Ultrasound Assessment of Ankle Syndesmotic Injuries in a Pediatric Population.

OBJECTIVE: To determine sensitivity and specificity for anterior-inferior tibiofibular ligament (AiTFL) integrity and tibiofibular clear-space (TFCS) cut-off points for dynamic evaluation using ultrasound (US) in a pediatric population. DESIGN: Prospective cohort study. SETTING: Tertiary care university-affiliated pediatric hospital patients between the ages of 12 and 18 sustaining acute ankle trauma with syndesmotic injury. INTERVENTIONS: Participants were assigned to the syndesmotic injury protocol that included a standardized MRI and US. MAIN OUTCOME MEASURES: Anterior-inferior tibiofibular ligament integrity for static assessment and TFCS measurements for dynamic assessment on US. For dynamic assessment, the distance between the distal tibia and fibula was first measured in neutral position and then in external rotation for each ankle. The US results on AiTFL integrity were compared with MRI, considered as our gold standard. Optimal cut-off points of TFCS values were determined with receiver operating characteristics curve analysis. RESULTS: Twenty-six participants were included. Mean age was 14.8 years (SD = 1.3 years). Sensitivity and specificity for AiTFL integrity were 79% and 100%, respectively (4 false negatives on partial tears). For dynamic assessment, the cut-off points for the differences in tibiofibular distance between the 2 ankles in 1) neutral position (TFCS N I-U ) and 2) external rotation (TFCS ER I-U ) were 0.2 mm (sensitivity = 83% and specificity = 80%) and 0.1 mm (sensitivity = 83% and specificity = 80%), respectively. CONCLUSIONS: Static US could be used in a triage context as a diagnostic tool for AiTFL integrity in a pediatric population as it shows good sensitivity and excellent specificity.

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.

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.

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.

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.

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.

Variation of Syndesmosis Anatomy With Growth.

BACKGROUND: Syndesmosis injury is common in trauma and in the sport medicine population. Diagnosis and treatment of this pathology is controversial in adult population and almost unknown in a growing and immature ankle. The objective of this study was to describe the relationship between the distal tibia and fibula in immature, growing, and mature children. METHODS: A retrospective imaging study was performed on ankle magnetic resonance images (MRI), which were divided into 3 groups according to age: immature, growing, or mature. The syndesmosis anatomy was described in 3 planes following an established measurement system. The measurement system was also validated (intraobserver and interobserver reproducibility) on a subgroup of 30 MRIs with 4 surgeons. RESULTS: The measurement system, previously described on CT scans, is valid when used on MRIs. The mediolateral translation significantly increases with growth and external rotation of fibula decreases. The anteroposterior position is also significantly different between groups but the ratios are similar. CONCLUSIONS: This study reported differences in distal tibiofibular relationship in a growing population. This information will be crucial in future development of diagnostic and follow-up criteria of syndesmosis injury. It also presented a valid and precise measurement system to describe syndesmotic anatomy in 3 planes. LEVEL OF EVIDENCE: Level IV.

Advances in bioadhesives for meniscal repair: A comprehensive review and criteria for the ideal candidate.

The latest studies agree that meniscal tears that require surgery should be repaired whenever possible to avoid early-onset osteoarthritis secondary to meniscectomy. Unfortunately, there are several limitations associated with meniscal sutures, making it difficult to put into practice the theory behind the concept of saving the meniscus. Meanwhile, there is an exponential growth in the use of tissue adhesives for surgery, but finding one suited to meniscal repair remains a struggle. This review has two main goals (1) to compile the various bioadhesives used in this field and (2) to list the criteria for an ideal meniscal bioadhesive. The review was conducted in PubMed, Google Scholar, and Web of Science in November 2023 without date restrictions. The inclusion criteria were: Studies published in English and focusing on meniscal repair using bioadhesives. The exclusion criteria were: Studies published in languages other than English. Adhesives used in combination with sutures, as the aim was to determine the adhesive's capabilities for meniscal repair alone. Synthetic adhesives such as polycyanoacrylates, polyethylene glycol, polyurethanes, and polyesters. Among the 11 bioadhesives found, fibrin is the only one that has been studied in humans. There are advantages and disadvantages to all the bioadhesives identified but none that fully meet the requirements for meniscal repair. The anatomy of meniscal tissue is complex and poses unique challenges that are compounded by arthroscopic stresses. The future of meniscal repair probably lies in combining the advantages of several bioadhesives, and this area should be the focus of future research.

