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ABSTRACT. Objective. Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists.Methods. A chart review of successive new referrals (n ‫؍‬ 286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms "appropriate" and "inappropriate" were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively.Results. This analysis shows that a significant percentage (

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Controversy exists over the management of the pediatric patient with a suspected tear of the meniscus. Twenty-six patients who underwent uncomplicated meniscectomy during a period of open epiphyseal plates were reviewed by personal followup. The average followup of these 26 patients was 8.3 years. Ligamentous laxity, early degenerative arthritis, and symptomatic knee pain were found; only 42% demonstrated an excellent or good result. Intensive preoperative evaluation and conservative management of selected meniscal lesions in children are recommended.

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