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For the athlete with a newly diagnosed osteochondritis dissecans of the knee, the first step in formulating a treatment plan is determining the stability of the lesion. When the lesion is found to be unstable but salvageable, several methods for fixation are available. Fixation of osteochondritis dissecans in the athletic population has been described and each has its own advantages and disadvantages. Determining the most appropriate method for fixation depends on several variables and should include the athlete's level of play, sport, and overall goals.

The importance and benefits of exercise are well documented. With childhood obesity rates rising in most developed countries, encouraging outdoor play and sports participation may be one of several solutions for this problem. However, with the increased youth sport participation seen over the past 10 years, there has also been a need to monitor the risks of participation within this unique population. Unfortunately, only a few well-designed epidemiologic surveillance studies have been conducted thus far. The pediatric and adolescent population is unique in that their skeletal system is still maturing, and thus, they may be susceptible to unique injury patterns and injury frequency. The frequency and severity of sports injuries can differ based on the type of exposure (competition vs practice), sport, gender, and age. Recording these variables is important to accurately determine risk and obtain reliable epidemiologic data. To do this, standard definitions for injury and exposure should be established and widely accepted. Standardization of injury reporting will allow comparison of results across studies so the associated factors can be more thoroughly explored. The purpose of this article is to review the types and patterns of knee and anterior cruciate ligament (ACL) injuries for youth sports based upon recent research. Much of this review is based upon the extensive research of Comstock et al using data compiled from the National High School Sports-Related Injury Surveillance Study. 1 This article will focus on the

For the athlete with a newly diagnosed osteochondritis dissecans of the knee, the first step in formulating a treatment plan is determining the stability of the lesion. When the lesion is found to be unstable but salvageable, several methods for fixation are available. Fixation of osteochondritis dissecans in the athletic population has been described and each has its own advantages and disadvantages. Determining the most appropriate method for fixation depends on several variables and should include the athlete's level of play, sport, and overall goals.

Patellar instability is a common problem in the pediatric population and has an estimated annual incidence of forty-three in 100,0001. More recently, the rate of recurrent patellar instability in the pediatric population has been reported to be as high as 70%2. It is well known that the medial patellofemoral ligament (MPFL) is an important stabilizer of the patella and supplies between 50% and 60% of the restraining force to lateral patellar translation3-5. Localizing and recreating the anatomic femoral insertion of the MPFL is important for surgical treatment since malpositioned grafts can lead to patellofemoral overload or recurrent instability6. Locating the anatomic femoral position of the MPFL in adults has been simplified by utilizing radiographic osseous landmarks with intraoperative fluoroscopy7. In children, the exact location of the MPFL relative to the distal femoral physis remains controversial. Utilizing the principles of the perfect lateral radiograph described in a study by Schottle et al. in 20077, Shea et al.8 have suggested that the midsubstance of the MPFL origin lies just proximal to the distal femoral physis. However, a radiographic-based study by Nelitz et al.9 and a study by Ladd et al.10 based on magnetic resonance imaging (MRI) both concluded that the MPFL femoral insertion is located distal to the physis. Furthermore, an MRI study by Kepler et al.11 identified the MPFL insertion to be variable, with 86% attaching distal to the physis, 7% attaching on the physis, and 7% attaching proximal to the physis. These discordant results make it difficult to decide where the most appropriate “anatomic” location truly lies. This translates into some surgeons recommending femoral graft placement proximal to the physis, while other surgeons recommend placement distal to the physis. This becomes more …