Flatfoot arch correction with generic 3D-printed orthoses at different body weight percentages.

BACKGROUND: Flatfoot can be associated with foot pathologies and treated conservatively with foot orthoses to correct arch collapse and alleviate painful symptoms. Recently, 3D printing has become more popular and is widely used for medical device manufacturing, such as orthoses. This study aims at quantifying the effect of generic 3D-printed foot orthoses on flatfoot arch correction under different static loading conditions. METHODS: Participants with normal and flatfeet were recruited for this cross-sectional study. Clinical evaluation included arch height, foot posture index, and Beighton flexibility score. Surface imaging was performed in different loading conditions: 1) 0% when sitting, 2) 50% when standing on both feet, and 3) 125% when standing on one foot with a weighted vest. For flatfoot participants, three configurations were tested: without an orthosis, with a soft generic 3D printed orthosis, and with a rigid 3D printed orthosis. Arch heights and medial arch angles were calculated and compared for the different loading conditions and with or without orthoses. The differences between groups, with and without orthoses, were analyzed with Kruskal-Wallis tests, and a p < 0.05 was considered significant. RESULTS: A total of 10 normal feet and 10 flatfeet were analyzed. The 3D printed orthosis significantly increased arch height in all loading conditions, compared to flatfeet without orthosis. Wearing an orthosis reduced the medial arch angle, although not significantly. Our technique was found to have good to excellent intra and interclass correlation coefficients. CONCLUSIONS: Generic 3D printed orthoses corrected arch collapse in static loading conditions, including 125% body weight to simulate functional tasks like walking. Our protocol was found to be reliable and easier to implement in a clinical setting compared to previously reported methods. LEVEL OF EVIDENCE: II.

Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Criteria.

BACKGROUND: Postoperative rehabilitation is an important component of recovery after anterior cruciate ligament (ACL) reconstruction (ACLR), facilitating successful return to sport (RTS) by reducing risk factors for repeat injury. PURPOSE: This systematic review aimed to determine the best protocol for RTS after ACLR in children. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: PubMed, Embase, PEDro, SPORTDiscus, and Web of Science databases were searched from October 3, 2014, to November 3, 2022. The inclusion criteria were the pediatric population (<18 years old) after ACLR with clear RTS criteria and/or mean/median time to RTS. Multiligament knee injuries were excluded from this study. The methodologic quality of the included articles was assessed using the methodological index for non-randomized studies (MINORS). The highest possible score was 24 points for comparative studies (ie, a study comparing 2 protocols or more). Noncomparative studies or studies with a single protocol could score a maximum of 16 points as assessed by the MINORS score. RESULTS: The search yielded 1816 titles, and 24 were retained based on the inclusion and exclusion criteria. Every study was published between 2015 and 2022. Among the 24 studies included, 13 were retrospective and 11 were prospective. The mean MINORS score for the noncomparative studies was 13 of 16 (n = 23) and 23 of 24 for the comparative study (n = 1). The studies were categorized into unspecified clearance (n = 10), milestone based (n = 13), and combined time and milestone (n = 1). A total of 1978 patients (57% female) were included in the review. The mean age at ACLR was 14.7 years. The most common endpoint used was graft rupture (0% to 35%). In the unspecified group, the quickest RTS was 5.8 months and the longest was 9.6 months. Statistically significant risk factors for ACL reinjury included younger age and earlier RTS. The latter was a significant contributor to graft failure for combined time-based and milestone-based RTS. In the milestone-based group, the most common criteria were ≥90% limb symmetry measured using hamstring strength, quadriceps strength, and/or hop tests. The mean RTS time was 6.8 to 13.5 months. CONCLUSION: RTS should be delayed, when possible, especially in the younger population. A combination of quantitative tests and qualitative tests is also recommended. However, optimal RTS criteria have yet to be determined. Future prospective studies should focus on comparing the different times and milestones currently available.

