Tibial Tubercle Fractures in Children and Adolescents

Objectives: To report patient characteristics, fracture types, treatment methods, and clinical outcomes of children and adolescents treated for tibial tubercle fractures. Methods: Patients age 19 and under treated for tibial tubercle fractures at a single institution from 1995 to 2015 were identified and their medical records were retrospectively reviewed. Clinical and radiographic outcomes were reported for patients with a minimum follow up of 6 months. Associations were tested using Fisher’s exact test. Results: Two-hundred thirty seven tibial tubercle fractures were identified in 229 patients; 198 (86%) male. There were 139 (59%) left sided injuries. Mean age was 14.3 years (range 4.9 - 19.8). Mean body mass index (BMI) was 25. Osgood-Schlatters was identified in 72 (30%) cases and was most commonly associated with Ogden type I fractures (p<0.001). Two-hundred and four (86%) fractures occurred while participating in athletics, most commonly basketball (87, 43%). Of the 228 cases for which mechanism of injury was identified, 69 (30%) occurred while landing, 60 (26%) resulted from a direct blow to the knee, and 51 (22%) occurred while jumping. Ogden III fractures were most common (96, 41%) followed by Ogden I fractures (67, 28%). Initial treatment was surgical for 158 (67%) fractures, of which 58 (37%) underwent reoperation, 53 (34%) for hardware removal. Ogden I fractures were most commonly treated non-operatively (91%) and Ogden II-V fractures were most commonly treated operatively (89%, p<0.001). Elevated BMI was associated with Ogden II-V fractures (p=0.003) and injuries requiring operative treatment (p<0.001). Compartment syndrome was identified in 4 (2%) injuries and required emergent fasciotomy. Prophylactic anterior and/or lateral fasciotomy was performed in 35 (15%) operatively treated injuries. Of the 117 (49%) patients for whom minimum 6-month follow up was documented, 103 (88%) returned to sports; among those treated operatively (87), 2 (2%) developed symptomatic limb length discrepancy, 1 (1%) developed tibial recurvatum, and 6 (7%) developed post-operative infection. At last follow up, 39 (45%) of surgical patients reported pain at the tibial tubercle, 23 (26%) reported pain with squatting, and 13 (15%) had patellar tendonitis. Thirty-seven (43%) complained of hardware prominence. Conclusion: Tibial tubercle fractures occur most commonly in adolescent male athletes and are associated with basketball, elevated BMI, Osgood-Schlatters, and a risk of compartment syndrome. Following treatment, most patients return to sport. As the largest single series of tibial tubercle fractures reported, this study provides valuable insight into injury epidemiology, relationship with Osgood Schlatters, and clinical outcomes.

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TIBIAL TUBERCLE FRACTURES IN CHILDREN AND ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00186 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0018

Author(s):

Daniel B. Haber ◽

Frances Tepolt ◽

Michael McClincy ◽

Leslie Kalish ◽

Mininder S. Kocher

Keyword(s):

Children And Adolescents ◽

Compartment Syndrome ◽

Patient Characteristics ◽

Tibial Tubercle ◽

Type I ◽

Return To Sports ◽

Type Iv ◽

Small Series ◽

Fractures In Children

Background: Tibial tubercle fractures are uncommon sports related injuries. Only small series are reported in the literature. The purpose of this study is to report patient characteristics, fracture types, treatment methods, and clinical outcomes of children and adolescents treated for tibial tubercle fractures. Methods: Patients age 18 and under treated for tibial tubercle fractures at a single institution from 1995 to 2015 were identified and their medical records were retrospectively reviewed. Clinical and radiographic outcomes were reported for patients with minimum follow up of 6 months. Results: Two-hundred thirty-six tibial tubercle fractures were identified in 228 patients, 198 (86%) of whom were males. Mean age was 14.3 years (range 7.7-17.6). Mean body mass index (BMI) was 25.0 (range 16.1-38.9). Osgood-Schlatter disease was identified in 72 (31%) cases and was most commonly associated with type I fractures (p<0.001). Two-hundred and three fractures (86%) occurred while participating in athletics, most commonly basketball (87, 43%). Thirty percent of fractures occurred while landing, 26% resulted from a direct blow to the leg, and 22% occurred while jumping. Type III fractures were most common (96, 41%) followed by type I fractures (67, 29%). Initial treatment was surgical for 157 (67%) fractures. Type I fractures were most commonly treated non-operatively (91%) and types II-V fractures were most commonly treated surgically (89%, p<0.001). Operative fractures were associated with higher BMI z-scores (mean 1.16, p=0.05) than those treated non-operatively. Compartment syndrome was identified in 4 (2%) patients, 3 of which were had type IV fractures. Eighty-eight percent of patients returned to sports. Among those treated operatively, 55% had hardware removed and 7% developed post-operative infection. At last follow up, 45% of surgical patients reported pain on palpation at the tibial tubercle and 26% reported pain with squatting. Conclusions: Tibial tubercle fractures are sports related injuries and occur most commonly in adolescent males. They are associated with Osgood-Schlatter disease, a higher than average BMI, and a small but relevant risk of compartment syndrome, particularly in type IV fractures. Whether treated surgically or non-surgically, most patients return to sports despite a high incidence of post-treatment pain at the tibial tubercle.

