scholarly journals Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096712
Author(s):  
Jennifer Kallini ◽  
Lyle J. Micheli ◽  
Patricia E. Miller ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Knee Pain ◽  
Surgical Techniques ◽  
Lateral Release ◽  
Return To Sports ◽  
Treatment Technique ◽  
Adolescent Athletes ◽  
Bipartite Patella ◽  
Competitive Athletes ◽  
Fragment Excision

Background: Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between ossification centers. Repetitive traction forces across the synchondrosis can cause knee pain, most commonly presenting in adolescence. Symptoms frequently resolve with nonoperative management. Few surgical case series exist to guide treatment approaches for refractory pain. Purpose: To investigate the clinical features, surgical techniques, and outcomes associated with operative treatment of symptomatic BPP in pediatric and adolescent athletes and to compare features of the series with a large control group managed nonoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective medical record review was conducted of all patients aged ≤20 years who were diagnosed with symptomatic, radiologically confirmed BPP between 2003 and 2018 at a single tertiary-care pediatric hospital (N = 266). Demographic and clinical variables were analyzed, and additional radiologic and perioperative variables were collected for the surgical subcohort. Results: Of the 266 patients included, 27 were treated operatively (10.2%). When compared with those treated nonoperatively (with rest, physical therapy, cryotherapy, and anti-inflammatory medications), the operatively managed group experienced a longer duration of symptoms before first presentation (21.5 vs 7.6 months; P < .001) and were more likely to be older (mean age, 15.4 vs 12.4 years; P < .001), female (59.3% vs 35.6%; P = .03), and competitive athletes (100% vs 84.5%; P = .02). In the 27 patients treated operatively, procedures were categorized as isolated fragment excision (n = 9), fragment excision with lateral release (n = 8), isolated lateral release (n = 5), fragment screw fixation (n = 4), and synchondrosis drilling (n = 1). The mean time between surgery and return to sports was 2.2 months. Four patients (14.8%) reported residual symptoms requiring secondary surgery, including lateral release (n = 1), excision of residual fragment (n = 1), and fixation screw removal (n = 2). Conclusion: BPP can cause knee pain in adolescent athletes and is generally responsive to nonoperative treatment. Patients undergoing surgical treatment—most commonly female competitive athletes with prolonged symptoms—represented 10% of cases. A variety of surgical techniques may be effective, with a 15% risk of persistent or recurrent symptoms warranting reoperation. Prospective multicenter investigations are needed to identify optimal candidates for earlier interventions and the optimal operative treatment technique.

scholarly journals PRESENTING FEATURES, CLINICAL COURSE, SURGICAL TECHNIQUES, AND OUTCOMES ASSOCIATED WITH OPERATIVE TREATMENT OF BIPARTITE PATELLA IN PEDIATRIC AND ADOLESCENT ATHLETES: A RETROSPECTIVE COMPARISON TO A NON-OPERATIVELY TREATED COHORT

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Jennifer Kallini ◽  
Lyle J. Micheli ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
Benton E. Heyworth
Keyword(s):  
Operative Treatment ◽  
Knee Pain ◽  
Clinical Course ◽  
Surgical Techniques ◽  
Lateral Release ◽  
Minor Trauma ◽  
Adolescent Athletes ◽  
Bipartite Patella ◽  
Competitive Athletes ◽  
Fragment Excision

