Publications by authors named "Jennifer J Beck"

27 Publications

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Gender and Socioeconomic Factors Affect Adolescent Patient and Guardian Preferences in Sports Medicine Physician Characteristics and Medical Decision Making.

J Am Acad Orthop Surg Glob Res Rev 2021 05 17;5(5). Epub 2021 May 17.

From the Orthopedic Institute for Children/UCLA (Dr. Beck and Ms. West); the DGSOM UCLA (Dr. Jackson), Los Angeles, CA; the Children's Heathcare of Atlanta, Atlanta, GA (Dr. Willimon and Dr. Busch); and the Boston Children's Hospital, Boston, MA (Dr. Christino).

Introduction: Diversity has increased within youth sports. It is unknown whether these demographic or socioeconomic factors affect adolescent patients' and their guardians' preferences of sports medicine physicians and involvement in medial decision making. Demographic and socioeconomic factors may affect adolescent patient and guardian preferences for sports medicine physicians.

Methods: Patients, age 10 to 18 years, and their guardians presenting to two sports medicine offices were asked to complete matched, anonymous surveys assessing their preferences for medical decision making, sports medicine physician gender, and personality characteristics. Analysis of demographic and socioeconomic effects on preferences was completed.

Results: Matched survey responses were collected from 353 patients and 325 corresponding guardians. Patient average age was 14.6 years (SD 2.1), with 43% female. Guardian average age was 43.4 years (SD 8.3), with 79% female. For both patients and guardians, the highest valued physician characteristic was being a good listener. Overall, 21% of patients and 17% of guardians reported a physician gender preference that matched the gender of the patient. Among all female patients, 32% preferred a female physician. Among all male patients, 12% preferred a male physician (P < 0.001). Ninety-two percent of patients reported wanting to be involved, and 93% of guardians thought that their child should be involved in the decision-making process. Hispanic, non-White, non-English speaking, government or no insurance, or less than college level of education patients and guardians reported a significantly greater importance of the physician independently determining the treatment plan (P < 0.001).

Conclusions: Demographic and socioeconomic factors do affect adolescent patient and guardian preferences for sports medicine physicians. Young patients have a desire to be included in the medical decision-making process. Female adolescent patients may have a same-gender preference for their sports medicine physician.

Study Design: This is a prospective, cohort study.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00069DOI Listing
May 2021

Current Concept Review: Inclusion and Analysis of Diverse Study Populations in Orthopaedic Research.

J Am Acad Orthop Surg 2021 May;29(10):e479-e487

From the Orthopaedic Institute for Children/UCLA, Los Angeles, CA (Beck), the Benioff Children's Hospital/UCSF, San Francisco, CA (Pandya), the NYU Langone Health, New York, NY (Carter), and the Tulane University School of Medicine, New Orleans, LA (Mulcahey).

As disparities in healthcare access and outcomes have been increasingly identified across medical specialties, the importance of recognizing and understanding the diversity of our patient populations and the influence of individual characteristics such as age, sex, gender, race, and ethnicity on clinical outcomes has been emphasized. Orthopaedic literature has advanced dramatically in the quality and quantity of research generated over the past 25 years, yet a consistent, sustained focus on studying musculoskeletal health in the context of these unique patient-specific variables has not been maintained. The result of this inattention may be the provision of orthopaedic care that is ill-suited for the individual patient whose biologic characteristics, life experiences, and cultural constructs differ from that of the typical research subject. The recent proliferation of meta-analyses-whose intention is to optimize statistical power-likely compounds the problem because improper, inconsistent, or absent categorization of patients in research articles precludes meaningful subgroup analysis. This article describes the current variability in demographic reporting in the orthopaedic literature, highlights the importance of complete, consistent demographic reporting and subgroup analysis, and reviews specific examples of orthopaedic conditions that illustrate how clinical outcomes may be affected by patient-specific variables such as age, sex, gender, race, and ethnicity.
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http://dx.doi.org/10.5435/JAAOS-D-20-01087DOI Listing
May 2021

Trochlear Morphology Development: Study of Normal Pediatric Knee MRIs.

J Pediatr Orthop 2021 Feb;41(2):77-82

UCLA/DGSOM, UCLA Department of Orthopedics, Orthopedic Institute for Children, Los Angeles, CA.

Introduction: Trochlear dysplasia is a known risk factor for patellar dislocations yet normal trochlea development is not well described. This study will define the articular cartilage (AC) and subchondral trochlear morphology development in pediatric patients using magnetic resonance imaging (MRI) evaluation.

Methods: A retrospective knee MRI review included patients aged 3 to 16 years with nonpatellofemoral-related diagnoses. International classification of diseases-9/International classification of diseases-10 codes were used to identify eligible study patients. Measurements of the trochlea were made on the basis of previously established methods using the axial MRI just distal to the physis at the deepest portion of the trochlear groove. Three linear [lateral trochlear height (LTH), medial trochlear height (MTH), and central trochlear height (CTH)] and 3 angular [sulcus angle (SA), lateral trochlear slope (LTS), and medial trochlear slope (MTS)] were made at AC and subchondral bone (SCB). The 12 measurements were made independently by 2 study authors. Inter-rater reliability was assessed using an interclass correlation coefficient for absolute agreement to the average of the scores. Trochlea measurements were summarized across age quartiles defined as first quartile (age, 5.1 to 8.3 y), second quartile (8.3 to 11.5 y), third quartile (11.5 to 14.3 y), fourth quartile (14.3to 16.9 y). Associations between age and trochlea measures were assessed using linear regression with Huber-White-adjusted SEs to account for clustering from a small number of patients (N=16) with >1 MRI.

