Background:Meniscal pathology in children and adolescents is now a common occurrence because of their ever-increasing participation in youth sports.Purpose:To investigate the outcomes of arthroscopic meniscal repair in an adolescent cohort and analyze the variables that may affect outcomes, specifically the number of fixation sites utilized during repair.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of all children and adolescents younger than 18 years who underwent arthroscopic meniscal repair at a single institution was performed. Patient characteristics, operative details (eg, tear pattern, tear location, method of repair, and number of fixation sites [determined based on the number of sutures used for repair]), and concomitant procedures were recorded.Results:A total of 175 primary meniscal repairs met inclusion criteria and were analyzed. Of this cohort, 115 were able to be contacted and were included in the final study cohort. The mean follow-up was 41 months. The mean age of the children was 14.9 years, and 91 (79%) had concomitant anterior cruciate ligament reconstructions with their meniscal repair. The mean Pediatric International Knee Documentation Committee functional outcome score was 91 (range, 43-100), and the mean Lysholm functional outcome score was 91 (range, 47-100). Of the 115 meniscal repairs, there were a total of 19 reoperations (17%); 15 (13%) were because of meniscal repair failures. The only variable that statistically increased the risk of meniscal repair failure was low number of fixation sites, with the failure group having a mean of 1.79 sutures and the nonfailure group having a mean of 2.97 sutures (P = .03).Conclusion:Successful meniscal repairs and a lower failure rate may be achieved with a greater number of fixation sites with promising results at a minimum 2-year follow-up. Validated functional outcome scores were good, with a 13% failure rate. Larger cohort, longer term, multicenter multisurgeon data are still needed to further elucidate the number of fixation sites needed when performing a meniscal repair in the pediatric and adolescent knee.

Background:Osteochondral lesions (OCLs) of the knee, whether occurring secondary to osteochondritis dissecans or a traumatic osteochondral fracture, are commonly encountered in the pediatric and adolescent population. Given the potential for healing in this population, coupled with adequate surgical reduction and stability of OCL fixation, an opportunity exists to avoid a major restorative procedure and the associated substantial costs and potential morbidity.Purpose:To analyze the outcomes of bioabsorbable fixation of OCLs in the adolescent knee at a minimum of 2 years.Study Design:Case series; Level of evidence, 4.Methods:An institutional review board–approved retrospective review was performed of patients younger than 18 years who underwent bioabsorbable fixation of an OCL of the knee with a minimum 2-year follow-up. Patient demographics, operative details, and postoperative clinical findings were detailed and recorded. All cases were performed by a single surgeon.Results:There were 38 patients treated surgically for an OCL between 2009 and 2016. Of these, 38 patients (mean age, 14.7 years) were evaluated at a mean of 59 months. OCL fixation consisted of a mean of 1.4 bioabsorbable screws and 1.5 darts. At final follow-up, mean pre- and postoperative Tegner scores were 6.6 and 6.4, respectively, while Lysholm and Pediatric International Knee Documentation Committee scores were 89.8 and 88.1, respectively. A total of 6 patients underwent secondary procedures postoperatively. One patient required a secondary procedure related to OCL fixation, which was secondary to a proud implant. The other secondary procedures included second-look arthroscopic surgery for pain after an injury postoperatively, planned anterior cruciate ligament reconstruction, staged medial patellofemoral ligament reconstruction, and manipulation under anesthesia for arthrofibrosis (n = 2). None of the 32 patients required a revision cartilage procedure at the time of final follow-up.Conclusion:The use of bioabsorbable implants in the adolescent knee appears to be a safe and efficacious treatment with good functional outcomes at long-term follow-up and a low revision rate. Additional long-term multisurgeon and multicenter trials with a larger cohort are needed to further elucidate the role of bioabsorbable fixation of an OCL in the adolescent knee.

Background: There is a growing need to improve patient education for nonsurgical fracture care in children. A Quick Response (QR) code was used as an alternative method to provide cast care instructions in our outpatient fracture clinic. We evaluated satisfaction and examined the convenience and impact this might have on the child's casting experience. Methods: A prospective study was conducted in which QR codes were embedded in the casting of nonsurgical pediatric fractures in 88 children. The number of times the QR code was scanned, who scanned the code, treatment satisfaction, cast-related issues, and whether scan helped prevent a call to the treating physician were recorded. Results: Google Analytics showed the QR code was scanned an average of 1.6 times by 60 participants with most scans done by a parent (65%). Seventy-nine participants (89.9%) found it useful to have the QR code on their cast, and 65 (73.9%) were “very satisfied” with the convenience of the QR code and 37 stated that the information they found kept them from contacting the physician. Discussion: We demonstrated that the use of QR codes for nonsurgical pediatric fracture care has a high level of satisfaction and may reduce calls to the treating physician.

Background: Osteochondral lesions (OCL), including osteochondritis dissecans (OCD) and traumatic osteochondral fractures (OCF), are often encountered when treating injuries affecting the pediatric and adolescent knee. There are an array of treatment options depending upon lesion size, location, chronicity, and equally important, surgeon experience. There is a potential for healing in children and adolescents that may not be present in adults and the intent of internal fixation is to reduce and restore the injured hyaline cartilage and underlying bone. Stable fixation utilizing bioabsorbable implants offers a possibility of OCL healing without the need for implant removal or a major restorative procedure such as an osteochondral autograft transfer, osteochondral allograft, or autologous chondrocyte implantation, therefore avoiding the associated costs and potential morbidity. The purpose of our study was to review the mid-term outcomes of internal fixation with bioabsorbable implants of osteochondral injuries of the knee in children and adolescents. Methods: An IRB approved retrospective review of patients younger than 18 years old who had internal fixation of knee OCLs with bioabsorbable implants was performed. All those included had a minimum 2-year follow-up and completed validated outcome scores (Pedi-IKDC, Tegner, Lysholm). Medical records were reviewed from 2009 to 2015 for patient demographics, intraoperative details, and postoperative outcomes. Pedi-IKDC and Tegner-Lysholm functional outcome scores were used to assess overall outcomes at final follow-up. Return to the operating room was recorded. All cases were performed at a single tertiary pediatric institution by a single pediatric fellowship trained orthopedic surgeon. Results: There were a total of 35 children and adolescents that had a knee OCL that underwent internal fixation with bioabsorbable implants. 7 patients were lost to follow-up with a final cohort of 28 of the 35 patients (80%). Average follow-up was 44 months (range 24-97 months). Average age was 14.7 years. Out of the 28 children, 14 had OCD and 14 OCFs. The average number of bioabsorbable darts and screws used per intervention was 2 and 1, respectively. The average Pedi-IKDC and Lysholm scoring at final follow-up was 89.5 and 91, respectively. Five patients returned to the operating room following the primary procedure: 2 for manipulation under anesthesia related to OCL fixation, 1 for a planned staged ACL reconstruction, 1 for MPFL reconstruction for recurrent patella instability following the index procedure, and 1 patient returned secondary to a proud implant that was in-turn debrided. None of the 28 patients underwent a revision cartilage procedure. Conclusion: The use of bioabsorbable implants (screws and darts) in children and adolescents appears to be a safe and efficacious treatment with good functional outcomes at mid-term follow up and in this cohort there was no need for a revision cartilage procedure. Larger multi-center longer-term follow studies are needed.