Background: The bipartite patella is a developmental variant in which incomplete ossification leads to a fibrocartilaginous synchondrosis between ossification centers; repetitive traction on the synchondrosis in young athletes may lead to pain. Few series of surgical cases exist to guide treatment approaches to refractory pain. Hypothesis/Purpose: To investigate the presenting features, clinical course, surgical techniques, and outcomes associated with operative treatment of symptomatic bipartite patella in pediatric and adolescent athletes, with comparison to a control group of symptomatic, non-operative patients. Methods: A retrospective medical record review of patients ≤20 years-old diagnosed with symptomatic, radiographically-confirmed bipartite patellae between 2003 and 2018 at a single tertiary-care pediatric hospital was conducted. Patients for whom knee pain could not be attributed to bipartite patella were excluded. Additional clinical and operative variables were collected for the subset that underwent surgical treatment. Outcomes analyzed included time to return to sport (RTS) and re-operation. Results: 278 patients (37.8% females; mean age: 12.7 years, range 7-20 years) were included, 27 (mean age: 15.3 years, range 10-20 years) of whom were treated operatively (9.7%). Compared to the 251 patients who underwent non-operative treatment (consisting of physical therapy, activity modification, non-steroidal anti-inflammatory medicines, and cryotherapy), the operatively treated patients were more likely to be older (mean age 12.4 years vs. 15.3 years, p<0.001), female (35.5% vs. 59.3%, p=0.02) and competitive athletes (83.6% vs. 100%, p=0.10). Of the operative patients, 16 (59%) had Saupe III (superolateral) ossicles, 8 (30%) had Saupe II (lateral) ossicles, and 3 (11%) had Saupe I (inferior) ossicles. Most operative patients (79%) reported insidious onset of pain, with minor trauma precipitating symptom onset in the remainder (21%). Symptom duration prior to surgery was 2.2 years (range 1.7 mo-10.1yrs). Procedures were categorized as isolated fragment excision (n=10), fragment excision with lateral release (n=9), isolated lateral release (n=4), ORIF (n=3), and arthroscopic drilling (n=1). Operative outcomes are found in Table 1. Conclusions: Bipartite patella may be an underappreciated cause of knee pain in adolescent athletes. Patients who underwent surgery displayed symptoms lasting >2 years, representing ˜10% of cases, and were most likely to have superolateral bipartite fragments with a mean size of ˜1cm2. Surgery was more common amongst females, competitive athletes, and older adolescents. There was an overall 11% risk of persistent or recurrent symptoms warranting re-operation. Prospective multi-center investigations may be warranted to identify optimal candidates for earlier interventions, as well as optimal non-operative and operative treatment techniques. [Table: see text]

scholarly journals Arthroscopic Management for Bipartite Patella: A Systematic Review

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110222
Author(s):  
Allison Loewen ◽  
Susan M. Ge ◽  
Yousef Marwan ◽  
Mark Burman ◽  
Paul A. Martineau
Keyword(s):  
Systematic Review ◽  
Journal Article ◽  
Case Series ◽  
Arthroscopic Treatment ◽  
Lateral Release ◽  
Return To Sports ◽  
Postoperative Rehabilitation ◽  
Arthroscopic Management ◽  
Bipartite Patella ◽  
Arthroscopic Excision

Background: Bipartite patella is a rare congenital condition that becomes painful following direct trauma or an overuse injury. If it remains painful despite nonoperative treatment, surgery may be warranted. The current gold standard is open fragment excision or lateral release; however, arthroscopic management is also possible. Purpose: To investigate the safety and efficacy of arthroscopic treatment of painful bipartite patella. Study Design: Systematic review; Level of evidence, 4. Methods: Using Medline and Embase, we systematically reviewed the literature as of March 8, 2020, using the subject headings “bipartite patella” and “arthroscopy” and related key terms. All levels of evidence involving human studies in English were included. Articles were excluded if only the abstract was published or the study was related to nonsurgical treatment or nonrelated diagnoses. Data related to journal/article information, demographic/clinical data, arthroscopic technique, length of follow-up, treatment outcomes, and complications were extracted. Results: Eleven articles with 43 patients were included in the review. Most patients (n = 34; 79%) underwent arthroscopic lateral release, while 16% (n = 7) had arthroscopic excision of the accessory fragment and 5% (n = 2) had arthroscopic excision and release. All patients except for one, who experienced postoperative trauma, were pain-free after arthroscopic treatment and were able to return to sports after a mean 2.6 months. Conclusion: This review demonstrated that arthroscopic management of painful bipartite patella is a safe and effective alternative to open surgical excision or release. However, all articles were case studies or small case series, owing to the rarity of the condition. In the future, higher-level studies comparing arthroscopic techniques and postoperative rehabilitation programs should be performed.

