Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injury and Reconstruction.

BACKGROUND: With the increasing involvement in organized athletics among children and adolescents, more anterior cruciate ligament (ACL) injuries are being recognized in the skeletally immature population. The goal of the present study is to utilize a national database to characterize the recent epidemiologic trends of ACL injuries, ACL reconstruction, and treatment of associated meniscal and chondral pathology in the pediatric and adolescent populations. METHODS: A national database was queried for ACL tear (ICD-9 844.2) and arthroscopic reconstruction of an ACL tear (CPT 29888) from 2007 to 2011. Searches were limited by age group to identify pediatric and adolescent cohorts: (1) ages 5 to 9 years old, (2) ages 10 to 14 years old, and (3) ages 15 to 19 years old. A comparative cohort of adult patients from ages 20 to 45 was also created. The database was also queried for concomitant procedures at the same time as ACL reconstruction for each age group, including partial meniscectomy, meniscus repair, microfracture, osteochondral autograft or allograft transfer, and shaving chondroplasty. The χ analysis was used to determine statistical significance. RESULTS: A total of 44,815 unique pediatric or adolescent patients with a diagnosis of an ACL tear and 19,053 pediatric or adolescent patients who underwent arthroscopic ACL reconstruction were identified. Significant increases in pediatric and adolescent ACL tear diagnosis and reconstruction compared with adult patients were noted. Significant increases in many concomitant meniscus and cartilage procedures in pediatric and adolescent patients compared with adult patients were also noted. CONCLUSIONS: The present study demonstrates a significant increase in the overall diagnosis of ACL injury and ACL reconstruction in both pediatric and adolescent patients, rising at a rate significantly higher than adults. In addition, pediatric and adolescent patients who undergo ACL reconstruction had significant increases in incidences of concomitant meniscal and cartilage procedures. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Hip Arthroscopy: Common Problems and Solutions.

The use of hip arthroscopy continues to expand. Understanding potential pitfalls and complications associated with hip arthroscopy is paramount to optimizing clinical outcomes and minimizing unfavorable results. Potential pitfalls and complications are associated with preoperative factors such as patient selection, intraoperative factors such as iatrogenic damage, traction-related complications, inadequate correction of deformity, and nerve injury, or postoperative factors such as poor rehabilitation. This article outlines common factors that contribute to less-than-favorable outcomes.

Knee Dislocation in the Morbidly Obese Patient.

Though a relatively rare orthopedic injury, knee dislocation in the morbidly obese population has been increasingly reported in the literature. These injuries are often referred to as "ultralow-velocity knee dislocations" since they commonly occur after a seemingly trivial injury, such as a ground level fall. As a result, these injuries are often underappreciated and initially misdiagnosed. Even though these injuries are low-velocity, they should still be regarded as a high energy injury because of the large amount of mass contributing to the dislocating force. Knee dislocations in the morbidly obese are associated with a particularly high rate of neurovascular injury. A timely and accurate diagnosis is crucial to avoid serious limb-threatening complications, including the need for amputation. Therefore, evaluating physicians should maintain a high suspicion for a knee dislocation in any morbidly obese patient who presents with knee pain following a seemingly innocuous injury. Management of these injuries is controversial. Associated vascular injuries must be identified promptly and appropriately managed by a vascular surgery team. There is no consensus on the ideal orthopedic treatment of knee dislocations in the morbidly obese patient. Operative treatment can be fraught with complications, including a higher rate of neurovascular injury, increased surgical complications, and poor subjective patient outcome scores compared with nonobese patients sustaining a high-velocity knee dislocation. It is paramount that treating physicians are familiar with the unique challenges of treating knee dislocations in the morbidly obese patient when discussing risks and benefits of treatment options. This article presents a review of the existing literature on knee dislocations in the morbidly obese population, including diagnosis, management, and outcomes.