Background: Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries. Purpose/Hypothesis: The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article. Exclusion criteria were revision ACL reconstruction, tibial spine avulsion fracture, case report or small case series (<5 patients), non–English language manuscripts, multiligamentous injuries, and nonclinical studies. Results: A total of 30 studies containing 50 cohorts and representing 1176 patients met our criteria. With respect to nonoperative treatment, knee instability was observed in 20% to 100%, and return to preinjury level of sports ranged from 6% to 50% at final follow-up. Regarding operative treatment, meta-analysis results favored early ACL reconstruction over delayed reconstruction (>12 weeks) for the presence of any meniscal tear (odds ratio, 0.23; P = .006) and irreparable meniscal tear (odds ratio, 0.31; P = .001). Comparison of any side-to-side differences in KT-1000 arthrometer testing did not favor early or delayed ACL reconstruction in either continuous mean differences ( P = .413) or proportion with difference ≥3 mm ( P = .181). Return to preinjury level of competition rates for early and delayed ACL reconstruction ranged from 57% to 100%. Conclusion: Delaying ACL reconstruction in pediatric or adolescent patients for >12 weeks significantly increased the risk of meniscal injuries and irreparable meniscal tears; however, early and delayed operative treatment achieved satisfactory knee stability. Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports.

There was no clinically significant difference between the pediatric and adult IKDC form scores in adolescents aged 13 to 17 years. This result allows use of whichever form is most practical for long-term tracking of patients. A simple linear equation can convert one form into the other. If the adult questionnaire is used at this age, it can be consistently used during follow-up.

Patients with first-time dislocations had lower postoperative instability rates and reoperation rates when compared with patients with recurrent dislocations before surgery. Young patients with shoulder instability should be offered early surgical intervention to lower the risk of postoperative instability and reoperation.

Background:With childhood sports opportunities continuing to increase at an enormous rate along with participation starting at younger ages, the number of female participants in sports has increased in paramount fashion over the past few decades. A review of the current literature reveals a very small number of studies (<30) that document specific injuries suffered by competitive female gymnasts.Purpose:To retrospectively evaluate the incidence of various injuries and injury rates for different gymnast levels among young precollegiate female gymnasts over a 21-year period, from 1985 to 2005.Study Design:Descriptive epidemiological study.Methods:This institutional review board–approved study retrospectively evaluated young, precollegiate female gymnasts over a 21-year period. Gymnasts were stratified into 1 of 4 competition levels based on the number of hours spent training. In addition to the frequency of injuries and hours trained, data collected on each gymnast included the following: age at the time of injury, body part injured, laterality of the injury, and diagnosis.Results:Over the 21-year period, 3681 new injuries were evaluated by a single physician. The injury incidence (2.155 per 1000 exposure hours) was slightly lower when compared with previously reported injury rates. There were 1,452,574 total exposure hours documented from training facility records. The injury rate per 1000 exposure hours was 2.859 for elite, 2.820 for high-level, 1.667 for intermediate, and 0.687 for novice gymnasts. The lower extremity was injured more often than the upper extremity (60.9% compared with 22.6% of total injuries). This difference was statistically significant across all levels.Conclusion:The injury incidence in this study was 2.155 per 1000 exposure hours. This was slightly lower when compared with previously reported injury rates. Although those studies only lasted 3 years or less, the injury rates can be directly compared because they are reported as injuries per 1000 training hours.Clinical Relevance:With the variability in data available and limited studies reported, a conclusive analysis is needed because of the long-term effects of injury seen on gymnasts, such as early degenerative disorders, cost of injury treatment, and reduction of well-being. In our 21-year study, we found the incidence of injury was slightly lower than that shown in prior shorter studies. In addition, we were able to evaluate specific injuries seen in this population over that time period. Also, this extended study revealed the longitudinal nature of a series of injuries over a period of time that has not been seen in other studies, thus giving insight into the effects of increased gymnastics in the young, female, adolescent population, which could be potentially used in guidelines for gymnasts in the future.

A thorough understanding of anterior cruciate ligament (ACL) function and the effects of surgical interventions on knee biomechanics requires robust technologies and simulation paradigms that align with clinical insight. In vitro orthopedic biomechanical testing for the elucidation of ACL integrity doesn't have an established testing paradigm to simulate the clinical pivot shift exam on cadaveric specimens. The study aim was to develop a robotically simulated pivot shift that represents the clinical exam. An orthopedic surgeon performed a pivot shift on an instrumented ACL-deficient cadaver leg to capture 6 degree-of-freedom motion/loads. The same knee was mounted to the robot and the sensitivity of the motion/loading profiles quantified. Three loading profile candidates that generated positive pivot shifts on the instrumented knee were selected and applied to 7 ACL-intact/deficient specimens and resulted in the identification of a profile that was able to induce a positive pivot shift in all ACL-deficient specimens (p < 0.001). The simulated shifts began at 22 ± 8°and ended at 33 ± 6°of flexion with the average magnitude of the shifts being 12.8 ± 3.2 mm in anterior tibial translation and 17.6 ± 4.3°in external tibial rotation. The establishment and replication of a robotically simulated clinical pivot shift across multiple specimens show the robustness of the loading profile to accommodate anatomical and experimental variability. Further evaluation and refinement should be undertaken to create a useful tool in evaluating ACL function and reconstruction techniques. Statement of clinical significance: Creation and successful demonstration of the simulated clinical pivot shift validates a profile for robotic musculoskeletal simulators to analyze ACL related clinical questions.