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.

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.

A modified position for optimized skeletal maturity assessment of AIS patients and its impact on 3D spinal and pelvic parameters.

PURPOSE: A hands-on-wall (HOW) position for low-dose stereoradiography of adolescent idiopathic scoliosis (AIS) patients would allow for skeletal maturity assessment of the hand and wrist. Our aims were twofold: confirm the reliability and validity of skeletal maturity assessment using the HOW radiographs and compare the spinal and pelvic 3D parameters to those of standard hands-on-cheeks (HOC) stereoradiographs. METHODS: Seventy AIS patients underwent two successive stereoradiographs and a standard hand and wrist radiograph on the same day. Patients were randomly assigned to begin with HOW and follow with HOC, or vice versa. Raters assessed digital skeletal age (DSA), Sanders Simplified Skeletal Maturity (SSMS) and Thumb Ossification Composite Index (TOCI). 3D reconstructions of the spine and pelvis bones were performed for each stereoradiograph to measure nine clinically relevant spinal and pelvic 3D parameters. RESULTS: Inter-rater and intra-rater reliabilities were excellent for DSA, SSMS and TOCI with both standard radiographs and HOW (ICC > 0.95). Strong correlation was found between ratings of both imaging types (ICC > 0.95). In the 3D reconstructions, kyphosis and sacral slope were slightly decreased in the HOW position, but within the clinical margin of error. All other parameters did not differ significantly between positions (p < 0.05). CONCLUSION: The results suggest that HOW stereoradiographs allow clinicians to assess skeletal maturity of the hand and wrist with adequate reliability and validity. We recommend that scoliosis clinics adopt the HOW position to assess skeletal maturity because there is no significant clinical impact on the spinal and pelvic evaluation, and on radiation exposure, cost or time.

Three-dimensional spine parameters can differentiate between progressive and nonprogressive patients with AIS at the initial visit: a retrospective analysis.

BACKGROUND: Knowledge concerning morphology of the spine is reported in 2-dimensional (2D) or focuses on modification of parameters with progression of spinal deformation. The objective of this study was to compare 3-dimensional (3D) morphologic parameters of the spine at the first visit between progressive and a nonprogressive group of immature adolescent idiopathic scoliosis (AIS). METHODS: The first group was made up of surgically corrected AIS patients (E) (n=19), whereas the second group was composed of nonprogressive AIS that had reached skeletal maturity (n=18). Computerized measurements were undertaken on reconstructed 3D spines. There were 5 categories of measurement: Cobb angles (scoliosis, kyphosis, lordosis), 3D wedging (apical vertebra, mean 2 apical disks), rotation (upper and lower junctional vertebra, apical vertebra, and disk), torsion, and slenderness (height/width ratio of T6, L4, and T1-L5). Nonparametric Mann-Whitney tests were also undertaken. RESULTS: There was no statistical difference between the 2 groups for age, 3D Cobb angle, lordosis, and kyphosis. Mean 3D wedging of the apical disks, lower junctional vertebral axial rotation, torsion and T6, and whole spine height/width ratio were all significantly affected. CONCLUSIONS: This study supports the theory that wedging begins in the disks and then in the vertebral body and identifies 3D morphologic parameters that could be used in the prediction of AIS evolution. The findings in the junctional area illustrate that a torsional deformity seems to occur distally from the apex and creates a progressive scoliosis. Curve progression could be predicted based on 3D morphometric parameters, as early as the initial visit.

Cavus Foot in Soccer Players: Increased Prevalence in Experienced Players and Risk Factor for Injury.