Results: In total, 246 knee MRIs from 230 patients were included in this study; 113 patients (51%) were female, whereas 117 (49%) were male. A total of 116 MRIs (47%) were of the left knee and 130 (53%) were right knee. The average patient age was 11.4±3.4 years. Inter-rater agreement was high across all measures with interclass correlation coefficient values >0.7. Mean values for measurements are presented by age quartiles. LTH, MTH, and CTH showed a linear increase with age (range, 2 to 2.6 cm/y; P<0.001). SA, LTS, MTS measured at AC showed no change with age (P>0.05); however, LTS and MTS measured at SCB showed significant increases with age (0.6 and 0.9 degrees/y; P<0.001), whereas SA showed a decrease with age (-1.4 degrees/y; P<0.001). There were no significant differences found in the age associations by laterality, left versus right. There were no sex differences in the age associations for SA, LTS (P>0.05); however, for MTH, LTH, and CTH, males were found to have a significantly greater growth rate (P<0.001).

Conclusions: This study found an increase in AC and SCB MTH, LTH, and CTH over time, as well as an increase in SCB LTS and MTS, with a decrease in SA. However, AC of the LTS and SA remained constant, with no significant change throughout growth. This normative data indicate that the LTS and SA of AC are predictors of final trochlea shape in normal development. Final trochlear morphologic development is nearly complete around age 12 years, with no significant changes occurring thereafter.
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http://dx.doi.org/10.1097/BPO.0000000000001697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790925PMC
February 2021

Delays in Obtaining Knee MRI in Pediatric Sports Medicine: Impact of Insurance Type.

J Pediatr Orthop 2020 Nov/Dec;40(10):e952-e957

Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery.

Background: Increased enrollment in government-based insurance plans has been reported. With youth sports injuries on the rise, increased ordering of advanced imaging such as magnetic resonance imaging (MRI) has occurred. This study sought to report on the impact of insurance type on access to and results of knee MRI in pediatric sports medicine patients.

Methods: A retrospective review of 178 consecutive pediatric sports medicine clinics was completed.

Inclusion Criteria: patients younger than 18 years, routine knee MRI ordered, sports medicine diagnosis, and insurance. Data included basic demographics, injury date, date and location (urgent care vs. clinic) of the first presentation, details of MRI ordering and approval, date and location of MRI follow-up, MRI results (negative, minor findings, major findings), and eventual treatment required.

Results: A total of 168 charts underwent a complete review. The patients' average age was 14±3 years and 54% (N=90) were female. Ninety-eight had government insurance and 70 had commercial insurance. The time between injury and MRI completion was significantly longer with government insurance (34 vs. 67 d, P<0.01). Government insurance had increased wait time between the first visit and MRI completion (11 vs. 40 d, P<0.001) as well as MRI order and completion (9 vs. 16.5 d, P<0.001). There was no significant difference in positive findings on MRI between insurance groups, including both major and minor findings nor in the proportion receiving eventual operative treatment.

Conclusion: Pediatric sports medicine patients with government insurance have delays in obtaining knee MRI, despite there being no difference in the rate of positive findings and subsequent operative treatments.

Level Of Evidence: Level III-case-control study.
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http://dx.doi.org/10.1097/BPO.0000000000001653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554190PMC
February 2021

Low Energy, Lateral Ankle Injuries in Pediatric and Adolescent Patients: A Systematic Review of Ankle Sprains and Nondisplaced Distal Fibula Fractures.

J Pediatr Orthop 2020 Jul;40(6):283-287

Department of Orthopaedic Surgery, University of Texas Southwestern.

Background: Lateral ankle injuries are one of the most common musculoskeletal injuries sustained by pediatric and adolescent athletes. These injuries can result in significant time lost from competition, affect performance when returning to play, and represent a significant burden on the health care system as a whole. The purpose of this study was to systematically review the literature on the diagnosis, treatment, and prevention of acute lateral ankle injuries and their chronic effects in pediatric and adolescent athletes (younger than 19 y).

Methods: This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines between September and December 2018. PubMed and Google Scholar were systematically searched using the search terms: ("distal fibula fracture" OR "ankle sprain") AND ("youth" OR "pediatric" OR "adolescent"). All authors participated in article review (N=172) for relevance and age restrictions in which 30 met the inclusion criteria.

Results: Thirty articles met inclusion criteria [Levels of Evidence I to IV (I: n=4, II: n=16, III: n=9, and IV: n=1)] including distal fibula fracture diagnosis and treatment, and risk factors, prevention, and chronic sequela of lateral ankle injuries in pediatric and adolescent patients.

Conclusions: Low-energy, lateral ankle injuries are common in pediatric and adolescent patients, yet underrepresented in the medical literature. There is a lack of high-quality literature on diagnosis, treatment, and outcomes after Salter-Harris I distal fibula fractures. Available literature, however, suggests that there remains over diagnosis and over treatment of presumed Salter-Harris I distal fibula fractures. Adolescent ankle sprains dominate the available literature likely due to the high recurrence rate. Youth athletes and coaches should address risk factors and engage in injury prevention programs to prevent and minimize the effect of acute lateral ankle injuries.

Levels Of Evidence: Level III-Systematic review.
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http://dx.doi.org/10.1097/BPO.0000000000001438DOI Listing
July 2020

Does generalized joint hypermobility influence the Ponseti treatment of clubfoot patients?

J Pediatr Orthop B 2021 Jan;30(1):66-70

David Geffen School of Medicine.

Previous investigators have suggested a role for generalized joint hypermobility (GJH) in the etiology of clubfoot deformity, while others have suggested its presence may influence treatment outcomes. We sought to determine if GJH was associated with the demographics, treatment, or propensity to relapse of patients whose clubfeet were managed using the Ponseti method. Fifty-seven patients with Ponseti-treated clubfeet comprised the cohort; median age 61 months (range, 38-111 months). A physical therapist evaluated each patient using the nine-point Beighton scale to quantify hypermobility. The scores were then correlated with patient sex, laterality, Dimeglio severity score, treatment, relapse, and surgery. The median Beighton score was 5; 49 of 57 patients (86%) had Beighton scores ≥4. All feet were plantigrade without symptomatic overcorrection at the time of evaluation. Although there was a slightly lower probability of relapse in patients with higher Beighton scores, this was not statistically significant (P = 0.10). Accordingly, the sex, laterality, initial severity, number of pretenotomy casts, need for tenotomy, relapse, and need for tendon transfer surgery were not significantly influenced by the Beighton score. The outcome of Ponseti clubfoot treatment is not altered by the presence of GJH in young children. Joint hypermobility does not appear to influence the likelihood of relapse or surgery. Unlike clubfeet reportedly treated with release surgery, Ponseti-treated clubfeet were not prone to excessive overcorrection regardless of joint laxity. Last, the distribution of Beighton scores in the study's cohort supports an association between GJH and clubfoot deformity.
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http://dx.doi.org/10.1097/BPB.0000000000000747DOI Listing
January 2021

Extensive Atraumatic Heterotopic Ossification of the Achilles Tendon in an Adolescent with Metabolic Syndrome: A Case Report.

