.Level of evidence III.