scholarly journals CLINICAL OUTCOMES OF OPERATIVE MANAGEMENT OF CAPITELLAR OSTEOCHONDRITIS DISSECANS IN ADOLESCENT ATHLETES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0009
Author(s):  
Richard M. Michelin ◽  
Bryn R. Gornick ◽  
John A. Schlechter
Keyword(s):  
Operative Treatment ◽  
Osteochondritis Dissecans ◽  
Return To Sport ◽  
Bone Age ◽  
Return To Sports ◽  
Adolescent Athletes ◽  
Duration Of Symptoms ◽  
Marrow Stimulation ◽  
Diagnostic Arthroscopy

Background: Capitellar osteochondritis dissecans (OCD) is commonly encountered in youth athletes. There are limited reports on long term outcomes using validated outcome scores following surgical treatment of elbow OCD in adolescents. Purpose: To examine the outcomes of operative treatment of elbow OCD in adolescent athletes and investigate return to sport rate as well as athletic and daily function. Methods: 17 adolescent athletes (average age 14.2 ± 1.5 years) and 18 elbows with OCD treated arthroscopically were retrospectively reviewed. The average duration of symptoms prior to surgery was 15.4 ± 12.5 months and average follow up was 4.4 ± 3.7 years. Data points examined included pre-operative lesion grade/size, range of motion (ROM), and bone age; intra-operative lesion grade/size; and post-operative ROM, Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Results: All patients were treated with initial diagnostic arthroscopy. 14/17 patients were definitively treated with arthroscopic debridement and marrow stimulation/microfracture. 3/17 patients required open treatment with two patients amendable to osteochondral fixation and one patient to open marrow stimulation/microfracture. 14/17 athletes returned to their sport post-operatively with 12/17 returning to the same level or higher, and 2/17 returning to a lower level of recreational play. 3/17 athletes did not return to sports but advised that this was by choice not due to their elbow OCD. Overall, there were significant improvements in elbow ROM post-operatively as well as excellent QuickDASH (average 1.9 ± 4.4) and KJOC scores (average 93 ± 8.0) seen amongst all athletes. There was no correlation between pre-operative lesion grade/size, bone age, or open versus arthroscopic treatment with outcome. Conclusion: Operative treatment of elbow OCD in adolescent athletes not only leads to high return to sports rates but also high levels of athletic and daily functional activity long term.

Isolated meniscus injuries in skeletally immature children and adolescents: state of the art

2021 ◽  
pp. jisakos-2020-000496
Author(s):  
Gustavo Vinagre ◽  
Flávio Cruz ◽  
Khalid Alkhelaifi ◽  
Pieter D'Hooghe
Keyword(s):  
Children And Adolescents ◽  
State Of The Art ◽  
Surgical Techniques ◽  
Meniscal Repair ◽  
Management Plan ◽  
Anatomical Location ◽  
Return To Sports ◽  
Meniscal Tears ◽  
Geographical Differences ◽  
Meniscal Healing

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

scholarly journals Anterior knee pain and functional outcome following different surgical techniques for tibial nailing: a systematic review

2020 ◽  
Author(s):  
Mandala S. Leliveld ◽  
Michael H. J. Verhofstad ◽  
Eduard Van Bodegraven ◽  
Jules Van Haaren ◽  
Esther M. M. Van Lieshout
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Surgical Techniques ◽  
Anterior Knee

scholarly journals Fixation of Traumatic Chondral-Only Fragments of the Knee in Pediatric and Adolescent Athletes: A Retrospective Multicenter Report