JBJS Case Connect 2020 Jan-Mar;10(1):e0394

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.

Case: A 15-year-old boy with type 1 diabetes mellitus, hypertension, and obesity presented with atraumatic posterior ankle pain and stiffness due to extensive heterotopic ossification (HO) of the Achilles tendon. The ossification was successfully surgically resected and tendon primarily repaired. Wound dehiscence was noted at the first preoperative visit, managed conservatively by local wound care, and healed uneventfully by secondary intention. One-year follow-up showed no recurrence of HO, return to baseline activities, yet low Oxford scores.

Conclusion: HO of the Achilles tendon is a rare clinical entity. We report an atraumatic case in an adolescent patient with metabolic syndrome, which may demonstrate systemic inflammation because of metabolic syndrome as a risk factor for HO.
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http://dx.doi.org/10.2106/JBJS.CC.19.00394DOI Listing
January 2021

Prospective Study of Acute Opioid Use After Adolescent Anterior Cruciate Ligament Reconstruction Shows No Effect From Patient- or Surgical-Related Factors.

J Am Acad Orthop Surg 2020 Apr;28(7):293-300

From the Orthopaedic Institute for Children/UCLA, Los Angeles, CA.

Introduction: Patient-reported pain scores and opioid use have not been quantified after outpatient adolescent anterior cruciate ligament reconstruction (ACLR).

Methods: Patients aged 12 to 18 years undergoing primary isolated ACLR, with or without meniscal treatment, were prospectively recruited. Patients actively taking opioids or with previous extended use of opioids were excluded. Two orthopaedic surgeons performed ACLR and determined the use of a hamstring or bone-patellar tendon-bone autograft. For postoperative pain management, patients were prescribed 40 tablets of hydrocodone/acetaminophen 5/325 mg. Patients were instructed to document daily pill consumption and side effects through a daily log for 6 weeks. Patients completed the American Pain Society Patient Outcome Questionnaire at the end of weeks 1 and 6.

Results: One hundred three patients were enrolled, with age: 12.5 to 18.9 years (mean 16.2 y ± 1.3), weight: 41.3 to 113.6 kg (mean 72.4 kg ± 17.2), and body mass index: 17.8 to 40.1 (mean 25.9 ± 4.9). Sixty-nine patients received a hamstring autograft, and 34 received a bone-patellar tendon-bone autograft. Fifty-six received additional meniscal procedures. The median number of postoperative opioids taken by patients was 17 (range 0 to 40). No notable differences were found in total pill consumption with regard to age, weight, body mass index, sex, block type, autograft type, or meniscal treatment at 1 week post-op or 6 weeks post-op. No correlation was found between the self-reported "worst pain in the past 24 hours" at the end of the first postoperative week or after 6 weeks (r = 0.112, P = 0.26, and r = 0.093, P = 0.36). No correlation was found between the level of satisfaction with pain treatment and total number of pills taken during the first postoperative week or at the end of 6 weeks (r = -0.090, P = 0.37, and r = -0.172, P = 0.08).

Conclusion: Patients take most pain medication during the first postoperative week after adolescent ACLR, although patient and surgical variables had no notable influence on pill consumption.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.5435/JAAOS-D-18-00766DOI Listing
April 2020

Gender of presenters at orthopaedic meetings reflects gender diversity of society membership.

J Orthop 2020 May-Jun;19:212-217. Epub 2019 Nov 27.

Director of Outreach and Research, Center for Sports Medicine, Orthopaedic Institute for Children, Department of Orthopaedic Surgery, DGSOM, UCLA, 403 W Adams Blvd, Los Angeles, CA, 900007, USA.

Objective: To quantify the number of women presenters and their roles at national meetings across all orthopaedic sub-specialties.

Methods: A retrospective review of annual meeting programs for 2008 and 2017 from ten North American orthopaedic societies was conducted.

Results: A statistically significant increase was seen in the proportion of women presenting at society annual meetings between 2008 and 2017 (p < 0.0001). Women were more often authors presenting abstracts (p < 0.0001)) and less frequently faculty/instructors (p = 0.0051) and moderators/chairs (p = 0.0003) when compared to men.

Conclusion: Men continue to hold a higher proportion of more respected roles within orthopaedic academia.
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http://dx.doi.org/10.1016/j.jor.2019.11.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015818PMC
November 2019

Recurrent Patellofemoral Instability in the Pediatric Patient: Management and Pitfalls.

Curr Rev Musculoskelet Med 2020 Feb;13(1):58-68

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.

Purpose Of Review: The purpose of the review is to discuss the relevant pathoanatomy, management, complications, and technical considerations for recurrent patellofemoral instability (PFI) in the pediatric population. Special consideration is given to recent literature and management of the patient with repeat instability following surgery.

Recent Findings: Patellar stabilization surgery is in principle dependent upon restoration of normal patellofemoral anatomy and dynamic alignment. Historically, treatment options have been numerous and include extensor mechanism realignment, trochleoplasty, and more recently repair and/or reconstruction of the medial patellofemoral ligament (MPFL) as a dynamic check rein during initial knee flexion. In skeletally immature patients, preference is given to physeal-sparing soft tissue procedures. While medial patellofemoral ligament reconstruction has become a popular option, postoperative failure is a persistent issue with rates ranging from 5 to 30% for PFI surgery in general without any single procedure (e.g., distal realignment, MPFL reconstruction) demonstrating clear superiority. Failure of surgical patellar stabilization is broadly believed to occur for three main reasons: (1) technical failure of the primary stabilization method, (2) unaddressed static and dynamic pathoanatomy during the primary stabilization, and (3) intrinsic risk factors (e.g., collagen disorders, ligamentous laxity). PFI is a common orthopedic condition affecting the pediatric and adolescent population. Treatment of repeat instability following surgery in the PFI patient requires understanding and addressing underlying pathoanatomic risk factors as well as risks and reasons for failure.
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http://dx.doi.org/10.1007/s12178-020-09607-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083998PMC
February 2020

Roux-Goldthwait and Medial Patellofemoral Ligament Reconstruction for Patella Realignment in the Skeletally Immature Patient.

