Background: Anterior cruciate ligament (ACL) tears are common among high school athletes, with sex-based differences accounting for higher injury rates in girls. Previous epidemiological studies on ACL injuries focusing on adolescent athletes have looked at injuries across multiple sports, but few have analyzed ACL tears in solely high school soccer athletes. Purpose: To examine sex-based differences in the epidemiology of ACL injuries among high school soccer players in the United States (US). Study Design: Descriptive epidemiological study. Methods: ACL injury data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance Study’s High School RIO (Reporting Information Online) system. Athletic trainers from a random sample of 100 high schools from 8 strata based on US Census geographic region reported data for athlete-exposures (AEs) (practice or competition) and ACL injuries from 2007 through 2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% CIs. Statistical differences in demographics between groups were examined using independent t tests. Comparisons of categorical data (ie, level of play) were performed using the Wald chi-square test. Results: The reported number of ACL injuries corresponded to weighted national estimates of 41,025 (95% CI, 33,321-48,730) ACL injuries in boys’ soccer and 110,028 (95% CI, 95,349-124,709) in girls’ soccer during the study period. The rate of injuries was higher in girls’ soccer (13.23/100,000 AEs) than boys’ soccer (4.35/100,000 AEs) (RR, 3.04 [95% CI, 2.35-3.98]). The rate of ACL injuries was higher in competition compared with practice for girls (RR, 14.77 [95% CI, 9.85-22.15]) and boys (RR, 8.69 [95% CI, 5.01-15.08]). Overall, a smaller proportion of ACL injuries were caused by player-player contact for girls (30.1%) compared with boys (48.6%) (IPR, 0.62 [95% CI, 0.41-0.93]). Conclusion: ACL injury rates and patterns in high school soccer players differed between sex, type of exposure (practice vs competition), and mechanism of injury.

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Purpose of Review To review the relevant literature and techniques regarding arthroscopic and open treatment of femoroacetabular impingement (FAI). To discuss both the senior authors' preferred method of arthroscopic and open treatment of FAI. Recent Findings Routine treatment of FAI has moved away from open techniques and is more focused arthroscopic methods. Arthroscopic treatment of FAI has more recently focused on differing techniques of hip access and capsular management. Open techniques still have a role in FAI, but indications for open management are focused on cases with more severe pathology.Summary While arthroscopic techniques have shown better outcomes in the short term and higher return to play, it is not without risk and is a procedure with a steep learning curve. In cases of complex joint pathology, such as FAI coupled with dysplasia or Legg-Calve-Perthes, arthroscopy may be not indicated and an open approach preferred. We outline various techniques for both arthroscopic and open treatment of FAI and their outcomes when possible.

Background: The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options. Purpose: To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort. Results: There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears ( P = .001). Higher BMI was associated with “complex” and “radial” tear repairs of the lateral meniscus ( P < .001) but was variable with regard to medial tear repairs. Conclusion: In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.

Introduction:The American Academy of Orthopaedic Surgeons (AAOS) created an evidence-based clinical practice guideline for the care of pediatric diaphyseal femur fractures in 2010. Our institution implemented checklists based off these guidelines embedded in a standardized EMR order. The purpose of this study was to describe compliance with checklist completion and to assess safety improvement in a large urban pediatric hospital.Methods: Retrospective and prospective data were collected from 2 years before and 5 years after checklist implementation. This included the patient safety checklists from August 2011 through August 2016. Patients aged 0 to 18 years with a diaphyseal femur fracture were queried from the EMR and included in this study. Patient charts were reviewed for complications, including nerve injury, pressure sore, leg length discrepancy, loss of reduction, failure of fixation, nonunion, delayed union, and infection. Compliance rates were reported based on the AAOS clinical practice guidelines.Results: A total of 313 patients for the postchecklist period were reviewed in this study. Of 219 patients eligible for inclusion, 198 had checklists completed (group B). This group was compared with 100 patients with diaphyseal femur fractures from the period before implementation of the checklist (group A). We found no statistical difference in the number of patients with complications between groups (12% in both groups, P = 0.988). Postoperative checklists demonstrated that 89.9% of patients (178/198) received ageappropriate treatment consistent with the AAOS guideline recommendations after implementation of the checklist. Before the checklist implementation (group A), 94% (94/100) adhered to the guidelines. Conclusion:This study reveals high compliance rates with the AAOS evidence-based clinical practice guideline for the management of

