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The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.

Background Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE. Questions/purposes We therefore determined whether (1) BMI percentile was a risk factor for BL-SCFE; and (2) postoperative increases and/or decreases in BMI percentile influenced the risk for BL-SCFE. Methods We retrospectively reviewed the records of 502 patients surgically treated for SCFE and identified 138 (27%) with BL-SCFE and 364 (73%) with unilateral SCFE (UL-SCFE); 173 patients, 60 (35%) with BL-SCFE and 113 (65%) with UL-SCFE met our inclusion criteria. Risk factors included sex, age, slip stability, slip chronicity, slip angle, and obesity. Percentile BMI was recorded at the time of first SCFE surgery, at the time of last followup for patients undergoing UL-SCFE, and at the time of second SCFE surgery for patients undergoing BL-SCFE. Results Sex, age, slip stability, and slip angle were not associated with BL-SCFE. Postoperative obesity (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.2–9.7) and acute slip chronicity (OR, 2.9; 95% CI, 1.3–6.7) had higher risks for sequential BL-SCFE. Obese patients who became nonobese postoperatively had a decreased risk of sequential BL-SCFE compared with those who remained obese (OR, 0.16; 95% CI, 1.2–116.5). Conclusions Only postoperative obesity and an acute slip were risk factors for sequential BL-SCFE. BMI reduction to lower than the 95% percentile after SCFE surgery was associated with lower risk for BL-SCFE development. The data suggest early supervised therapeutic weight management programs for patients treated for UL-SCFE are important to reduce risk of subsequent SCFE. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Necrotizing soft tissue infections are aggressive manifestations of , often described after minor skin trauma. However, a subset of infections may present without cutaneous findings. We report a case of toxic shock syndrome and recalcitrant streptococcal infection of the forearm in a healthy teenager following blunt trauma.

Child abuse is one of the most common causes for child fatality in the United States. Inaccurate reporting of child abuse combined with scarcity of resources for child abuse evaluations can lead to unintended consequences for children and their families. The differential diagnosis of child abuse is varied. To our knowledge, there are no reports in the literature on Lyme disease mimicking child abuse. The current study presents the case of a child from an endemic area for Lyme disease presenting with skin bruising, fracture, and swollen knee. The child was reported for child abuse by the pediatrician and then referred to the orthopaedic surgeon for fracture care.

Abstract Purpose This study aims to critically analyze the major and minor complications that may be associated with plate fixation of pediatric diaphyseal femur fractures. Methods The medical records of skeletally immature patients (6–15 years of age) who underwent plate fixation of a diaphyseal femur fracture at a tertiary-care level-1 pediatric trauma center between 1/2003 and 12/2010 were reviewed. Demographic and clinical information regarding the mechanism of injury, fracture type, and surgical technique were recorded. Radiographic evaluation of bony healing, hardware position, and deformity was performed throughout the study period. All intraoperative and postoperative complications were recorded. Complication incidence and time from surgery to complication were described. Multivariate logistic regression and multivariate Cox regression models were used to assess the association between different variables and the occurrence of a complication. Kaplan–Meier survivorship curves were used to evaluate the freedom from a complication with longer follow-up. Results Over an 8-year period, 85 skeletally immature patients (83 % males, mean age 10.2 years) underwent plate fixation for diaphyseal femur fractures. Overall, complications were identified in 11 patients (13 %). Major complications, defined as those resulting in unplanned reoperation (excluding elective removal of asymptomatic plate/screws), occurred in five patients (6 %) and included two patients (2 %) with wound infections requiring irrigation and debridement, two patients (2 %) with distal femoral valgus deformity (DFVD) leading to osteotomy and hardware removal, respectively, and one patient (1 %) with a 3-cm leg length discrepancy (LLD) requiring epiphysiodesis. Minor complications, defined as those not requiring unplanned operative intervention, occurred in six patients (7 %) and included two patients (2 %) with delayed union, two patients (2 %) with symptomatic screw prominence, one patient (1 %) with a superficial wound infection effectively treated with oral antibiotics, and one patient (1 %) with valgus malunion, which was asymptomatic at early follow-up. There were no intraoperative complications and no reports of postoperative knee stiffness, shortening, or reoperations to address fracture stability. Fifty-two patients (61 %) underwent routine elective removal of hardware without related complications following fracture union. Overall, complications occurred postoperatively at a mean time of 20 months (range 0–65 months), though major complications occurred at a later time point (mean 29.1 months, range 0–65 months) than minor complications (mean 12.5 months, range 0–40.1 months). Longer follow-up was associated with higher occurrence of a complication [p = 0.0012, odds ratio = 1.05, 95 % confidence interval (CI): 1.02–1.08]. Conclusions The plating of pediatric femur fractures is associated with 6 and 7 % rates of major and minor complications, respectively. There were minimal long-term sequelae associated with the complications noted. This complication rate compares favorably with the published rate of complications (10–62 %) associated with titanium elastic nail fixation of similar fracture types. Most complications occurred >4 months postoperatively, with major complications occurring at a later time point than minor complications. Long-term follow-up of these patients is recommended to ensure that complications do not go undetected. Level of evidence Retrospective case series, Level IV.

