Background Meniscus tear patterns in the pediatric population have not been well described. Hypothesis/Purpose The purpose of this study was to delineate the pattern of meniscus tears and the likelihood of repair at the time of surgery in both children and adolescents. Study Design Case series; Level of evidence, 4. Methods Retrospective review was performed on all patients between the age of 10 and 19 years who underwent arthroscopic surgery for meniscus pathology. Patients were classified into two groups: those with open growth plates were classified as children while those with closed growth plates were classified as adolescents. Demographic data was documented, including: age, sex, BMI, mechanism of injury, and duration from injury to surgery. Operative reports and intraoperative photographs were used to assess tear pattern: type, location, zone, as well as all concomitant procedures and pathology. Tears were classified as discoid, vertical, bucket-handle, radial, oblique, horizontal, fray, root detachment, or complex. ANOVA and chi-squared tests were then performed. Results Of the 293 patients reviewed, 197 (67%) had lateral meniscus tears, 65 (22%) had medial meniscus tears, and 31 (11%) had tears to both menisci. The cohort was separated into groups: 119 (41%) children (open growth plates) and 174 (59%) adolescents (closed growth plates). The mean age between groups was 13.5 years compared to 16.4 years (p < 0.001), respectively. Children were more likely to have discoid meniscus tears, lower BMI, and meniscus pathology not associated with ligamentous injuries (p<0.05). The rate of associated ligament injuries in children was 29% compared to 51% in adolescents. Overall, the most frequent tear pattern was complex (28%) followed by vertical (16%), discoid (14%), bucket-handle (14%), radial (10%), horizontal (8%), oblique (5%), fray (3%), and root detachment (2%). Complex tears were associated with boys (32% vs. 20% girls, p < 0.03) and greater mean BMI (27.4 vs. 25.1 kg/m2, p < 0.002), even when taking sex into account. Surgical repair was performed in 46% of all cases (56% in those treated within 3 months of injury compared to 42% in those treated after 6 months (p<0.03) and there was no difference in repair rate based on patient age (46% vs 48%; p>0.05)). Conclusions Adolescents and children sustain more complex meniscus injuries that are often less repairable than previously reported in the literature. Factors that are associated with greater tear complexity include: male sex and obesity. Our findings also suggest that earlier treatment of meniscus tears may increase the likelihood of repair in younger patients.

Historically, the most common mechanism of total knee arthroplasty (TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. Clinical database and worldwide national registries confirm these reports. With an increasing amount of TKA operations performed in the United States, and with focus on value-based healthcare, it is imperative to understand why total knees fail.

The success rate of meniscal surgery is 87% in children and adolescents. The revision rate was higher when repair was attempted in the index procedure, particularly in those children with open physes and bucket-handle tears. Most failures are the result of an acute reinjury within 1 year, and nearly half will require debridement of the retorn meniscus.

* Adult septic arthritis of the native hip can be difficult to diagnose; often, care is delayed >24 hours, which may result in a failure to preserve the joint.* Treatment options include aspiration, open and arthroscopic irrigation and debridement, and resection arthroplasty with an antibiotic spacer and subsequent total hip arthroplasty.* Risk factors for repeat irrigation and debridement include inflammatory arthritis, diabetes, synovial cell count of >85,000 cells/mL, and Staphylococcus aureus infection.* Ten percent of patients undergoing resection arthroplasty and use of an antibiotic spacer may need an exchange spacer.* Outcomes after use of an antibiotic spacer and staged total hip arthroplasty can be highly successful and rewarding.

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