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Fresh-frozen porcine knees were used to demonstrate the effects of diverging Kurosaka screw placement on linear load to failure in simulated anterior cruciate ligament reconstructions. Screws, placed anteromedially (rear-entry or tibial type) or intraarticularly (endoscopic femoral type) into each tibia, were directed at 0 degree, 15 degrees, or 30 degrees divergence angles relative to a guide wire. Grafts were axially loaded to failure to determine holding strength. Hierarchical analysis of variance was used to analyze differences between tibial side and endoscopic femoral type screw placement and the angles of divergence. Overall, the difference in pullout strength between rear-entry (or tibial side) and endoscopic femoral type fixation was shown to be statistically significant (P < 0.001). Anteromedially placed screws showed a statistically significant decrease in holding strength at 15 degrees and 30 degrees compared with 0 degree of divergence (P < 0.05). Intraarticular screw placement resulted in a statistically significant decrease in holding strength only at 30 degrees of divergence (P < 0.05). This study supports the importance of accurate screw placement within the tibia to ensure optimal interference fixation and suggests that endoscopic screw placement may offer significant added security when there are minor degrees of divergence.

We have established the kinematic and kinetic parameters of the adolescent baseball pitch. These measured parameters and the differences between adolescent pitchers and their adult counterparts can be used to examine and help determine the causes of the rapid increase in adolescent pitching injuries.

Purpose Equinus is the most common deformity in cerebral palsy (CP) and gastrocsoleus lengthening (GSL) is the most commonly performed surgery to improve gait and function in ambulatory children with CP. Substantial variation exists in the indications for GSL and surgical technique. The purpose of this study was to review surgical anatomy and biomechanics of the gastrocsoleus and to utilize expert orthopaedic opinion through a Delphi technique to establish consensus for surgical indications for GSL in ambulatory children with CP. Methods A 17-member panel, of Fellowship-trained paediatric orthopaedic surgeons, each with at least 9 years of clinical post-training experience in the surgical management of children with CP, was established. Consensus for the surgical indications for GSL was achieved through a standardized, iterative Delphi process. Results Consensus was reached to support conservative Zone 1 surgery in diplegia and Zone 3 surgery (lengthening of the Achilles tendon) was contraindicated. Zone 2 or Zone 3 surgery reached general agreement as a choice in hemiplegia and under-correction was preferred to any degree of overcorrection. Agreement was reached that the optimum age for GSL surgery was 6 years to 10 years and should be avoided in children aged under 4 years. Physical examination measures with the child awake and under anaesthesia were important in decision making. Gait analysis was supported both for decision making and for assessing outcomes, in combination with patient reported outcomes (PROMS). Conclusions The results from this study may encourage informed practice evaluation, reduce practice variability, improve clinical outcomes and point to questions for further research. Level of Evidence V

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