Arthrosc Tech 2019 Dec 9;8(12):e1479-e1483. Epub 2019 Nov 9.

Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, U.S.A.

Surgical management of patellofemoral instability is technically challenging in skeletally immature patients. Special considerations in this population include activity and sports limitations, recurrence rate, risk of long-term injury to patellofemoral cartilage, and potential for physeal disruption with operative intervention. Numerous procedures have been described to address causative pathoanatomy in the patellofemoral joint, as well as its static and dynamic stabilizers. We describe our technique of combined medial patellofemoral ligament and modified Roux-Goldthwait reconstruction to address both proximal and distal malalignment in a skeletally immature patient with open physes.
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http://dx.doi.org/10.1016/j.eats.2019.07.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928364PMC
December 2019

Trends in Concomitant Meniscal Surgery Among Pediatric Patients Undergoing ACL Reconstruction: An Analysis of ABOS Part II Candidates From 2000 to 2016.

Orthop J Sports Med 2019 Sep 24;7(9):2325967119869848. Epub 2019 Sep 24.

Department of Orthopaedic Surgery, University of Texas Southwestern, Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, Texas, USA.

Background: Rates of anterior cruciate ligament (ACL) reconstruction among pediatric and adolescent patients are increasing. Limited knowledge exists about population-level rates of concomitant meniscal surgery in this age group.

Purpose/hypothesis: This study sought to examine trends in concomitant meniscal procedures and describe short-term complications in pediatric and adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing and that the likelihood of performing meniscal repair or meniscectomy is associated with patient- and surgeon-specific factors.

Study Design: Cross-sectional study.

Methods: We queried ACL procedures in patients younger than 19 years reported by American Board of Orthopaedic Surgery (ABOS) part II examination candidates from 2000 to 2016. Regression models examined associations between patient and surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications.

Results: A total of 9766 cases were identified. Females represented 46% (n = 4468) of included cases. Mean patient age was 16.1 years (SD, 1.62 years; range, 0-18 years). The rate of concomitant ACL-meniscal procedures increased from the years 2000 to 2016 (49%-60%; = .005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedic fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscal procedure ( = .003 and .006, respectively). Sports medicine-trained surgeons were more likely to perform meniscal repair compared with meniscectomy (+3.0%; = .016). Younger patient age was associated with increased likelihood of undergoing meniscal repair compared with meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included infection (1.61%), arthrofibrosis (1.14%), and deep venous thrombosis or pulmonary embolism (0.11%). Sports medicine and pediatric orthopaedic fellowship training was associated with higher rates of reporting postoperative stiffness and/or arthrofibrosis.

Conclusion: Among ABOS part II candidates, concomitant ACL-meniscal surgery has become more common than isolated ACL procedures. Procedures involving sports medicine fellowship-trained surgeons and younger patients were associated with increased rates of meniscal repair compared with meniscectomy. Pediatric orthopaedic and sports medicine training was associated with a greater likelihood of being involved in a concomitant ACL-meniscal procedure of any kind, and surgeons with such training also reported a higher incidence of postoperative stiffness and/or arthrofibrosis in patients.
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http://dx.doi.org/10.1177/2325967119869848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759752PMC
September 2019

Clinical Approach in Youth Sports Medicine: Patients' and Guardians' Desired Characteristics in Sports Medicine Surgeons.

J Am Acad Orthop Surg 2019 Jul;27(13):479-485

From the Orthopedic Institute for Children/UCLA, Los Angeles, CA (Dr. Beck), the Boston Childrens Hospital, Boston, MA (Dr. Murray), and the Childrens Hospital of Atlanta, Atlanta, GA (Dr. Christino).

Introduction: Adolescent athletes' and their guardians' preferences for sports medicine surgeon characteristics are unknown.

Methods: Unique, anonymous surveys regarding preferences in characteristics of sports medicine surgeons were given to both patients (aged 10 to 18 years) and their guardians before being seen by a sports medicine surgeon.

Results: Patients and their guardians reported shared decision making as the most important surgeon characteristic, followed by understanding patients' sports and goals. A higher percentage of male patients than female patients had a surgeon sex preference (P = 0.005); however, for both the groups, this ranked lower than other surgeon qualities. Nearly all respondents reported that the adolescent patient should be involved in medical decision making; yet, physician selection was determined by the guardian 65% of the time.

Conclusions: Both adolescent patients and their guardians reported shared decision making and understanding patients' sports and goals as surgeon qualities that were more important to them than surgeon sex.

Level Of Evidence: Level IV, cross-sectional study.
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http://dx.doi.org/10.5435/JAAOS-D-18-00263DOI Listing
July 2019

Chronic exertional compartment syndrome: current management strategies.

Open Access J Sports Med 2019 23;10:71-79. Epub 2019 May 23.

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. Needle manometry can be used to confirm diagnosis of CECS by measuring intracompartmental pressure. Operative treatment of CECS with fasciotomy has been shown to be effective in resolution of CECS, and new surgical techniques are being developed. In the pediatric population, endoscopy-assisted compartment release has provided high success rates with low complication rates. Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. Nonetheless, larger samples and a more diverse population are needed to better understand the outcomes of nonoperative management. There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.
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http://dx.doi.org/10.2147/OAJSM.S168368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537460PMC
May 2019

Iliotibial band autograft: what size is the graft? A mathematical and cadaveric model : ITB single and double strand size.

Arch Orthop Trauma Surg 2020 Jan 25;140(1):19-23. Epub 2019 May 25.