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711775314 ◽  
Author(s):  
Peter D. Fabricant ◽  
Yi-Meng Yen ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
Lyle J. Micheli ◽  
...  
Keyword(s):  
Case Reports ◽  
Femoral Condyle ◽  
Tertiary Care ◽  
Case Series ◽  
Return To Sports ◽  
Adolescent Athletes ◽  
Patient Registries ◽  
Level Of Evidence ◽  
Bioabsorbable Implants ◽  
Clinical And Radiological Results

Background: While traditional biological principles have suggested that fragments consisting of cartilage alone cannot be reaffixed to bone with expectable long-term healing, case reports of successful healing after fixation in younger patients indicate that this concept remains incompletely explored. Purpose: To evaluate the presenting features, techniques, healing rates, and clinical and radiological results in a cohort of pediatric and adolescent athletes who underwent fixation of traumatic chondral-only fragments in the knee. Study Design: Case series; Level of evidence, 4. Methods: Patient registries at 2 tertiary care children’s hospitals were reviewed to identify patients ≤18 years old who underwent fixation of a “chondral-only” fragment in the knee, defined as the inability to visualize the fragment on injury radiographs or discern bone on the articular portion of a fragment intraoperatively. The mechanism of injury, fragment features, fixation technique, and postoperative clinical course, including timing of sports clearance, healing on postoperative magnetic resonance imaging (MRI), and any complications or reoperations, were assessed. Results: Fifteen patients with a median age at surgery of 12.7 years (interquartile range [IQR], 11.7-14.2 years) and median follow-up of 12.0 months (IQR, 6.0-19.2 months) were analyzed. All patients sustained an acute knee injury before surgery. The injured sites, as assessed on MRI, were the patella (n = 6), trochlea (n = 5), and lateral femoral condyle (n = 4). The median fragment surface area was 492.0 mm2 (IQR, 400.0-787.5 mm2). Fixation with bioabsorbable implants was performed in all patients at a median of 1.6 weeks (IQR, 1.0-2.6 weeks) after the injury. One patient (7%) sustained a fall 8 weeks postoperatively, requiring secondary surgery for excision of a dislodged fragment, and 1 patient (7%) underwent unrelated patellar stabilization surgery 3.4 years postoperatively, at which time the fragment was found to be stable. MRI was performed in 9 of 14 patients with retained fragments (median, 12.0 months postoperatively), with 5 patients (56%) showing restoration of the cartilage contour and the resolution of subchondral edema; 2 patients showed thinning but intact cartilage, 1 had cartilage thickening, and 1 had subchondral edema, fissuring, and cystic changes. The median time to return to sports for all 15 patients was 26.0 weeks (IQR, 22.8-40.9 weeks), including 2 patients who required second surgery and returned to sports at 26.1 and 191.1 weeks. Conclusion: Fixation of traumatic chondral-only fragments using bioabsorbable implants may result in successful short-term healing in the majority of pediatric and adolescent athletes.

Peroneal Tendon Subluxation in Athletes: Fibular Groove Deepening and Retinacular Reconstruction

2005 ◽  
Vol 26 (6) ◽  
pp. 436-441 ◽  
Author(s):  
David Porter ◽  
John McCarroll ◽  
Erin Knapp ◽  
Jennifer Torma
Keyword(s):  
Range Of Motion ◽  
Operative Treatment ◽  
Clinical Evidence ◽  
Sports Participation ◽  
Bone Flap ◽  
Return To Sports ◽  
Peroneal Tendon ◽  
Male Athletes ◽  
Instability Range ◽  
Accelerated Rehabilitation

