Infection after spinal deformity in idiopathic scoliosis is rare but is relatively common in neuromuscular conditions. Eradication of infection can be expected, but implant removal is often required. Should implants be totally removed, significant progression of the deformity is possible.

The increasing number of pediatric anterior cruciate ligament (ACL) injuries and the failure of nonoperative management of these patients has elicited a concordant response in the surgical community to devise reconstruction techniques that stabilize the knee joint without causing iatrogenic growth disturbances. Likewise, the rise in pediatric ACL reconstructions forecasts a consequent rise in revision ACL reconstructions in patients with open physes. In this case report, we describe a prepubescent with Ehlers-Danlos syndrome and congenital ACL deficiency, who underwent physeal-sparing iliotibial band ACL reconstruction and revision to an all-epiphyseal ACL reconstruction with allograft. We also underscore the lack of evidence addressing graft choice and outcomes for ACL reconstructions in patients with connective tissue disorders.

Level IV therapeutic study.

Background: There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. Purpose: To develop consensus-based guidelines for management of first-time dislocation in adolescents. Methods: A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral RIG. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed Results: 81/276 (29%) members responded to the survey and 6 consensus-based guidelines were generated from those responses. [Table: see text] There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process. Conclusion: There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes.

BACKGROUND: Variability that exists amongst the radiographic measurement parameters associated with tibial spine fractures may have direct consequences when comparing, reporting, or treating these injuries. In developing data collection of tibial spine fractures amongst multiple centers, it is important to establish reliability in radiographic parameters. Therefore, we designed a study to validate the classification and a proposed cohort of measurements of tibial spine fractures amongst multiple institutions to assist with standardizing fracture classification and treatment decisions. METHODS: Radiographic assessment of de-identified acute tibial spine fractures was performed by members of the Pediatric Research in Sports Medicine (PRISM) Tibial Spine Research Interest Group. A descriptive Powerpoint presentation was provided to each reviewer demonstrating specific measurements and classification prior to review. Reviewers were also asked to provide treatment recommendations. DICOM files were provided to the surgeon through a web-based shared drive and reviewers were required to use the same imaging software. There were 40 patients included, determined through power analysis performed based on previous reliability studies and the number of participants. Assuming the intraclass correlation coefficient (ICC) will be .85 and 95% confidence interval to be 0.2, the sample size of 40 will achieve the desired 95% confidence. Data will be reviewed using both kappa and ICC reliability measures due to both categorical and continuous data points. RESULTS: A majority of radiographic measures demonstrated moderate ICC including posterior-proximal displacement (0.378), length and height of tibial spine fracture (0.466 and 0.535, respectively), and superior displacement of medial fragment (0.420). Good ICC was seen with superior displacement of the anterior tibial spine fragment (0.734). Poor correlation was seen with the measurements for anterior displacement, posterior sagittal displacement, and roof inclination angle. Classifying tibial spine fractures according to the historical Meyer & McKeever Classification demonstrated fair agreement (kappa = 0.347). 18 of 40 (45%) fracture patterns were classified by reviewers in three or more different classifications types while only 1 fracture pattern (Type 1) was agreed upon by all reviewers. A majority of reviewers recommended arthroscopic treatment with suture for more fracture patterns. However, there was fair agreement with the initial treatment regarding operative versus closed reduction (kappa = 0.328). CONCLUSION: Measurement of superior displacement of anterior tibial spine fracture on the lateral images is the only radiographic assessment with good correlation or agreement amongst a group of surgeons in a Tibial Spine Research Group. Classification of tibial spine fractures did not demonstrate acceptable agreement. Further studies and classification methodology is needed to standardize fracture patterns and thereby study outcomes based on pattern and treatment.