Orthopaedic Institute for Children/UCLA, 403 W Adams Blvd, Los Angeles, CA, 90007, USA.

Background: The iliotibial band (ITB) is used in anterior cruciate ligament (ACL) reconstruction in skeletally immature patients as well as several other orthopedic reconstructions. The purpose of this study is to determine the size of the ITB as an autograft option in ACL reconstruction surgery or other orthopedic soft tissue reconstructions.

Methods: Five adult cadavers resulting in nine ITB were used. Thickness and width of the ITB were determined. Using ITB width of 15-60 mm, single and doubled graft sizes were determined using standard surgical graft size technique. Geometric calculations based on average graft thickness were used to mathematically confirm the graft size of the ITB.

Results: The ITB is less than 1 mm in thickness in males and females. Cadaveric measurements were less than 1 mm larger than mathematical measurements, in majority of measurements. ITB autograft can be harvested to a maximum 9 mm single-stranded graft or > 12 mm doubled graft. A minimum of 50 mm of ITB width is required to make a 8 mm graft.

Conclusions: ITB is a versatile graft that can be used for a graft size up to 9 mm single strand and over 12 mm double strand. A minimum of 50 mm width of ITB is required to obtain a 8 mm-diameter autograft. To ensure appropriate graft size, surgeons should consider harvesting the maximum amount of ITB when performing ACL reconstructions in skeletally immature patients.

Clinical Relevance: Surgeons have a quick reference for the width of ITB they should harvest based on the size of graft they require for a successful surgery.
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http://dx.doi.org/10.1007/s00402-019-03208-5DOI Listing
January 2020

Hamstring Autograft Too Small: How Much Allograft Do You Need to Supplement to a Desired Hybrid Graft Size?

Arthroscopy 2019 02 3;35(2):530-534. Epub 2019 Jan 3.

Orthopaedic Institute for Children and Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A.

Purpose: To determine a simple rule for choosing supplemental allograft size for hybrid anterior cruciate ligament reconstruction using mathematical and cadaveric models.

Methods: Mathematical and cadaveric models were used to determine the rule. The mathematical model required application of the geometric Pythagorean theorem to add areas of circles. Cadaveric semitendinosus and gracilis tendons were combined in multiple quadrupled hamstring size combinations and then sized using standard surgical techniques to confirm the mathematical model.

Results: Geometric measurement, not simple addition, of graft diameters was required to determine the final graft size. Direct comparison of cadaveric and mathematical models showed close relations. If a final graft size of 7 mm is desired, an added diameter of all grafts of approximately 9.5 mm is needed. If a final graft size of 8 mm is desired, an added diameter of all grafts of approximately 11 mm is needed. If a final graft size of 9 mm is desired, an added diameter of all grafts of approximately 12.5 mm is needed. If a final graft size of 10 mm is desired, an added graft diameter of approximately 14 mm is needed. Cadaveric hamstring measurements were similar to the mathematical model.

Conclusions: By use of mathematical and cadaveric models, simple rules for determining the additional size of allograft diameter needed to supplement undersized hamstring autograft were created.

Clinical Relevance: With the increasing availability of allograft types and sizes, surgeons currently have no guidelines on the size of allograft that is required to supplement an undersized hamstring autograft. Simple rules were created for determining the amount of allograft supplementation required for undersized hamstrings and are easily applied to clinical situations.
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http://dx.doi.org/10.1016/j.arthro.2018.08.037DOI Listing
February 2019

Defining a Safe Zone for All-Inside Lateral Meniscal Repairs in Pediatric Patients: A Magnetic Resonance Imaging Study.

Arthroscopy 2019 01;35(1):166-170

Orthopaedic Institute for Children, University of California, Los Angeles, Los Angeles, California, U.S.A.

Purpose: To establish a safe zone for all-inside meniscal fixation in pediatric patients by use of magnetic resonance imaging (MRI) measurements between the popliteal tendon (PT) and popliteal neurovascular bundle (PNVB).

Methods: Patients aged 5 to 16 years with normal or nearly normal knee MRI scans were included. They were grouped by age: group I, 5 to 7 years (n = 61); group II, 8 to 10 years (n = 59); group III, 11 to 13 years (n = 60); and group IV, 14 to 16 years (n = 70). At the level of the lateral meniscus, 2 lines starting at the lateral patellar tendon border and ending at the medial edge of the PT (D1) and the lateral edge of the PNVB (D2) were made on an axial knee MRI scan. A third line (D3) connected D1 to D2 at the meniscocapsular junction of the posterior horn of the lateral meniscus (PHLM). A fourth line (D4), derived geometrically, was parallel and 8 mm anterior to D3, simulating the anterior edge of the PHLM.

Results: Axial MRI scans of 250 pediatric patients (aged 5-16 years) were retrospectively reviewed. Analysis showed significant correlation between age and sex for D3 (P < .0001). For D3, there were significant differences among all age groups, except between groups III and IV. The average D3 by age group was 14.1 mm (standard deviation [SD], 3.1 mm) for group I, 15.8 mm (SD, 2.5 mm) for group II, 17.0 mm (SD, 3.3 mm) for group III, and 17.2 mm (SD, 3.1 mm) for group IV. The average D4 was 11.39 mm (SD, 2.6 mm), 13.24 mm (SD, 2.24 mm), 14.59 mm (SD, 2.89 mm), and 14.80 mm (SD, 2.79 mm), respectively. There were significant differences in D3 and D4 in male versus female patients (17.6 mm vs 15.7 mm, P < .001, and 14.9 mm vs 13.2 mm, P < .001, respectively), particularly in groups III and IV (17.0 mm vs 13.8 mm and 16.8 mm vs 13.9 mm, respectively).

Conclusions: This study provides normative data of the distance between the PNVB and PT at the meniscocapsular junction (D3) and anterior edge of the PHLM (D4) with the knee in full extension. Combined with previous studies showing that the addition of knee flexion increases the distance between the meniscus and the neurovascular bundle, these data can be used by surgeons to improve the safety of PHLM repair in pediatric patients.

