This study quantifies the increasing rate of ACL reconstruction in the skeletally immature and suggests that there may be some disparities in care based on insurance status.

The neurological basis of an increased incidence of cerebral palsy (CP) in preterm males is unknown. This study examined neonatal brain structure on magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) at term‐equivalent age, sex, and neurodevelopment at 1 year 6 months on the basis of the Amiel−Tison neurological examination, Gross Motor Function Classification System, and Bayley Scales of Infant Development in 78 very‐low‐birthweight preterm children (41 males, 37 females; mean gestational age 27.6wks, SD 2.5; mean birthweight 1021g, SD 339). Brain abnormalities on MRI and DTI were not different between males and females except in the splenium of the corpus callosum, where males had lower DTI fractional anisotropy (p=0.025) and a higher apparent diffusion coefficient (p=0.013), indicating delayed splenium development. In the 26 infants who were at higher risk on the basis of DTI, males had more abnormalities on MRI (p=0.034) and had lower fractional anisotropy and a higher apparent diffusion coefficient in the splenium (p=0.049; p=0.025) and right posterior limb of the internal capsule (PLIC; p=0.003; p=0.033). Abnormal neurodevelopment was more common in males (n=9) than in females (n=2; p=0.036). Children with abnormal neurodevelopment had more abnormalities on MRI (p=0.014) and reduced splenium and right PLIC fractional anisotropy (p=0.001; p=0.035). In children with abnormal neurodevelopment, right PLIC fractional anisotropy was lower than left (p=0.035), whereas in those with normal neurodevelopment right PLIC fractional anisotropy was higher than left (p=0.001). Right PLIC fractional anisotropy correlated to neurodevelopment (rho=0.371, p=0.002). Logistic regression predicted neurodevelopment with 94% accuracy; only right PLIC fractional anisotropy was a significant logistic coefficient. Results indicate that the higher incidence of abnormal neurodevelopment in preterm males relates to greater incidence and severity of brain abnormalities, including reduced PLIC and splenium development.

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Background In 2001, the Institute of Medicine released a report stating that sex must be considered in all aspects and at all levels of biomedical research. Knowledge of differences between males and females in responses to treatment serves to improve our ability to care for our patients. Questions/purposes The purpose of our study was to determine (1) if there is an increase in the proportion of sex-specific reporting from 2000 to 2005 and to 2010; and (2) whether there is a proportional difference in such reporting based on journal type: subspecialty versus general orthopaedics. We hypothesize that assessment of the role of sex in outcomes has improved during the past 15 years and that the proportion of studies with of sex-specific analyses has increased with awareness of the role of sex in clinical outcomes and disease states. We additionally hypothesized that the reporting of sex would be similar between subspecialty and general orthopaedic journals. Methods Five high-impact orthopaedic journals, consisting of two general and three subspecialty journals, were chosen for review. Issues from even-numbered months during three calendar years (2000, 2005, 2010) were critically assessed for the presence of sex-specific analyses and reporting by two separate reviewers. Retrospective and prospective clinical studies, with a minimum of 20 patients, were included for analysis. Cadaveric, biomechanical, and in vitro studies were excluded. Review articles and clinical studies with less than 20 patients were excluded. A total of 821 studies that met inclusion criteria were analyzed 004; 2005: 22.9%, 33/144, [95% CI, 0.16-0.30], and 33.1%, 44/133, [95% CI, 0.25-0.41], p = 0.059; 2010: 28.2%, 51/181, [95% CI, 0.22-0.35] and 32.5%, 51/157, [95% CI, 0.25-0.40], p = 0.390). Conclusions Our findings indicate that inclusion of sexspecific analysis and reporting in the orthopaedic literature Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request.

Level III-diagnostic.