Background: Management of discoid meniscus in pediatric patients requires understanding of the presentation, associated risks, and appropriate techniques. Surgical treatment consists of saucerization, meniscus repair, meniscocapular stabilization, and, periodically, subtotal meniscectomy. The type of meniscal treatment is commonly determined during arthroscopy. Thus, surgeons, patients, and their parents/guardians must be prepared for a variety of surgical options. Hypothesis/Purpose: To compare intraoperative arthroscopic findings and treatment of discoid meniscus across pediatric age groups in a large multicenter quality improvement registry. Methods: A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of discoid meniscus surgery was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases from 2018-2020 were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Patients were grouped into five groups based on age at time of surgery (<7, 7-10, 11-13, 14-16, >16). Demographic characteristics, discoid type, presence and type of tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons. Results: 274 patients were identified (mean age 12.4 years, range 3-18; 47.3% females). Complete discoid meniscus and peripheral rim instability were found to be more prevalent in younger age groups (Table 1). Peripheral rim instability was noted in 55.5% of cases, most commonly in the posterior horn (24.8%). While a focal region of instability was most common, the youngest age group was more likely to have either multifocal instability or no instability. Repair was conducted more commonly in the younger cohorts, with a significant decrease in repair percentage (p=0.008) per age group. All-inside was the most common repair technique in all age groups. Partial meniscectomy/debridement beyond saucerization occurred more frequently in older age groups than younger age groups (p=.0002), including 38.4% of cases in the oldest age group (Table 2). Conclusion: Younger patients experienced a greater incidence of complete discoid menisci and meniscus repair in this age group and was more likely to have more than one area of rim instability. However, when meniscal resection beyond a saucerization was required, this was more likely to occur in older patients. [Table: see text][Table: see text]

BACKGROUND Return-to-Sport (RTS) after knee surgery involves the return of strength and dynamic knee stability, which can be assessed with isometric strength and functional performance testing. There is little evidence-based data to assist with RTS decision-making after meniscus repair. Furthermore, there is limited RTS data comparing patients with discoid meniscus tears and instability from those with non-discoid tears. The purpose of this study was to compare the performance on functional RTS tests between pediatric patients with discoid and non-discoid meniscus tears. METHODS A retrospective review was performed of pediatric patients that underwent isolated meniscus repair by a single pediatric orthopaedic surgeon from 2010-2016. Thirty patients (14 discoid, 16 non-discoid) were identified who underwent a postoperative RTS assessment consisting of isometric strength testing, the Lower Quarter Y-balance Test (YBT-LQ), and single-leg hop testing (single hop for distance, triple hop for distance, crossover triple hop for distance, and timed hop). Demographic information and RTS data were compared between groups. Recovery of muscle strength was defined by a limb symmetry index (LSI) =90%. Statistical significance was set at P = 0.05. RESULTS The mean age of the patients was 13.95 years (range, 8-19 years). Patients in the discoid group were younger than those with non-discoid meniscus tears (12.9 vs 15.1 years, respectively) (P =0.05). There was a statistically significant difference in the average time from surgery to RTS test between the discoid (269 days) and non-discoid (184 days) groups. (P =0.02). For isometric strength testing, both groups had mean LSIs greater than 90% for quadriceps, hamstring, and hip abduction. There were no statistically significant differences between groups in isometric strength or performance on the YBT-LQ or any of the single-leg hop tests. CONCLUSIONS Pediatric patients who undergo repair of a discoid meniscus may require prolonged rehabilitation to achieve satisfactory completion of RTS testing. In our study, an additional 3 months on average were required to allow adequate recovery of muscle strength and dynamic functional stability when compared to those with a non-discoid meniscal repair. However, upon completion of a structured physical therapy program with stringent RTS guidelines, at the time of testing, there was no significant difference in performance on any of the RTS tests between patients with discoid and non-discoid meniscus tears. The findings of this study can assist orthopedic surgeons in safely returning pediatric patients back to sporting activities following meniscus repair.

BACKGROUND Anterior cruciate ligament (ACL) injuries are common among adolescent athletes, with soccer being the sport most frequently implicated in girls’ ACL injuries. The current literature on ACL injuries, while extensive, lacks a comprehensive study of ACL injuries in United States (US) high school soccer players. The objective of this study was to describe the epidemiology of ACL injuries among US high school soccer players. METHODS ACL injury and athlete exposure (AE) data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance System, High School RIO (Reporting Information Online) dataset collected from school years 2007-2008 through 2016-2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% Confidence Intervals (CIs). Subgroup differences were examined with independent t-tests. Comparisons of categorical data (i.e., mechanism of injury) were performed using Pearson’s?2 tests. RESULTS The number of ACL injuries reported to High School RIO corresponded to weighted national estimates of 41,205 (95% CI = 33,321 – 48,730) ACL injuries in boys’ soccer and 110,029 (95% CI = 95,349 – 124,709) in girls’ soccer during the study period. ACL injury rates were significantly higher in girls’ soccer (13.23 per 100,000 AEs) than boys’ soccer (4.35 per 100,000 AEs) (RR = 3.04, 95% CI = 2.35 – 3.98) and were significantly higher in competition compared to practice for both girls (RR = 14.77, 95% CI = 9.85 – 22.15) and boys (RR = 8.69, 95% CI = 5.01 – 15.08). A greater proportion of ACL injuries were due to player-player contact in boys (48.6%) compared to girls (30.1%) (IPR = 1.62, 95% CI = 1.08 – 2.42). There was no statistical difference in the proportion of ACL injuries managed surgically in boys and girls (84% vs. 78%, respectively). CONCLUSIONS There are sex-based differences in mechanism of injury and ACL injury rate in high school soccer players. In addition, boys and girls showed higher rates of injury during competition. This study suggests several areas for targeted evidence-based ACL injury prevention strategies in US high school soccer players.