Level Of Evidence: Level III, diagnostic study of nonconsecutive patients.
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http://dx.doi.org/10.1016/j.arthro.2018.07.046DOI Listing
January 2019

Sustained Results in Long-Term Follow-Up of Autologous Chondrocyte Implantation (ACI) for Distal Femur Juvenile Osteochondritis Dissecans (JOCD).

Adv Orthop 2018 23;2018:7912975. Epub 2018 Sep 23.

The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.

Introduction: Concern regarding ability of autologous chondrocyte implantation (ACI) to correct for the bone and cartilage pathology of knee juvenile osteochondritis dissecans (JOCD) exists. The purpose of this study was to determine long-term, patient-based outcomes of ACI treatment of JOCD in young patients. Authors hypothesized long-term outcomes are comparable to reported mid-term outcomes.

Methods: A single institution, longitudinal cohort study design combining medical record review and outcome surveys was used. Inclusion criteria included isolated JOCD diagnosis, failed primary healing of operatively treated JOCD, ACI surgery > 5 years ago, and ≤20 years of age at time of ACI.

Results: 10/26 eligible patients (38.5%) participated (M: F = 5:5, age at ACI: 18.3 ± 2.5 y, current age: 30.8 ± 5.1 y, and current BMI: 24.6 ± 2.1). Follow-up was 12.0 ± 4.5 y. Lesion size at ACI was 9.1 ± 1.9 cm. Femoral condyle location was medial = 6 and lateral = 4. All required treatment at some point for knee symptoms after ACI. During the past one year, four patients required treatment. Patient reported outcome scores at 12 years following ACI were IKDC score: 73.0 ± 3.6, KOOS scores including pain [88.7 ± 2.3], symptoms [78.2 ± 4.6], activity of daily living [94.7 ± 1.9], function, sports, and recreational activities [73.0 ± 5.3], and quality of life [57.5 ± 5.8], and Modified Cincinnati Knee Rating score was 77.9 ± 4.1. A moderate to good relationship was found between KOOS symptoms and BMI and lesion size. Function, sports, and recreational activities of the KOOS were greater in participants who had ≤1 lesion prior to ACI procedures (p = 0.044).

Conclusion: This study of ACI treatment of knee JOCD patients confirms sustained, long-term results. Number of lesions prior to ACI procedure influenced status of function, sports, and recreational activities.
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http://dx.doi.org/10.1155/2018/7912975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174812PMC
September 2018

A novel method for determining sagittal pediatric patellar height with the Blumensaat-Epiphyseal Containment of the Knee Angle.

J Pediatr Orthop B 2018 Nov;27(6):510-515

Department of Orthopedic Surgery, University of California Los Angeles.

Defining normal pediatric patellar height is complicated. Current methods use ratios calculated from lateral radiographs, but often provide inconsistent results and are time-consuming. It has been observed that the angle formed by Blumensaat's line and the distal femoral physis, when extended, form an area of patellar containment throughout a range of knee flexion. Deemed the Blumensaat-Epiphyseal Containment of the Knee (BECK) Angle, the objective of this study was to investigate this as a simple alternative to identify normal pediatric patellar height. Lateral radiographs were taken every 15° from 0° to 90° flexion on 10 fresh-frozen cadaveric knees. Patellar height was measured as the percentage of pole-to-pole patellar length contained within the BECK angle. The method was then applied to normal lateral radiographs of 105 pediatric knees, divided into age groups of 7-9, 10-12, and 13-16 years old. BECK angle patellar containment was compared with previously described methods. For cadaveric specimens, at least 50% patellar containment occurred between 0° and 71° flexion without quadriceps tension and between 21° and 81° flexion with 30 N of quadriceps tension. For pediatric radiographs, flexion ranged from 9° to 81°. At least 50% patellar containment occurred in 96% of knees in all three age groups. Knee flexion fell within a range of 15°-60° in 92 of the 105 pediatric knees. Limiting the analysis to this range, at least 50% patellar containment occurred in 99% of knees in all three age groups. On the basis of this study, normal pediatric knee lateral radiographs between 15° and 60° flexion should show at least 50% patellar containment within the BECK angle.

Level Of Evidence: Diagnostic Level II study.
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http://dx.doi.org/10.1097/BPB.0000000000000527DOI Listing
November 2018

Operative Treatment of Isolated Meniscus Injuries in Adolescent Patients: A Meta-Analysis and Review.

Sports Health 2018 Jul-Aug;10(4):311-316. Epub 2018 Apr 12.

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.

Context: With the rise in sports participation and increased athleticism in the adolescent population, there is an ever-growing need to better understand adolescent meniscus pathology and treatment.

Objective: To better understand the operative management of meniscus tears in the adolescent population.

Data Sources: A systematic review of PubMed (MEDLINE) and Google Scholar was performed for all archived years.

Study Selection: Studies that reported on isolated meniscus tears in adolescent patients (age, 10-19 years) were included.

Study Design: Systematic review and meta-analysis.

Level Of Evidence: Level 4.

Data Extraction: Two authors reviewed and extracted data from studies that fulfilled all inclusion criteria.

Results: Nine studies on isolated meniscus tears in adolescent patients were found, with level of evidence ranging from 3 to 4. These studies evaluated a total of 373 patients (248 males, 125 females) and 390 knees. Seven studies were published between 1979 and 2000, all of which discuss meniscectomy as the primary treatment. Two studies were published after 2000 and report on meniscus repair surgery. The mean patient age was 14.4 years. A total of 308 meniscectomies and 64 meniscus repairs were performed. Follow-up ranged from 1.8 to 30 years (mean, 10.8 years). A 37% retear rate was reported for patients undergoing meniscus repair. Different outcome measures were used for meniscectomy versus meniscus repair. Three studies evaluating meniscectomy reported Tapper-Hoover scores, showing 54 patients with an excellent result, 58 with good, 57 with fair, and 23 with poor results.

Conclusion: A shift in the management of isolated adolescent meniscal tears is reflected in the literature, with a recent increase in operative repair. This is likely secondary to poor outcomes after meniscectomy reflected in long-term follow-up studies. The current literature highlights the need for improved description of tear patterns, standardized reporting of outcome measures, and improved study methodologies to help guide orthopaedic surgeons on operative treatment of meniscal tears in adolescent patients.
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http://dx.doi.org/10.1177/1941738118768201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044115PMC
July 2018

What's New in Pediatric Sports Conditions of the Knee?