Background: The purpose of this study was to evaluate the results of operative treatment of recurrent peroneal tendon dislocations followed by accelerated rehabilitation incorporating early range of motion and intermittent immobilization. Methods: Four female and nine male athletes with an average age of 24 years had objective clinical evidence of peroneal tendon dislocation (14 ankles). Operative treatment involved removing a bone flap from the distal posterior fibula, deepening the posterior fibular groove, and reattaching the bone flap within the deepened groove. The superior peroneal retinaculum also was reconstructed. Postoperatively, a removable boot was worn for approximately 4 weeks, when it was replaced with a stirrup brace. Results: At an average followup of 35 months, no recurrent subluxation or dislocation of the peroneal tendons had occurred. All patients were able to return to sports by 3 months after surgery. Nine of the 14 ankles regained normal range of motion, and the remaining five were within 5 degrees of the opposite side. Four patients were completely pain free, and nine patients had mild occasional pain that did not limit their activities. Eight patients returned to preinjury sports participation, and five patients elected to participate in sports at a level lower than they had before surgery for reasons not related to their ankle injury. Conclusions: This procedure was reliable for preventing recurrent peroneal tendon instability. Range of motion was nearly normal, immobilization time was minimal, and all patients returned to daily activities and sports within 3 months of surgery.

scholarly journals Arthroscopic Lateral Retinacular Ligament Release in Patellofemoral Pain Syndrome

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0018
Author(s):  
Teoman Başaran ◽  
Ahmet Ozgur Atay ◽  
Mahmut Nedim Doral ◽  
Pınar Özge Başaran
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Bleeding Time ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Lateral Release ◽  
Lateral Retinacular Release ◽  
Anterior Knee ◽  
Surgery Duration

Objectives: Arthroscopic lateral retinacular release in patellofemoral pain syndrome Comparing the amount of hemorrhage and times of release between electrocautery and a new techniques for arthroscopic lateral release with scissors Methods: 77 patients included in this prospective randomized controlled study. Inclusion Criteria: 1. Over the age of fourteen and have anterior knee pain syndrome 2. Tightness in lateral part of knee 3. Despite receiving conservative treatment for 6 months, patients who have anterior knee pain complaints Exclusion Criteria: 1. Diseases that prolong bleeding time 2. Drugs that prolong bleeding time 3. Abnormal APTT-INR levels 4. Patients underwent anterior cruciate reconstruction surgery 5. Patients underwent microfracture surgery 6. Patients underwent meniscus repair surgery 7. Patients underwent synovectomy -- Due to inflammatory diseases and synovial chondromatosis is excluded from the study. In this study 77 (25M 52W med age 50,14 ± 14,17 ) patients divided into three groups which was similar in age and sex. All patients underwent standard arthroscopic surgery for patellofemoral knee sydrome and meniscal debridement 1. Group 1 (Control) (n:10) LRL was preserved 2. Group 2 (Scissors) (n:33) LRL was released with Scissors 3. Group 3 (Electrocautery) (n:34) LRL was released with Electrocautery Results: There was no difference between the groups in terms of socio-demographic characteristics. All lateral ligaments releases were performed under tourniquet . The release is not considered to be complete unless the patella can be stood on its medial edge without difficulty . In all patients, surgery duration was recorded. To calculate the amount of bleeding the blood in the drainage tube was recorded for 24 hours after surgery. For 67 patients based on clinical examination at surgery and in the immediate postoperative period, all releases were felt to be adequate. For all groups total bleeding at 24 h postoperatively is the statistically same (p:0.850) . In first 8 hours the amount of bleeding is more in scissors group (p:0.002). Lateral release time is longer in electrocautery group (380 seconds) than in scissors group (24 seconds). In release with electrocautery sometimes we used additional techniques scissors and scalpel for enough release. There was no difference between groups in terms of complications such as deep vein thrombosis , hemarthrosis or severe complications. Conclusion: In this study the amount of bleeding was the same in the groups but surgery duration was longer in electrocautery group. Our new technique for intraarticular arthroscopy guided lateral retinacular release uses with scissors which is simple, effective, rapid, and have resulted a few surgical complications such as superficial skin infection which responds oral antibiotics. Electrocautery is difficult and needs experience.

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