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A Randomized, Controlled Trial Comparing Autologous Matrix-Induced Chondrogenesis (AMIC®) to Microfracture: Analysis of 1- and 2-Year Follow-Up Data of 2 Centers

The Open Orthopaedics Journal ◽

10.2174/1874325001307010133 ◽

2013 ◽

Vol 7 (1) ◽

pp. 133-143 ◽

Cited By ~ 73

Author(s):

Sven Anders ◽

Martin Volz ◽

Hubert Frick ◽

Jörg Gellissen

Keyword(s):

Randomized Controlled Trial ◽

Clinical Outcomes ◽

Controlled Trial ◽

Collagen Type I ◽

Cartilage Defects ◽

Type I ◽

Randomized Controlled ◽

First Results ◽

Post Operation

Microfracture (MFx) is currently the recommended option for the treatment of small cartilage defects but is not regarded as suitable for the treatment of defects larger than 2.5 cm2. To extent its applicability to medium-sized defects MFx has been combined with a collagen type I/III matrix (Chondro-Gide®). This technique is called Autologous Matrix-Induced Chondrogenesis (AMIC®) and meanwhile a clinically established treatment option for localized full-thickness small- to medium-sized cartilage defects. Despite its more spreading clinical use, clinical data published so far are limited to mainly case report series.In this study, we report the first results of a randomized, controlled trial assessing the efficacy and safety of AMIC®versus MFx. Patients enrolled in 2 centers were included in this analysis. 38 patients (aged 21-50 years, mean defect size 3.4 cm2) were randomized and treated either with MFx, with sutured AMIC®or glued AMIC®. Clinical outcomes (modified Cincinnati and ICRS score) could be assessed in 30 patients at 1-year and 27 patients at 2-years post-operation. Improvements in both scores were seen at 1-and 2-years post-operation, irrespective of the technique used. MRI assessment revealed a satisfactory and homogenous defect filling in the majority of patients. No treatment-related adverse events were reported.This interim analysis confirms the mid-term results for AMIC®reported in literature. It demonstrates clearly that clinical outcomes at 1-year post-operation are maintained at 2-years. Therefore we consider enhancing MFx with Chondro-Gide®is a valid and safe cartilage repair option for small- to medium-sized cartilage defects of the knee.

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Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06385-8 ◽

2020 ◽

Author(s):

Kenny Lauf ◽

Jari Dahmen ◽

J. Nienke Altink ◽

Sjoerd A. S. Stufkens ◽

Gino M. M. J. Kerkhoffs

Keyword(s):

Clinical Outcomes ◽

Median Time ◽

Outcome Measures ◽

Return To Sport ◽

Injury Type ◽

Sinus Tarsi ◽

Sinus Tarsi Syndrome ◽

Improved Performance

Abstract Purpose The purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome. Methods Subtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20–40), median follow-up 60 months (IQR 42–76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations. Results Fifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0–49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0–39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0–46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0–4.0), 2.0 during walking (IQR 0.0–5.3) during walking, 3.0 during running (IQR 1.0–8.0) and 2.0 during stair-climbing (IQR 0.0–4.5). The summarized FAOS score was 62 (IQR 50–90). The median SF-36 PCSS and the MCSS were 46 (IQR 41–54) and 55 (IQR 49–58), respectively. No complications and one re-do subtalar arthroscopy were reported. Conclusion Six out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. Level of evidence IV.

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Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118822452 ◽

2019 ◽

Vol 7 (1) ◽

pp. 232596711882245 ◽

Cited By ~ 3

Author(s):

Ellie A. Moeller ◽

Darby A. Houck ◽

Eric C. McCarty ◽

Adam J. Seidl ◽

Jonathan T. Bravman ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Return To Sport ◽