Background Injuries of the hip in the adolescent and young adult athlete are receiving more attention with advances in the understanding of femoroacetabular impingement (FAI), labral pathology, and hip arthroscopy. Labral tears have not been well characterized in rowers. Questions/purposes The purposes of this study were (1) to describe the clinical presentation of labral pathology in rowers; (2) to describe the MRI and radiographic findings of labral pathology in rowers; and (3) to determine the likelihood that a rower with labral injury, treated arthroscopically, will return to sport. Methods We conducted a review from August 2003 to August 2010 to identify all rowers with MRI-confirmed intraarticular pathology of the hip presenting to our institution. Baseline demographics, symptoms and physical findings, and location of the labral tear with associated pathology, management, and early followup were recorded. The review yielded a total of 21 hips (18 rowers, three with bilateral labral pathology) with a mean patient age of 18.5 years (range, 14–23 years). Most of the rowers (85%) were female and the series included prep school (44%) and collegiate rowers (56%). Eighteen of the 21 hips (85%) eventually underwent arthroscopic surgery at our institution. Results A large majority of patients had isolated groin pain (71%) and physical findings consistent with impingement (81%). There was no single, dominant location for the labral tears on MRI. Among the 18 patients who had surgery, 10 (56%) returned to rowing, six (33%) never returned, and return data were not available for two (11%) at a mean of 8 months (range, 3–25 months) after surgery. Conclusions The repetitive motions of the hip required for rowing may be a factor leading to intraarticular labral injuries in the athletes. Underlying anatomic abnormalities of the hip such as FAI may predispose certain patients to these injuries. However, many patients treated arthroscopically did not return to sport at a mean of 8 months after surgery. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Objectives:To aid in the interpretation of Pedi-IKDC scores by characterizing normative data in children and adolescents. Also, to validate the Pedi IKDC by examining differences in Pedi IKDC scores between patients with knee ailments compared to patients without a history of knee problems. Methods:Cross sectional survey of 2000 children and adolescents aged 10-18 years living in the United States, recruited by ORC International to obtain equal numbers by sex and by integer age group. In addition to completing the Pedi-IKDC for one study designated “index” knee (right or left), subjects were asked demographic questions and for information on history of knee surgery and recent (four weeks) activity limitations. Raw Pedi-IKDC total scores were re scaled to a 0-100 scale. Non-parametric Wilcoxon or Kruskal-Wallis tests were used to compare subgroup scores and the van Elteren test was used to adjust for age. Unadjusted and adjusted p values were similar and only unadjusted values are reported. Results:Numbers of respondents are uniform with respect to age and sex, with 11% in each age group (10-18) and 50% female. 68% identified themselves as white, and 86% as non-Hispanic. 49 states and DC are represented. 136 (7%) reported prior surgery in one or both knees; 79(4%) in the index knee. The Pedi IKDC score distribution is skewed left with mean score (±SD) of 86.7(±16.8), median 94.6 and 34% reaching the ceiling value of 100. Subjects reporting prior surgery or limited activity in the index knee had median Pedi IKDC scores about 25 points lower than those without these histories (p<0.0001 for both comparisons). In contrast, although statistically significant, the variation by age (p=0.02), race (p=0.02), ethnicity (p=0.01), and level of sports/exercise participation (p=0.04) was much smaller (all ranges of median scores <4.5). There were no significant differences by sex or geographic region. Conclusion:There is only minor variation in Pedi IKDC scores across demographic factors. The strong association between Pedi IKDC score and prior knee surgery and also with recent limitation of activity in the index knee supports the construct validity of the Pedi-IKDC. Using a large, broadly representative sample, this study supports the use of the Pedi-IKDC as a knee specific outcome instrument for pediatric patients aged 10-18 and provides normative values to aid the interpretation of scores in this age range.