J Pediatr Orthop 2018 Feb;38(2):e66-e72

Orthopedic Institute for Children, UCLA, Los Angeles, CA.

Background: Sports injuries are common in pediatric and adolescent patients and the evaluation and treatment of these injuries continues to evolve. The purpose of this review is to provide a comprehensive appraisal of the literature, highlighting recent updates on sports-related knee injuries in the pediatric athlete. We specifically examined literature on tibial spine fractures, osteochondritis dissecans (OCD) of the knee, and patellar instability. Because of the volume of literature on the subject, pediatric, and adolescent anterior cruciate ligament injuries were not included in this review.

Methods: An electronic search of the PubMed, EMBASE, and Google Scholar databases was performed for keywords related to pediatric: tibial spine fractures, patellar instability, and osteochondritis dissecans (OCD). Search results were filtered by publication date to yield articles published electronically or in print on or after January 1, 2013. Papers were selected based on expert opinion and consensus by the authors and included if deemed to have contributed important findings to the above topics.

Results: A total of 31 articles were deemed to have contributed significant findings to the literature: 5 tibial spine, 17 patellar instability, and 9 OCD. The level of evidence for most studies was either level III or IV.

Conclusions: The optimal treatment for tibial spine fractures remains controversial. The evaluation of risk factors for recurrent patellar instability is important in determining the optimal treatment strategy following first-time patellar dislocation. Future multicenter studies on pediatric OCD have the potential to further understanding of this difficult problem. High-level, comparative outcomes research on a variety of pediatric sports related injuries is lacking and this review may help inform topics for future study.

Level Of Evidence: Level IV-literature review.
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http://dx.doi.org/10.1097/BPO.0000000000001107DOI Listing
February 2018

What's New in Pediatric Upper Extremity Sports Injuries?

J Pediatr Orthop 2018 Feb;38(2):e73-e77

Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI.

Background: Sports injuries are common in pediatric and adolescent patients and the evaluation and treatment of these injuries continues to evolve. The purpose of this review is to provide a comprehensive appraisal of the most recent literature, highlighting updates on sports-related upper extremity injuries in pediatric patients.

Methods: An electronic search of the PubMed, EMBASE, and Google Scholar databases was performed for keywords related to pediatric overhead athletes, osteochondritis dissecans (OCD) of the capitellum, medial epicondyle fractures, shoulder instability, and clavicle fractures. Search results were filtered by publication date to yield articles published electronically or in print on or after January 1, 2013 to May 30, 2017. Papers were selected based on expert opinion and consensus by the authors and included if deemed to have contributed important findings to the above topics.

Results: A total of 51 articles were deemed to have contributed significant findings to the literature: 11 overhead athlete, 9 OCD of the capitellum, 6 medial epicondyle fractures, 17 shoulder instability, and 8 clavicle fractures. The level of evidence for most studies was either Level III or IV.

Conclusions: Overuse and traumatic conditions of the pediatric elbow including UCL tear, capitellar OCD, and medial epicondyle fractures represent a significant portion of injuries in the overhead athlete. Research in the prevention and treatment of primary and recurrent shoulder instability in young athletes continues to evolve. The operative treatment of clavicle fractures in adolescents has been increasing without a commensurate increase in the level of evidence supporting such treatment. Advances have been made in the treatment of sports-related upper extremity injuries in pediatric patients, however, high-level, comparative outcomes research in many areas is lacking and this review may help inform topics for future study.

Level Of Evidence: Level IV-Literature review.
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http://dx.doi.org/10.1097/BPO.0000000000001104DOI Listing
February 2018

Opioid Prescription and Usage in Adolescents Undergoing Orthopaedic Surgery in the United States: A Systematic Review.

JBJS Rev 2017 08;5(8):e5

1The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center (E.A.D., E.E., and S.N.S.), Orthopaedic Institute for Children (J.J.B. and R.E.B.), in alliance with the Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California2College of Osteopathic Medicine, Touro University Nevada, Henderson, Nevada.

Background: The proper use of opioid analgesia for postoperative pain management is controversial. While opioids are considered the standard of care for multimodal postoperative pain modulation in the United States, there is a lack of established protocols for prescribing opioids in adolescents undergoing outpatient orthopaedic surgery. The objective of this review was to identify and report on current literature on opioid prescription for pain management in adolescents undergoing all procedures, as well as in adults undergoing outpatient orthopaedic surgery.

Methods: A comprehensive literature search using PRISMA guidelines was performed to identify all articles relevant to opioid use in adolescents for postoperative pain and in adults following outpatient orthopaedic procedures.

Results: A total of 4,446 results were identified from databases and relevant journal web sites. Of these, 9 articles were selected that fit the criteria for review. Five studies discussed the dosage and type of opioids prescribed in adolescent populations, and 4 quantified patient self-administration in adult populations.

Conclusions: Adolescent opioid pain management following outpatient orthopaedic surgery is not documented. Current recommendations for opioid prescription in adolescents lack support and are primarily based on adult dosages. Adult studies suggest that opioid medications may be overprescribed following outpatient orthopaedic surgery. These results clearly indicate that there is a pressing need for quantitative research on pain management following outpatient orthopaedic surgery in the adolescent population in the United States.

Clinical Relevance: There appear to be no studies on self-administered opioid pain medication following orthopaedic surgery in an adolescent population, suggesting that there is no objective basis for the current prescription recommendations.
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http://dx.doi.org/10.2106/JBJS.RVW.16.00093DOI Listing
August 2017

What's New in Pediatric Medial Epicondyle Fractures?

J Pediatr Orthop 2018 Apr;38(4):e202-e206

Orthopedic Institute for Children.

Background: Medial epicondyle fractures are predominantly seen in adolescent, male patients. Historically, nonoperative intervention was the mainstay of treatment. With increasing upper extremity demands of young athletes and reports of valgus instability after nonoperative treatment, there has been an increased interest in operative indications. Controversy regarding proper imaging and measurement of displacement complicates decision-making algorithms. Review of recent literature is required for improved decision making.