Patient Reported Outcome ◽

Shoulder Stabilization ◽

Posterior Shoulder ◽

Significant Difference ◽

Patient Reported ◽

Instability Rate

Background: Arthroscopic posterior shoulder stabilization can be performed with patients in the beach-chair (BC) and the lateral decubitus (LD) positions; however, the impact of patient positioning on clinical outcomes has not been evaluated. Purpose: To compare clinical outcomes and recurrence rates after arthroscopic posterior shoulder stabilization performed in the BC and LD positions. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library for studies reporting the clinical outcomes of patients undergoing arthroscopic posterior shoulder stabilization in either the BC or LD position. All English-language studies from 1990 to 2017 reporting clinical outcomes after arthroscopic posterior shoulder stabilization with a minimum 2-year follow-up were reviewed by 2 independent reviewers. Data on the recurrent instability rate, return to activity or sport, range of motion, and patient-reported outcome scores were collected. Study methodological quality was evaluated using the Modified Coleman Methodology Score (MCMS) and Quality Appraisal Tool (QAT). Results: A total of 15 studies (11 LD, 4 BC) with 731 shoulders met the inclusion criteria, including 626 shoulders in the LD position (mean patient age, 23.9 ± 4.1 years; mean follow-up, 37.5 ± 10.0 months) and 105 shoulders in the BC position (mean patient age, 27.8 ± 2.2 years; mean follow-up, 37.9 ± 16.6 months). There was no significant difference in the overall mean recurrent instability rate between the LD and BC groups (4.9% ± 3.6% vs 4.4% ± 5.1%, respectively; P = .83), with similar results in a subanalysis of studies utilizing only suture anchor fixation (4.9% ± 3.6% vs 3.2% ± 5.6%, respectively; P = .54). There was no significant difference in the return-to-sport rate between the BC and LD groups (96.2% ± 5.4% vs 88.6% ± 9.1%, respectively; P = .30). Range of motion and other patient-reported outcome scores were not provided consistently across studies to allow for statistical comparisons. Conclusion: Low rates of recurrent shoulder instability and high rates of return to sport can be achieved after arthroscopic posterior shoulder stabilization in either the LD or the BC position. Additional long-term randomized trials comparing these positions are needed to better understand the potential advantages and disadvantages of surgical positioning for posterior shoulder stabilization.

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Suture Versus Screw Fixation of Tibial Spine Fractures in Children and Adolescents: A Comparative Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119881961 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988196 ◽

Cited By ~ 4

Author(s):

Mark Callanan ◽

Judd Allen ◽

Brett Flutie ◽

Francis Tepolt ◽

Patricia E. Miller ◽

...

Keyword(s):

Children And Adolescents ◽

Surgical Outcomes ◽

Screw Fixation ◽

Cruciate Ligament ◽

Return To Sport ◽

Spine Fractures ◽

Avulsion Fractures ◽

Tibial Spine ◽

Intercondylar Eminence ◽

Fractures In Children

Background: Tibial spine fractures involve an avulsion injury of the anterior cruciate ligament (ACL) at the intercondylar eminence, typically in children and adolescents. Displaced fractures are commonly treated with either suture or screw fixation. Purpose: To investigate differences in various outcomes between patients treated with arthroscopic suture versus screw fixation for tibial spine avulsion fractures in one of the largest patient cohorts in the literature. Study Design: Cohort study; Level of evidence, 3. Methods: A search of medical records was performed with the goal of identifying all type 2 and type 3 tibial spine avulsion fractures surgically treated between 2000 and 2014 at a pediatric hospital. All patients had a minimum of 12 months clinical follow-up, suture or screw fixation only, and no major concomitant injury. Results: There were 68 knees in 67 patients meeting criteria for analysis. There were no differences with regard to postsurgical arthrofibrosis ( P = .59), ACL reconstruction ( P = .44), meniscal procedures ( P = .85), instability ( P = .49), range of motion ( P = .51), return to sport ( P >.999), or time to return to sport ( P = .11). Elevation of the repaired fragment on postoperative imaging was significantly greater in the suture group (5.4 vs 3.5 mm; P = .005). Postoperative fragment elevation did not influence surgical outcomes. The screw fixation group had more reoperations (13 vs 23; P = .03), a larger number of reoperations for implant removal (3 vs 22; P < .001), and nearly 3 times the odds of undergoing reoperation compared with suture patients (odds ratio, 2.9; P = .03). Conclusion: Clinical outcomes between suture and screw fixation were largely equivalent in our patients. Postoperative fragment elevation does not influence surgical outcomes. Consideration should be given for the greater likelihood of needing a second operation, planned or unplanned, after screw fixation.

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Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-3-319-321 ◽

2021 ◽

Vol 27 (3) ◽

pp. 319-321

Author(s):

K. Li ◽

◽

S. Rong ◽

C. Zheng ◽

Y. Teng ◽

...

Keyword(s):

Clinical Outcomes ◽

Radial Head ◽

Fracture Reduction ◽

Proximal Ulna ◽

Compression Fractures ◽

Fractures In Children ◽

Ulnar Fracture

Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini–fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.