Objectives:To aid in the interpretation of Pedi-IKDC scores by characterizing normative data in children and adolescents. Also, to validate the Pedi IKDC by examining differences in Pedi IKDC scores between patients with knee ailments compared to patients without a history of knee problems.Methods:Cross sectional survey of 2000 children and adolescents aged 10-18 years living in the United States, recruited by ORC International to obtain equal numbers by sex and by integer age group. In addition to completing the Pedi-IKDC for one study designated “index” knee (right or left), subjects were asked demographic questions and for information on history of knee surgery and recent (four weeks) activity limitations. Raw Pedi-IKDC total scores were re scaled to a 0-100 scale. Non-parametric Wilcoxon or Kruskal-Wallis tests were used to compare subgroup scores and the van Elteren test was used to adjust for age. Unadjusted and adjusted p values were similar and only unadjusted values are reported.Results:Numbers of respondents are uniform with respect to age and sex, with 11% in each age group (10-18) and 50% female. 68% identified themselves as white, and 86% as non-Hispanic. 49 states and DC are represented. 136 (7%) reported prior surgery in one or both knees; 79(4%) in the index knee. The Pedi IKDC score distribution is skewed left with mean score (±SD) of 86.7(±16.8), median 94.6 and 34% reaching the ceiling value of 100. Subjects reporting prior surgery or limited activity in the index knee had median Pedi IKDC scores about 25 points lower than those without these histories (p<0.0001 for both comparisons). In contrast, although statistically significant, the variation by age (p=0.02), race (p=0.02), ethnicity (p=0.01), and level of sports/exercise participation (p=0.04) was much smaller (all ranges of median scores <4.5). There were no significant differences by sex or geographic region.Conclusion:There is only minor variation in Pedi IKDC scores across demographic factors. The strong association between Pedi IKDC score and prior knee surgery and also with recent limitation of activity in the index knee supports the construct validity of the Pedi-IKDC. Using a large, broadly representative sample, this study supports the use of the Pedi-IKDC as a knee specific outcome instrument for pediatric patients aged 10-18 and provides normative values to aid the interpretation of scores in this age range.

Necrotizing soft tissue infections are aggressive manifestations of Streptococcus pyogenes, often described after minor skin trauma. However, a subset of infections may present without cutaneous findings. We report a case of toxic shock syndrome and recalcitrant streptococcal infection of the forearm in a healthy teenager following blunt trauma.

Background/Objectives: Despite its well-established health benefits, adherence to the Mediterranean lifestyle (MedLife) has declined globally, including in its region of origin, alongside a significant shift toward ultra-processed food consumption. Understanding the factors associated with MedLife adherence is essential for developing targeted interventions and tailored policy recommendations. As part of the MEDIET4ALL PRIMA project, this cross-sectional study aimed to comprehensively examine geo-demographic, socio-economic, psychological, behavioral, and barrier-related factors associated with and potentially contributing to MedLife adherence. Methods: Data were collected from 4010 participants aged 18 years and above across ten Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey, which included the validated MedLife index, along with various other questionnaires. Results: Results indicate that only 22% of respondents demonstrated high adherence to the Mediterranean lifestyle (MedLife), with significant variability observed across countries, age groups, education levels, and health statuses. Spain had the highest proportion of participants with high adherence (38%). Factors associated with significantly higher adherence rates include older age, living in the Mediterranean region, higher education levels, a greater awareness of MedLife principles, lower perceived barriers, normal BMI, better health status, and stable economic and marital conditions (p-values ranging from 0.04 to <0.001). Additionally, individuals with high MedLife adherence exhibited more socially and physically active lifestyles and experienced less psychological strain (p < 0.001). Regression analyses identified MedLife awareness as the strongest positive predictor of adherence (β = 0.206), followed by social participation (β = 0.194) and physical activity (β = 0.096). Additional positive contributors include life satisfaction, sleep quality, living in the Mediterranean region, age, and education (β ranging from 0.049 to 0.093). Conversely, factors that are negatively associated with adherence include sedentary behavior, living environment, and barriers such as low motivation, taste dislike, price unaffordability, limited availability, and the time-consuming nature of preparing Mediterranean food (MedFood; β ranging from −0.036 to −0.067). Conclusions: These findings indicate that fewer than one in four adults across Mediterranean and neighboring countries demonstrate high adherence to MedLife, supporting prior evidence of suboptimal adherence even within Mediterranean regions. This study identified a range of behavioral, socio-demographic, and environmental factors—both positive and negative predictors—that can help guide the design of targeted, culturally adapted interventions to promote MedLife behavior. Future research should incorporate objective measurements and longitudinal monitoring to better understand underlying mechanisms, establish causality, and develop sustainable strategies for enhancing MedLife adherence in diverse populations.