This systematic review aimed to investigate whether the use of a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR). This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without a brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Two reviewers independently extracted the data. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials. A total of 1196 patients in three studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patients (≤17 years). The effectiveness of knee bracing when RTS remains ambiguous. Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction.

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Background There is little information in the literature about the outcomes of retrograde drilling for osteochondritis dissecans of the talus in a pediatric population. The purposes of this study were therefore to investigate the efficiency of retrograde drilling among a young population and to identify factors that are predictive for failure of the treatment. The primary objective was to retrospectively evaluate clinical outcomes of pediatric patients with OCD of the talus who have undergone retrograde drilling. The criteria for failure of treatment was the necessity for subsequent surgeries. The secondary objective was to identify factors predictive of a failure of retrograde drilling. Therefore, we tried to establish correlations between clinical outcomes and a range of factors such as demographic factors (age, sex, BMI, etc.) or clinical characteristics (lesion size, lesion stability, etc.). Methods A retrospective study was done. The data used for this study came from the medical records of pediatric patients (? 18 years old at time of treatment) who were treated by the principal investigator at the CHU Sainte-Justine. All patients were treated between September 2013 and December 2017. The selected patient files were obtained either through Chartmaxx software or by physically consulting charts at the medical archives of the hospital. The inclusion criteria for patients were: (1) an osteochondritis dissecans of the talus (2) no other lower limb injuries (3) retrograde drilling of the OCD (4) available pre- and post-operative imaging (5) at least one postop follow up visit. The information collected from each patient were the following: date of birth, age at surgery, sex, height, weight, BMI, affected ankle, location of OCD on talar dome, duration of symptoms, dimensions of lesion, history of ankle injuries, stability, status of tibial physis, date of surgery, details of surgery, follow-up duration, number of follow-up appointments, patient status at the last follow-up appointment, post-operative complications, necessity of subsequent surgeries, time interval between additional treatments and retrograde drilling. Clinical outcomes for each patient, determined at the last follow-up, were classified according to the Berndt and Harty treatment result grading. Regarding the secondary objectives, Pearson’s correlations were performed between the different patient variables and the necessity for another surgery and as well between the former and the clinical result Berndt and Harty score measured at the last follow-up appointment. Results Twenty-one patients were initially identified for this study and their medical records were reviewed. Of these original patients, 4 were left out because they had undergone microfracture procedure. In our revised population of 17 patients, there were 16 girls and 1 boy and the average age at the time of the procedure was of 14.8 (?2.12) years old. The mean follow-up period for this group was of 9.82 (?9.84) months. In terms of the osteochondral lesion, 1 patient presented with an OCD on the lateral part of the dome of the talus while 16 patients had theirs medially. Table 1 illustrates more in depth the characteristics of the group. Among the patients studied, 4/17 (24%) required a secondary surgery after retrograde drilling signifying that they had a failure of the initial treatment. Moreover, based on the Berndt and Harty treatment result grading measured at the last follow-up appointment, 8/17 (47%) had good results, 4/17 (24%) had fair results and 5/17 (29%) had poor results. The initial Pearson’s correlations do not indicate any links between the various patient variables and the necessity for a subsequent surgery or between patient variables and the clinical result scores. However, there is a correlation between the clinical results scores and the necessity for another treatment thus illustrating the reliability of the Berndt and Harty treatment result grading. Conclusion Despite being in a pediatric population, it seems that the clinical outcome of retrograde drilling has a limited success rate with only 47% of patients from this study having good results at the last follow-up appointment. Those results emphasize the importance of more studies in order to understand what factors are predictive of a bad and good outcome. [Table: see text]

Background: Proprioception is an important function which allows the brain to perceive the body’s position. It is a safety mechanism aiding the generation of movements to correct and maintain balance. During a return to sports for adults, it is essential to have a good postural control. However, this requirement is applied subjectively in a pediatric setting. The Biodex Stability System (BSS) is a validated instrument capable of evaluating proprioception by producing stability indexes. Unfortunately, the stability indexes for a healthy pediatric population and the associated characteristics have not yet been determined. Purpose: The primary objective was to establish normal pediatric values of proprioception using the BSS. The secondary objectives were to find correlations between various subgroups (sex, physical activity participation and joint laxity, etc) and the stability indexes. Methods: An observational cohort study was done. Patients from July 2018 to September 2018 were included from the facture clinic. Inclusion/exclusion criteria were: (1) a consolidated upper limb fracture, (2) no previous history of lower limb injury, (3) no congenital anomalies of the lower limb or neuromuscular disease. Included subjects underwent 3 test trials of 20 seconds each of single-leg shoeless postural control with eyes open and at a stability level of 4. The overall stability index (OSI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI) were noted. The protocol was conducted on both legs. Kolmogorov-Smirnov test will be used for the primary objective and, Pearson correlation for secondary objective. Results: Seventy-one participants (29 girls and 42 boys) with a mean age of 12.75±2.2 years old and a mean Beighton laxity score of 2.5±2.5 were recruited. The mean left OSI is 4.4±3.1 and the mean right OSI is 4.5±3.3. When comparing the subgroups, we were able to find correlations between the body mass index (BMI) and the OSI for both legs (left: r= 0.312, p = 0.008; right: r= 0.437, p = 0.001). We did not find any other correlations for any other groups (sex, age and Beighton score). Conclusion: A larger sample size will be needed to establish normal values based on sex and skeletal maturity but a mean value for OSI for a normal pediatric population was established. This study illustrates that, in our pediatric population, an increase in BMI is associated with an increase in OSI. Therefore, children with a higher BMI could potentially benefit from a proprioception training program in order to prevent the occurrence of injuries.

Background: Recent literature shows a rate of ACL retear after ACLR when returning to sport between 8% and 23%, depending on the population and clinical implications. The risk of a second injury is higher in patients who (1) return to cutting and pivoting sports, (2) do not meet the return to sport criteria before returning to sport, and (3) returning to pivoting sports earlier than 9 months after ACLR. A second ACL injury, either a graft rupture or contralateral ACL injury after ACLR, negatively impacts knee function, quality of life, accelerates degenerative changes in the knee and challenges an athlete’s career. Purpose: This systematic review aimed to investigate whether a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR). Methods: This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Data were extracted independently by two reviewers. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials. Results: A total of 1196 patients in 3 studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patient. (p < 0.05). Conclusion: Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction. [Table: see text][Figure: see text][Table: see text][Table: see text][Table: see text][Table: see text]