Anterior Cruciate Ligament Rupture in Skeletally Immature Patients.

In the past 20 years, sports injuries in pediatric and adolescent athletes have increased dramatically, with anterior cruciate ligament (ACL) injuries accounting for more than 25% of all knee injuries at this age. Diagnosis is based on detailed clinical history, physical examination, and imaging assessment, where magnetic resonance imaging plays a central role. The growing immature skeleton presents specific characteristics, which require unique methods for surgical reconstruction, ideally avoiding the physes or minimizing the risk of damaging them. Specific rehabilitation protocols are needed, and these patients face a higher risk of recurrent and contralateral ACL injury. Nonsurgical treatment or delayed reconstruction has been associated with persistent instability, activity modifications, worst functional outcomes, and increased risk of irreparable injuries to menisci and articular cartilage. Consequently, surgical stabilization is the preferred treatment for most patients, despite the eventual risk of angular deformities or limb-length discrepancies due to iatrogenic physeal injury. A variety of surgical techniques have been described, depending on the skeletal maturity and growth remaining. Targeted prevention programs play a key role in reducing the risk of ACL injury, are easy to implement, and require no additional equipment. High-quality evidence supports its use in all pediatric athletes.

Developmental dysplasia of the hip screening programme in Chile.

PURPOSE: Developmental dysplasia of the hip (DDH) encompasses a wide pathological spectrum, from mild acetabular dysplasia to complete congenital hip dislocation at birth. Screening policies have been implemented in an effort to effectively identify and treat patients with DDH. Since 2009 there has been a national DDH programme in Chile. The current study evaluates the results of the programme in patients born between 2010 and 2015. METHODS: Records of patients hospitalized from 1st January 2010 to 31st December 2019 were retrieved from national databases. Those born from 1st January 2010 to 31st December 2015 who underwent a procedure for DDH under general anaesthesia during their first five years of life were selected. Sex, first surgical procedure and age at first surgical procedure were analyzed. The incidence of DDH that required major surgical treatment was calculated. RESULTS: A total of 961 children born from 1st January 2010 to 31st December 2015 underwent a procedure for DDH during their first five years of life. The number of major procedures was significantly lower than the number of minor procedures (269 vs 692). The incidence of major procedures was 0.18 per 1000 live births. Girls underwent a higher number of procedures than boys (831 vs 130), whereas 39.2% of the boys and 26.2% of the girls had major procedures. The mean age at the time of the first procedure was 15.35 months (sd 10.09; range 0.03 to 55.92 months). CONCLUSION: The present study suggests that the Chilean National DDH Screening Program is an appropriate programme with substantial benefits with respect to public health. LEVEL OF EVIDENCE: II.