Background:The number of ulnar collateral ligament (UCL) reconstructions in adolescent athletes has increased over the past 2 decades. Clinical results in this population have not been well studied.Purpose/Hypothesis:The purpose of this study was to evaluate the outcomes and return to sport after UCL reconstruction in a large group of adolescent baseball players. We hypothesized that excellent clinical outcomes and high rates of return to sport would be observed in this population at a minimum 2-year follow-up.Study Design:Case series; Level of evidence, 4.Methods:We reviewed 140 adolescent (aged ≤19 years) baseball players who underwent UCL reconstruction with the American Sports Medicine Institute (ASMI) technique by a single surgeon. Medical records were reviewed for patient demographics, injury characteristics, operative details, and surgical complications. Patient-reported outcomes were assessed using the Conway scale, the Andrews-Timmerman (A-T) score, the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, and a 0- to 100-point subjective scale for elbow function and satisfaction. Return to sporting activity was assessed using a custom-designed questionnaire.Results:The mean age at the time of surgery was 18.0 years (range, 13-19 years), and the mean follow-up was 57.9 months (range, 32.4-115.4 months). Over half (60%) of patients were high school athletes. The mean duration of symptoms before surgery was 6.9 months (range, 0.5-60.0 months). Partial tears were identified in 57.9% of patients, and 41.3% of patients had preoperative ulnar nerve symptoms. Graft type included the ipsilateral palmaris in 77.1% of patients. Concomitant procedures were performed in 25% of patients. Outcomes on the Conway scale were “excellent” in 86.4% of patients. The mean A-T and KJOC scores were 97.3 ± 6.1 and 85.2 ± 14.6, respectively. Mean patient satisfaction was 94.4. Overall, 97.8% of patients reported returning to sport at a mean of 11.6 months (range, 5-24 months), and 89.9% of patients returned to sport at the same level of competition or higher. A total of 11.6% of patients went on to play professional baseball.Conclusion:UCL reconstruction with the ASMI technique is an effective surgical option in adolescents, with excellent outcome scores. At a minimum of 2-year follow-up, nearly 90% of patients returned to their preinjury level of sport.

Background:The number of adolescent anterior cruciate ligament (ACL) injuries is rising with increased participation in higher level athletics at earlier ages. With an increasing number of primary ACL reconstructions (ACLRs) comes a rise in the incidence of revision ACLRs.Purpose:To evaluate the clinical results of revision ACLR across a group of high-level adolescent athletes with at least 2-year follow-up.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review of 21 adolescent athletes (age range, 10-19 years) who underwent revision ACLR with at least 2-year follow-up was conducted. Patient-reported outcome measures (PROMs) included the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, Tegner activity level scale, and modified Cincinnati Knee Rating System. Return to sport (RTS) and overall patient satisfaction were also assessed.Results:The mean age at the time of surgery was 16.5 years (range, 14-19 years), and the mean follow-up was 46.4 months (range, 24-97 months); 42.9% of patients were female, and 52.4% of patients participated in collision sports. The mean time to failure after primary ACLR was 13.1 ± 8.0 months, and the most common mechanism of failure was noncontact in at least 66.7% of cases. The revision graft type included bone–patellar tendon–bone (BPTB) in 71.4% of cases; 26.7% of BPTB grafts were from the contralateral extremity. Concomitant procedures were performed for intra-articular lesions in 71.4% of patients. The mean patient satisfaction rate was 95.3%. There were 3 cases of a graft reinjury at a mean of 25 months postoperatively. The mean PROM scores were as follows: IKDC, 87.5 ± 12.7; Tegner, 7.2 ± 2.0; Lysholm, 93.7 ± 9.8; and Cincinnati, 93.4 ± 10.0. Of those attempting to RTS, 68.4% of patients successfully returned at the same level of competition. Patients with a lateral compartment chondral injury were less likely to RTS (P < .05). Independent variables shown to have no significant relationship to PROMs or RTS included age, follow-up, sport classification, associated meniscal tears, revision graft size/type, and concomitant procedures.Conclusion:Revision ACLR can be an effective surgical option in adolescents participating in collision and contact sports, with good to excellent subjective outcome scores. At a minimum 2-year follow-up, a graft rupture after revision ACLR occurred in 14% of cases. Of the athletes attempting to RTS, 68.4% returned to their preinjury level of competition.

Background: This study is the first to test Friberg’s equation’s (Vt =V 0[e (−ßt)]) accuracy in predicting the residual angular deformity in pediatric distal forearm fractures. Methods: Angular deformities from distal forearm fractures in 50 children (mean age, 9 y) were retrospectively measured on follow-up radiographs once healed and compared to extrapolated angles at respective follow-up intervals from 2013 to 2015. Results: The predicted and actual angulations from 120 radiographs (mean follow-up, 3mo) showed that the mean predicted angle was similar to the measured angle in the radioulnar plane and only 2 degrees greater than the measured angle in the dorsovolar plane. A strong correlation was observed between predicted and measured angles in both planes. Conclusions: Friberg’s equation is a valid tool for predicting remodeling potential in pediatric distal 25% forearm fractures. Level of Evidence: Prognostic Study—Level II.

Anterior shoulder instability is a common pathology, particularly among active adolescents. In recent decades, our understanding of anterior shoulder instability and its management has evolved, with more emphasis on osseous abnormalities of the glenoid and humeral head, multidirectional instability, and patient factors that increase the risk of recurrence 1 . Although the arthroscopic Bankart repair is often considered the first-line treatment for anterior shoulder instability, concerns regarding high failure rates exist, specifically in younger patients and/or those with >15% glenoid bone loss 1 . The Latarjet procedure, which functions to improve stability by increasing the glenoid width and by using the sling effect, is often considered an effective treatment option in these cases 2 . As a result of the complexity of many of the factors that contribute to anterior shoulder instability, optimal surgical management remains controversial.We commend Waltenspül et al. for their long-term retrospective analysis of adolescents who underwent an arthroscopic Bankart repair or an open Latarjet procedure for the treatment of recurrent anterior shoulder instability. In their study, with failure defined as redislocation or persistent anterior apprehension, the authors reported failure rates of 57% for arthroscopic Bankart repair and 6% for open Latarjet procedures. This led the authors to conclude that surgeons should consider the open Latarjet procedure for primary treatment of recurrent anterior shoulder instability in adolescents. These results are in contradiction to most other studies on arthroscopic Bankart repair. Although the high failure rate is concerning, it is important to recognize the methodological limitations of the study, as it was not appropriately designed to compare the 2 treatments. Preoperatively there were significant differences in group characteristics, and there was limited discussion of indications for Bankart repair, raising major concerns for selection bias. Additionally, there are concerns about the technical aspects of the arthroscopic repairs and the experience of the surgeons performing them. Included Bankart repairs utilized a mean of 3 anchors, but as few as only 1 anchor. The number of anchors, in conjunction with the utilization of anchors of an outdated design, may indicate inadequate fixation and the use of improper surgical technique 3 . Finally, the study included 81 total cases compiled from 12 surgeons over a 10-year period, raising substantial concerns with regard to surgeon volume and its relationship to the reported outcomes.Although we undoubtedly agree that, in specific circumstances, the Latarjet procedure is a superior option to the arthroscopic Bankart repair, it must be recognized that proceeding with a nonanatomic procedure is a nuanced decision that is not without risk 2 . This choice is complicated further in the adolescent population given their potential need for a future surgical procedure on a nonnative shoulder, the inherently smaller size of the coracoid in a gro...

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