Methods: We searched the PubMed database for all papers related to the treatment of medial epicondyle fractures in patients under 18 years of age published between January 1, 2005 and March 15, 2016. This resulted in 39 papers written in English for review. Papers were included based upon subject matter and contribution of new findings to literature. Review articles were excluded.

Results: In total, 39 papers were reviewed and 30 were included in this review. Five classic manuscripts on medial epicondyle fractures in children provide appropriate historical and background information as needed.

Conclusions: Medial epicondyle fractures represent a variety of low and high-energy mechanisms, displacement, treatment options, and complications. This paper reviews recent literature on these topics. Controversy regarding imaging modality, displacement measurement accuracy, and surgical indications still exist. Long term, patient based, functional outcome studies of operative versus nonoperative treatment are needed to improve our treatment algorithms of this injury. Treatment algorithms should be individualized to each specific patient and fracture.

Level Of Evidence: Level 5.
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http://dx.doi.org/10.1097/BPO.0000000000000902DOI Listing
April 2018

Surgical Treatment of Chronic Exertional Compartment Syndrome in Pediatric Patients.

Am J Sports Med 2016 Oct 30;44(10):2644-2650. Epub 2016 Jun 30.

Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA

Background: Chronic exertional compartment syndrome (CECS) is a cause of leg pain in running athletes and is treated with fasciotomy after failure of nonoperative management. CECS is being seen with increased frequency in younger patients. The demographics and outcomes of fasciotomy for CECS in pediatric patients, including risk factors for treatment failure, have not been described.

Purpose: To describe characteristics of pediatric patients with CECS and determine surgical outcomes of the condition in this population.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective review was performed for patients 18 years and younger treated surgically for CECS with compartment release at a single institution from 1995 to 2014. Demographic and condition characteristics, operative procedure, postoperative course, and clinical outcomes were recorded for 286 legs of 155 patients. Compartment pressure testing using the Pedowitz criteria confirmed the diagnosis in all patients.

Results: A total of 155 patients were included in the study (average patient age at presentation, 16.4 ± 1.38 years); 136 (88%) were female. All 155 patients presented with leg pain; of these patients, 8 (5%) also had neurologic symptoms, and 131 (85%) presented with bilateral symptoms requiring bilateral compartment release. Symptoms were chronic in nature, with duration over 1 year in 63% of patients. The primary sport was most commonly reported as running (25%), soccer (23%), or field hockey (12%); 50% of patients were multisport athletes. Of 286 legs, 138 (48%) had only anterior and/or lateral compartments released, while 84 (29.4%) had all 4 compartments released. Documented return to sport was seen in 79.5% of patients. Outcomes analysis was performed for 250 of 286 legs. Of these 250 legs, 47 (18.8%) had recurrent CECS requiring reoperation at a median of 1.3 years (interquartile range, 0.8-3.5) after initial compartment release. For each additional month between presentation and release, the odds of recurrence decreased by 12% (P = .04). Legs with only anterior and/or lateral compartment released had 3.4 times (95% CI, 1.29-9.14) the odds of reoperation compared with legs that had all 4 compartments released (P = .01). Twenty-eight of 250 legs (11.2%) had wound issues that resolved with nonoperative management. No wounds required repeat surgical management.

Conclusion: CECS in pediatric patients most commonly occurs in adolescent females participating in running sports. Fasciotomy results in a 79.5% return-to-sports rate. Recurrence occurs in 18.8% of patients, more commonly in patients undergoing anterior and lateral release only.
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http://dx.doi.org/10.1177/0363546516651830DOI Listing
October 2016

Congenital tibial dysplasia with lateral bowing and duplication of hallux: case presentations.

J Pediatr Orthop B 2013 May;22(3):213-8

Department of Orthopedic Surgery and Rehabilitation, Loyola University Medical Center, Shriners Hospital for Children-Chicago, Chicago, IL 60707, USA.

This article reports on two children with congenital unilateral tibial dysplasia with lateral bowing with no associated sagittal plane deformity. In both cases, it is associated with ipsilateral duplication of the hallux. Long-term follow-up of the patients showed spontaneous, almost complete resolution of the bowing without progressing into fracture or pseudoarthrosis. Leg length discrepancy appeared to be the only orthopedic sequela related to this phenomenon.
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http://dx.doi.org/10.1097/BPB.0b013e328352ad09DOI Listing
May 2013

Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992-2003).

J Am Vet Med Assoc 2006 Dec;229(12):1934-9

Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

Objective: To evaluate risk factors associated with death and development of perioperative complications in dogs undergoing surgery for treatment of gastric dilatation-volvulus (GDV).

Design: Retrospective case series.

Animals: 166 dogs.

Procedures: Records of dogs with confirmed GDV that underwent surgery were reviewed. Logistic regression was performed to identify factors associated with development of complications (ie, hypotension, arrhythmias, gastric necrosis necessitating gastrectomy, disseminated intravascular coagulation, peritonitis, sepsis, postoperative dilatation, postoperative vomiting, and incisional problems) and with short-term outcome (ie, died vs survived to the time of suture removal).

Results: Short-term mortality rate was 16.2% (27/166). Risk factors significantly associated with death prior to suture removal were clinical signs for > 6 hours prior to examination, combined splenectomy and partial gastrectomy, hypotension at any time during hospitalization, peritonitis, sepsis, and disseminated intravascular coagulation. Partial gastrectomy was not a significant risk factor for death but was for peritonitis, disseminated intravascular coagulation, sepsis, and arrhythmias. Age, gastrectomy, and disseminated intravascular coagulation were risk factors for development of hypotension. Use of a synthetic colloid or hypertonic saline solution was associated with a significantly decreased risk of hypotension.

Conclusions And Clinical Relevance: Results suggest that the prognosis for dogs undergoing surgery because of GDV is good but that certain factors are associated with an increased risk that dogs will develop perioperative complications or die.
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http://dx.doi.org/10.2460/javma.229.12.1934DOI Listing
December 2006