Paediatric injuries around the knee: Soft tissue injuries.

We review the diagnosis, management and potential pitfalls of acute soft tissue injuries in the skeletally immature knee, including anterior cruciate ligament (ACL) injuries, meniscal injuries, patellar dislocation and patellofemoral instability (PFI). There has been an increasing incidence of such injuries in the paediatric population, and controversy remains regarding their treatment. We summarise evidence-based treatments for these injuries and discuss strategies to minimise complications as the child reaches skeletal maturity.

An analysis of national variance in coding for patellofemoral instability.

BACKGROUND: We sought to identify which specific set of codes are used by each acute NHS trust in England to document the diagnosis and management of patellofemoral instability (PFI). METHODS: All acute NHS Trusts in England were sent freedom of information (FOI) requests regarding their use of International Statistical Classification of Diseases and Related Health Problems version 10 (ICD-10) codes for the diagnoses related to PFI, and Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures 4th revision (OPCS-4) codes for surgical management of PFI. RESULTS: 106 of 132 (80%) relevant trusts who manage patients with PFI responded with information. Coding for diagnosis of patellar dislocation and recurrent dislocation were largely consistent with 96% of the trusts using the same code. However, coding of patellar instability varied widely with 10 different codes being used, the most common of which was being used by only 34% of trusts. Coding for operative management exhibited greater variety with the number of different codes being used by trusts for each of the eight surgical treatments ranging from 11 to 19 and the range for the most common code being used by trusts from 34% to 64%. Furthermore, a large number of trusts used multiple different codes for the same diagnosis or treatment of PFI. CONCLUSION: There is a lack of uniformity in how trusts code PFI diagnosis and treatment. Standardisation will enable further research involving focused analysis of trust databases to facilitate a better understanding of the epidemiology of this condition.

Paediatric injuries around the knee: Bony injuries.

The aim of this article is to discuss the diagnosis, management and pitfalls of bony injuries around the skeletally immature knee. Each within their own right is a relatively uncommon injury but associated with potential complications. Distal femoral physeal fractures can result in growth arrest and vascular injury. Tibial spine avulsions can result in an unstable knee. Tibial tubercle fractures can be associated with compartment syndrome and pose a risk to the extensor mechanism of the knee. Fixation can be complicated by growth arrest and subsequent recurvatum deformity. Finally, patella sleeve injuries are often missed and this can also threaten the extensor mechanism. We discuss the approach to clinical and radiological assessment of these injuries, and evidence based recommendations as to how they are best managed to avoid complications.