Risk Factors for the Development of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in Children and Adolescents.

BACKGROUND: Arthrofibrosis is a fibrotic joint disorder resulting in restricted joint motion and pain. Risk factors associated with the development of postoperative arthrofibrosis include female sex, type of graft, and quicker time to reconstruction. These patients have typically benefitted from manipulation under anesthesia or arthroscopic lysis of adhesions. The purpose of this study was to retrospectively review the rate of arthrofibrosis in children and adolescents who previously underwent anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: This was a retrospective chart review examining patients 18 years or younger who underwent ACL reconstruction between 2013 and 2023. Data collected included age, body mass index, reconstruction technique, concomitant meniscal or ligamentous pathology, and need for revision surgery for arthroscopic lysis of adhesions vs manipulation under anesthesia. RESULTS: A total of 461 patients 18 years or younger who underwent ACL reconstruction were included in this study. Eighteen (3.90%) patients required reoperation for the development of arthrofibrosis. Skeletally immature patients were found to have a statistically significant lower rate of arthrofibrosis compared with skeletally mature patients (0% vs 4.80%; P=.0184). Patients with a higher weight and body mass index had an increased rate of arthrofibrosis (P=.0485 and P=.0410, respectively). Graft type did not have a significant impact on arthrofibrosis rates. There were no significant findings in terms of concomitant injuries and rate of arthrofibrosis. CONCLUSION: Arthrofibrosis developed in 3.90% of patients after ACL reconstruction. Skeletal immaturity may be protective against the development of arthrofibrosis. No association was found between graft type or concomitant knee pathology and arthrofibrosis. [Orthopedics. 2024;47(4):e161-e166.].

Decreasing respiratory device-related pressure injuries in the NICU using 3D printed barrier templates.

OBJECTIVE: Use of non-invasive ventilation (NIV) in very low birthweight infants to decrease the incidence of bronchopulmonary dysplasia can also lead to pressure injuries (PI) caused by the respiratory device interface. We aimed to decrease our incidence of PIs related to the mask/prongs interface used for NIV (PI-NIV). STUDY DESIGN: We identified correct use of barriers and appropriate interface fit as key targets for intervention. Over several PDSA cycles, we developed custom 3D printed barrier templates to allow for barriers to be cut at the bedside and created concise educational documents to assist with interface fitting and troubleshooting. RESULTS: The incidence of all PI-NIV decreased from 5.64 to 2.27 per 1000 NIV patient-days and the incidence of reportable (stage 3-4 and unstageable) PI-NIV decreased from 1.13 to 0 per 1000 NIV patient-days during the study period. CONCLUSIONS: With appropriate barrier usage and targeted education, the risk of PI-NIV can be minimized.