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Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420905484 ◽

2020 ◽

Vol 45 (7) ◽

pp. 679-686 ◽

Cited By ~ 1

Author(s):

Marc Olivier Gauci ◽

Thomas Waitzenegger ◽

Pierre-Emmanuel Chammas ◽

Bertrand Coulet ◽

Cyril Lazerges ◽

...

Keyword(s):

Clinical Outcomes ◽

Revision Surgery ◽

Functional Outcomes ◽

Type I ◽

Type Ii ◽

Level Of Evidence ◽

Wrist Motion

We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion. Level of evidence: III

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Return to Physical Activities after Scarf Osteotomy for Hallux Valgus

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.1166 ◽

2020 ◽

Vol 22 (2) ◽

pp. 95-106

Author(s):

Dawid Ciechanowicz ◽

Jan Kozłowski ◽

Łukasz Kołodziej ◽

Justyna Kromuszczyńska

Keyword(s):

Physical Activity ◽

Clinical Outcomes ◽

Hallux Valgus ◽

Return To Sport ◽

Physical Activities ◽

Activity Score ◽

Ucla Activity Score ◽

Scarf Osteotomy ◽

Positive Effect

Background. Scarf osteotomy is an effective method of surgical treatment of hallux valgus. The final impact of the procedure on patients’ physical activity has not been assessed so far. Our goals were to evaluate sports and physical activities in patients following the Scarf osteotomy and to compare these with clinical outcomes. Material and methods. The study included 79 patients who were treated for hallux valgus with a Scarf osteotomy in 2015-2016. The average age in the examined group at the time of surgery was 55.43 (± 11.97) years, while the follow-up was on average 3.13 (± 0.42) years. Physical activity was measured using the UCLA - Activity Score and Author’s Sport Specific Questionnaire. Clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Score (AOFAS HMI) and compared to sports outcomes. Results. After the procedure, the frequency of undertaking physical activity increased by about 21% (p = 0.0005) and the time spent by patients during the week on sports (minutes per week) increase by about 19% (p = 0.005). The result of the UCLA – Activity Score after surgery increased by an average of about 4.7% (p = 0.016). The average satisfaction with the result of the surgery was 8.2 (1-10 scale). The majority of patients (67%) were able to maintain the amount of physical activity after the surgery and few patients (24%) were able to increase this amount. Conclusion. The study suggests that Scarf osteotomy has a positive effect on the ability of patients with hallux valgus to return to sport and physical activity.

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Clinical Outcomes of the Traditional Latarjet Versus the Congruent Arc Modification for the Treatment of Recurrent Anterior Shoulder Instability: A Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211030204 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110302

Author(s):

Sunita R.P. Mengers ◽

Derrick M. Knapik ◽

Matthew W. Kaufman ◽

Gary Edwards ◽

James E. Voos ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Shoulder Instability ◽

Meta Analysis ◽

Return To Sport ◽

Late Complications ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Recurrent Instability

Background: Few studies have compared clinical outcomes between the traditional Latarjet procedure for anterior shoulder instability and the congruent arc modification to the Latarjet procedure. Purpose: To systematically evaluate the literature for the incidence of recurrent instability, clinical outcomes, radiographic findings, and complications for the traditional Latarjet procedure and the congruent arc modification and to compare results of each search. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies published between January 1990 and October 2020 that described clinical outcomes of the traditional Latarjet and the congruent arc modification with a follow-up range of 2 to 10 years. The difference in surgical technique was analyzed using a chi-square test for categorical variables, while continuous variables were evaluated using a Student t test. Results: In total, 26 studies met the inclusion criteria: 20 studies describing the traditional Latarjet procedure in 1412 shoulders, and 6 studies describing the congruent arc modification in 289 shoulders. No difference between procedures was found regarding patient age at surgery, follow-up time, Rowe or postoperative visual analog scores, early or late complications, return-to-sport timing, or incidence of improper graft placement or graft fracture. A significantly greater proportion of male patients underwent glenoid augmentation using the congruent arc modification versus traditional Latarjet ( P < .001). When comparing outcomes, the traditional Latarjet procedure demonstrated a lower incidence of fibrous union or nonunion ( P = .047) and broken, loose, or improperly placed screws ( P < .001), and the congruent arc modification demonstrated improved outcomes with regard to overall return to sport ( P < .001), return to sport at the same level ( P < .001), incidence of subluxation ( P = .003) or positive apprehension ( P = .002), and revision surgery for recurrent instability ( P = .027). Conclusion: Outcomes after the congruent arc modification proved at least equivalent to the traditional Latarjet procedure in terms of recurrent instability and return to sport, although early and late complications were equivalent. The congruent arc procedure may be an acceptable alternative to traditional Latarjet for the treatment of anterior shoulder instability with glenoid bone loss; however, long-term outcomes of this procedure are needed.

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