BACKGROUND: Foot type, especially cavus foot, is associated with foot and ankle soccer injuries, such as ankle sprains, ankle instability, and foot and ankle lateral injuries. The aim of this study was to identify risk factors for foot and ankle injuries among soccer players. METHODS: Male and female soccer players, from beginners to semiprofessionals, aged between 10 and 40 years were enrolled in this cross-sectional study. Players filled in questionnaires about their training and injury history. Clinical measurements included foot length, Foot Posture Index-6, and arch height flexibility. Each variable was dichotomized: age (<18 years versus ≥18 years), level of play (AA and below versus AAA and above), foot type (cavus or not), and injury. Injury occurrence was analyzed using χ2 tests between each group of variables, and significance was set at P < .05. RESULTS: A total of 277 players, including 81 females, volunteered; 147 were younger than 18 years and 180 were AA level or below. Cavus foot prevalence was 30%. In the cavus foot group, 51.8% of players had reached at least an AAA level compared with 27.8% in the normal-arched group (P < .001 [χ2]). Injuries were associated with a cavus foot type (P < .01 [χ2]) and with sex, age, or highest level played (P < .001 [χ2]). CONCLUSIONS: This study identified a high prevalence of cavus foot among soccer players of all ages, with an increased prevalence among higher-level players. The injury risk factors were female sex, older age, playing at a higher level, and cavus feet.

Modification of the properties of a suture thread with a tough gel coating: A baseline ex-vivo study.

The mechanical properties of sutures are important for wound closure and meniscus repair. A tough gel coating technology has been developed to modify and functionalize sutures, but its effects on suture degradation remain unexplored. Our aim is to investigate how a tough gel coating mediates the properties of the suture. The Polyglactin910 (Vicryl) suture was chosen because it is widely used, strong, easy to handle, and degradable. This study compared six pristine Vicryl sutures and six coated Vicryl sutures at 0, 2, 4, and 6 weeks. All the sutures were soaked in phosphate-buffered saline (PBS), to mimic degradation in physiological conditions, and tensile strength was tested at each time point. The pH of the soaking mediums was measured weekly and compared at 4, 5, and 6 weeks. No significant difference (p = 0.059 and p = 0.576) was found between the absolute and normalized breaking force of coated and pristine Vicryl sutures at 0, 2, 4, and 6 weeks. After 4 weeks of immersion, the soaking medium became more acidic for both suture types. The decrease in pH was less significant for coated Vicryl sutures than for pristine ones (p < 0.001) at 4, 5, and 6 weeks of immersion. Although coating does not affect the strength of Vicryl sutures soaked in PBS, it can effectively act as a buffer to the acidic environment caused by suture degradation, which could help reduce inflammation. Hydrogel coating is a promising technology to modify suture characteristics.

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.

Tough gel adhesive is an effective method for meniscal repair in a bovine cadaveric study.

PURPOSE: To test tough gel adhesives to repair meniscus tears under relevant loading conditions and determine if they have adequate biomechanical properties to repair meniscus tears in a bovine cadaveric study. METHODS: Cyclic compression tests on 24 dissected bovine knees were performed. The tough gel adhesive was used either as an adhesive patch or as a coating bonded onto commercially available surgical sutures. Forty-eight menisci were tested in this study; 24 complete radial tears and 24 bucket-handle tears. After preconditioning, the specimens underwent 100 cycles of compression, (800 N/0.5 Hz) on an Instron© machine and the size of the gaps measured. One third of the menisci were repaired with pristine sutures, one third with adhesive patches, and one third with sutures coated in adhesive gel. The size of the gaps was compared after 100 and 500 cycles of compression. RESULTS: The mean gap measured at the tear site without treatment was 6.46 mm (± 1.41 mm) for radial tears and 1.92 mm (± 0.65 mm) for bucket-handle tears. After treatment and 500 cycles of compression, the mean gap was 1.63 mm (± 1.41 mm) for pristine sutures, 1.50 mm (± 1.16 mm) for adhesive sutures and 2.06 mm (± 1.53 mm) for adhesive gel patches. There was no significant difference between treatments regardless of the type of tear. Also, the gaps for radial tears increased significantly with the number of compression cycles applied (p > 0.001). CONCLUSION: From a biomechanical standpoint, the tough adhesive gel patch is as effective as suturing. In addition, it would allow the repair of non-suturable tears and thus broaden the indications for meniscus repair. LEVEL OF EVIDENCE: Controlled laboratory study.

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.