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Purpose of review Osgood–Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children and adolescents resulting from a traction apophysitis of the tibial tubercle. While a peak in boys aged 12–15 years old was well documented, there seems to be no difference in sex distribution nowadays. This may result from increased participation of young females in high-impact sports. This review provides an up-to-date account on contemporary prophylaxis as well as diagnostic and therapeutic approaches. Recent findings Numerous studies have examined risk factors for OSD. These include body weight, muscle tightness, muscle weakness during knee extension and flexibility of hamstring muscles. In particular, shortening of the rectus femoris may substantially alter biomechanical functions of the knee. Conservative management remains successful in over 90% of patients. However, if disabling symptoms and pain persistent after physeal closure, operative treatment may be necessary. Summary OSD is a mostly self-limiting apophysitis of the tibial tubercle and the adjacent patella tendon in young active patients with open physis. Prevention strategies include quadriceps and hamstring stretching and therefore should be implemented in everyday practice routines for children who partake in regular sports activities.

Physicians should be alerted to the possibility of phosphate toxicity in children and adolescents treated with laxatives.

Abstract:We introduce an anatomic reconstruction technique for the medial patellofemoral ligament using a free hamstring autograft in skeletally immature patients. We dock the 2 ends of the graft in the superior-medial patella using sockets and secure the femoral graft attachment in a socket tunnel distal to the physis. This technique minimizes the risk of injury to the growth plate and still enables accurate and successful anatomic positioning of the hamstring autograft.

Today, the preferred treatment of displaced supracondylar humerus fractures in children is immediate closed reduction and percutaneous fixation with two or three lateral pins. In case of instability of the medial column, a medial pin may be used, but possibility of iatrogenic ulnar nerve injury should be considered.

Background and objectivesThe significance of intravenous over oral acetaminophen (APAP) as part of multimodal analgesic protocols is contested, particularly when considering its relatively high price and use in a surgical cohort such as total hip or knee arthroplasty (THA/TKA), which generally tolerates oral medications. This study aims to elucidate APAP’s effectiveness in a large, population-based patient sample.Methods1 039 647 THA/TKA procedures were sampled from the Premier Healthcare claims database 2011–2016. APAP use was categorized by intravenous/oral and use on the day of surgery, postoperative day 1 and thereafter. Outcomes were opioid utilization (in oral morphine equivalents), length and cost of hospitalization, and opioid-related adverse effects (respiratory, gastrointestinal, and naloxone use as a proxy). Mixed-effects models measured the associations between intravenous/oral APAP use and outcomes. Percent (%) change and 95% CIs are reported.ResultsOverall, 23.6% (n=245 454) of patients received intravenous APAP; of these, 56.3% (n=138 180) received just one dose on the day of surgery. After adjustment for relevant covariates, particularly use of >1 dose of intravenous APAP (compared with no use) on postoperative day 1 was associated with −6.0% (CI −7.2% to −4.7%) reduced opioid utilization; this was −10.7% (CI −11.4% to -9.9%) for use of > 1 dose oral APAP on postoperative day 1. Further comparisons regarding other outcomes also favored oral (over intravenous) APAP.ConclusionsThese results do not support the routine use of intravenous APAP in patients undergoing lower joint arthroplasty, especially since oral APAP shows more beneficial outcome patterns.

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Early specialization and increased demand for peak performance at a time of major physiological change, lack of physical fitness and neuromuscular deficits have contributed to an increase in ACL injuries in young athletes. Various preventive training programmes have been developed, but their effectiveness is debatable. We encourage young athletes to partake in preseason training programmes focused on strengthening, neuromuscular and proprioceptive training units under the appropriate supervision of qualified personnel.