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Background: Prior research has shown decreased accuracy of meniscal injury detection using magnetic resonance imaging (MRI) for anterior cruciate ligament (ACL)-deficient adult patients as well as ACL-deficient pediatric and adolescent patients. The objectives of this study were the following: (1) assess the diagnostic ability of MRI in detecting meniscal injuries for pediatric and adolescent patients undergoing arthroscopic ACL reconstruction and (2) characterize the unrecognized meniscal injuries., Methods: The sensitivity, specificity, positive predictive value, and negative predictive value of meniscal tears (medial, lateral, or both) on MRI were calculated for the 107 patients in this cohort. Fisher exact tests were used to compare event frequencies between medial meniscal (MM) and lateral meniscal (LM) tears. One-way analysis of variance tests were performed to compare event rates between the location and type of unrecognized meniscal tears., Results: The median age of the cohort was 15 (range: 7 to 18). The sensitivity, specificity, positive predictive value, and negative predictive value of MRI in detecting meniscal tears (medial, lateral, or both) in ACL-deficient pediatric and adolescent patients was 62.3%, 68.4%, 78.2%, and 50.0%, respectively. There were 26 (24.3%) cases in which a meniscal injury was not detected on MRI, but was discovered arthroscopically (MM: 5 knees, LM: 20 knees, both: 1 knee). These unrecognized meniscal injuries were more commonly the LM than the MM (77.8%, P-value=0.100), a vertical/longitudinal tear type (77.8%, P-value <0.001), and located in the posterior horn (74.1%, P-value <0.001)., Conclusions: In this ACL-deficient pediatric and adolescent cohort, there were 26 (24.3%) patients with unrecognized meniscal injuries. A vertical tear in the posterior horn was the most commonly unrecognized meniscal injury, supporting the findings of prior research postulating that the location and configuration of a tear influence the accuracy of MRI in detecting these injuries. More research is needed to investigate strategies to improve the detection of meniscal tears in pediatric and adolescent patients preoperatively. These findings have implications with regard to patient counseling, operative planning, anticipatory guidance with regard to postoperative rehabilitation, recovery expectations, and surgical outcomes., Level of Evidence: Level IV.

Background: The tibial tubercle to trochlear groove (TT-TG) distance is often utilized for determining the surgical treatment for patients with patellar instability (PI). It is thought to directly represent the position of the TT on the tibia. Recent work has shown that the measurement of the TT-TG distance is multifactorial. Purpose: To investigate the relationship between relative tibial external rotation (rTER) and trochlear dysplasia (TD), as well as the location of the TG and TT in patients with and without PI, and to correlate these and other anatomic measurements with the TT-TG distance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 89 patients with PI who underwent magnetic resonance imaging were identified with 92 matched control patients. A standardized measurement protocol on axial magnetic resonance imaging determined rTER, the proximal and distal TG lateralization (pTGL and dTGL, respectively) ratios, and the TT lateralization (TTL) ratio. Other measures of interest included the lateral trochlear inclination angle, sulcus angle, and lateral patellar inclination angle. Univariate regression was used to determine the associations of TD (lateral trochlear inclination angle, sulcus angle) with rTER and the TG position, and multivariate regression was used to model associations among all the variables with the proximal and distal TT-TG distances. Results: rTER was significantly higher in the study group (P <.001), and univariate regression showed a significant association between dysplasia measures and rTER (P <.001). The pTGL ratio was lower in the study group (P =.025), but there was no difference in the dTGL ratio (P =.090) or the TTL ratio (P =.098) between the groups. There were no associations between dysplasia measures and the pTGL and dTGL ratios (P >.05). Multivariate regression showed that the proximal TT-TG distance is predicted by the sulcus angle, pTGL ratio, rTER, and TTL ratio (P <.05) and that the distal TT-TG distance is predicted by the lateral patellar inclination angle, dTGL ratio, sulcus angle, rTER, and TTL ratio (P <.05). Conclusion: rTER had a significant association with TD. The position of the proximal TG was more medial in patients with PI. There was no significant difference in the TTL ratio between patients with and without PI. The TT-TG distance was associated with multiple anatomic measures and was not solely predicated on the position of the TT. [ABSTRACT FROM AUTHOR]

Case: Knee flexion contractures are difficult to treat effectively. We present the case of a ten-year-old boy with a flexion contracture due to a hypertrophied ligamentum mucosum treated with an arthroscopic posterior capsular release. The patient obtained full extension and maintained it at the time of final follow-up. Conclusion: This case represents a unique cause of an impinging ligamentum mucosum and provides anecdotal support to the concept of an arthroscopic posterior capsular release as a safe and effective option for flexion contractures. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of published literature on diagnosis and surgical management of muscle herniation of the extremities,with most reported cases involving military personnel and men aged 18 to 40 years.Hypothesis/Purpose: The purpose of this study is to describe the presentation, diagnosis, and results of fasciotomy for symptomaticmuscle herniation in young athletes. We hypothesize that fasciotomy can be a safe and effective treatment option thatallows the majority of athletes to return to sports.Study Design: Case series; Level of evidence, 4.Methods: From 2001 to 2011, 26 athletes (19 women; 11 runners) with a mean age 19.0 ± 4.0 years (range, 14.2-28.4 years)underwent fasciotomy for symptomatic muscle herniation at the authors’ institution. Retrospective chart review recorded pertinentpatient data and clinical course. Questionnaires were sent to all patients to assess satisfaction with surgery, ability to returnto sports, and residual symptoms.Results: Muscle hernias were classified as primary (n = 8, 31%), postsurgical (n = 8, 31%), and associated with underlyinguntreated chronic exertional compartment syndrome (n = 10, 38%). The tibialis anterior muscle (n = 12, 46%) was most commonlyinvolved. The mean time from onset of symptoms to surgery was 15.1 6 8.6 months (range, 3-38 months). Dynamic ultrasound(5/6 patients, 83%) was more accurate than magnetic resonance imaging (3/18, 17%) at identifying the hernia. At median followupof 28 months (range, 12-127 months), 17 patients (65%) had returned to sports. Seventeen patients (65%) completed the postoperativequestionnaire; 14 reported being satisfied with their results (82%). Mild residual symptoms were common (9 of 17respondents, 53%), especially in runners (5 of 7, 71%), all of whom were satisfied with surgery. Patients with a postsurgical muscleherniation took the longest to return to sports and were the least likely to return to sports, had the highest rate of dissatisfactionwith surgery, and were most likely to have persistent symptoms not improved by surgery.Conclusion: Fasciotomy is a safe surgical option for symptomatic muscle herniation in young athletes. Many patients are able toreturn to sports and most are satisfied with surgery. Residual symptoms are common, especially in runners. Patients with postsurgicalmuscle herniations may have the worst clinical outcome. [ABSTRACT FROM AUTHOR]