Discoid meniscus is the most frequent congenital malformation of the menisci, and primarily affects the lateral meniscus; it is highly prevalent in the Asian population. The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears. Discoid meniscus anomalies are described according to their shape; however, there is consensus that peripheral stability of the meniscus should also be defined. Initial workup includes plain X-rays and magnetic resonance imaging, while arthroscopic evaluation confirms shape and stability of the meniscus. Clinical presentation is highly variable, depending on shape, associated hypermobility, and concomitant meniscal tears. Treatment seeks to re-establish typical anatomy using saucerization, tear reparation, and stable fixation of the meniscus. Cite this article: EFORT Open Rev 2020;5:371-379. DOI: 10.1302/2058-5241.5.190023

Purpose of review To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications. Recent findings Although TTAFs amount to fewer than 1% of all physeal injuries in children, the incidence is increasing, likely because of greater participation in high-level athletics. Summary TTAFs tend to occur in adolescents nearing skeletal maturity who engage in sports with repetitive jumping. The most popular classification system was proposed by Ogden, which defines five fracture types based on the fracture pattern and extent of fragment displacement. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Arthroscopic approaches can reveal associated soft tissue injuries, such as meniscal tears, and confirm articular reduction. The most common postoperative complication is irritation because of hardware. With proper treatment, both nonsurgical and surgical outcomes are excellent. TTAFs have high rates of union and patients typically return to sports.

Observational Study, Level IV.

Fractures of the anterior tibial tuberosity during childhood are an infrequent pathology (around 3% of all proximal tibial fractures), but the incidence of this injury has risen over recent years, likely due to the increased involvement of this age group in sports activities. This fracture is more commonly seen in children 12–14 years old. It is vital to identify the anatomical structures associated with this type of fracture, along with the pathophysiological mechanisms involved. Treatment includes non-operative and operative options, with the goal of achieving articular congruency, restoring the extensor mechanism function, and avoiding damage to the proximal tibial physis. Understanding the management of this fracture, and the complications that might arise, is critical. The provision of an appropriate clinical management plan and the avoidance of complications are vital in the prevention of disability. Cite this article: EFORT Open Rev 2020;5:260-267. DOI: 10.1302/2058-5241.5.190026

Level III-case-control study.

Physicians should be aware of the nonmodifiable risk factors for ACL tears in active children and adolescents and should also encourage avoidance of modifiable risk factors in this population. Young athletes with nonmodifiable risk factors are at a particularly increased risk of recurrent injury following ACL reconstruction (ACLR). We believe that a primary extra-articular augmentation via iliotibial band tenodesis at the same time of ACLR may decrease the rate of reinjury for the high risk athlete with multiple nonmodifiable risk factors.

Diagnostic Study, Level II.

Meniscal allograft transplantation is indicated following symptomatic meniscal loss in young, active patients to relieve pain and improve knee function. The quality of the available evidence regarding meniscal transplantation is limited, and no published series to date has focused exclusively on a pediatric population. Further high-quality studies are needed to establish improved indications, timing, and outcomes in a pediatric population.