Context:Overuse injuries of the musculoskeletal system in immature athletes are commonly seen in medical practice.Evidence Acquisition:An analysis of published clinical, outcome, and biomechanical studies of adolescent epiphyseal and overuse injuries was performed through 2008 to increase recognition and provide treatment recommendations.Results:Adolescent athletes can sustain physeal and bony stress injuries. Recovery and return to play occur more swiftly if such injuries are diagnosed early and immobilized until the patient is pain-free, typically about 4 weeks for apophyseal and epiphyseal overuse injuries. Certain epiphyseal injuries have prolonged symptoms with delayed treatment, including those involving the bones in the hand, elbow, and foot. If such injuries are missed, prolonged healing and significant restrictions in athletic pursuits may occur.Conclusion:Some of these injuries are common to all weightbearing sports and are therefore widely recognized. Several are common in gymnastics but are rarely seen in other athletes. Early recognition and treatment of these conditions lead to quicker recovery and so may prevent season-ending, even career-ending, events from occurring.

Context:Popliteal synovial cysts, also known as Baker’s cysts, are commonly found in association with intra-articular knee disorders, such as osteoarthritis and meniscus tears. Histologically, the cyst walls resemble synovial tissue with fibrosis evident, and there may be chronic nonspecific inflammation present. Osteocartilaginous loose bodies may also be found within the cyst, even if they are not seen in the knee joint. Baker’s cysts can be a source of posterior knee pain that persists despite surgical treatment of the intra-articular lesion, and they are routinely discovered on magnetic resonance imaging scans of the symptomatic knee. Symptoms related to a popliteal cyst origin are infrequent and may be related to size.Evidence Acquisition:A PubMed search was conducted with keywords related to the history, diagnosis, and treatment of Baker’s cysts—namely, Baker’s cyst, popliteal cyst, diagnosis, treatment, formation of popliteal cyst, surgical indications, and complications. Bibliographies from these references were also reviewed to identify related and pertinent literature.Study Design:Clinical review.Level of Evidence:Level 4.Results:Baker’s cysts are commonly found associated with intra-articular knee disorders. Proper diagnosis, examination, and treatment are paramount in alleviating the pain and discomfort associated with Baker’s cysts.Conclusion:A capsular opening to the semimembranosus–medial head gastrocnemius bursa is a commonly found normal anatomic variant. It is thought that this can lead to the formation of a popliteal cyst in the presence of chronic knee effusions as a result of intra-articular pathology. Management of symptomatic popliteal cysts is conservative. The intra-articular pathology should be first addressed by arthroscopy. If surgical excision later becomes necessary, a limited posteromedial approach is often employed. Other treatments, such as arthroscopic debridement and closure of the valvular mechanism, are not well studied and cannot yet be recommended.

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Purpose The purpose of this study was to evaluate the effectiveness of three constructs and techniques for repair of radial tears of the meniscus. Methods Thirty fresh frozen porcine menisci were divided equally into three groups consisting of (1) inside-out repair group, (2) a commonly used all-inside suture with anchor hybrid repair construct (AISAH) (Meniscal Cinch™), and (3) an all-inside all-suture repair construct (AIAS) (Knee Scorpion™). Radial tears were created and repaired and then the menisci were secured to the materials testing machine. Both cyclic loading and load-to-failure testing were performed. The displacement, stiffness, response to cyclic loading, and mode of failure were recorded and analyzed statistically. Results The displacement after cyclic loading (DACL) of the Cinch repair construct group was significantly higher than that of the inside-out repair construct group (p = 0.000) and AIAS repair construct (p = 0.000). There was not a statistical difference of DACL between inside-out and AIAS groups (n.s.). The inside-out construct failed at a significantly higher load than the AISAH repair construct (p = 0.000) and AIAS construct (p = 0.006). The AIAS construct failed at a significantly higher load than the AISAH repair construct (p = 0.009). The AIAS had a higher stiffness than AISAH (p = 0.047). The AIAS had a higher load at 3 mm protrusion than AISAH (p = 0.034). ConclusionThe AIAS repair construct had better biomechanical behaviors than AISAH construct and inside-out repair technique. Inside-out sutures and AIAS repair construct had similar biomechanical responses to cyclic loading. The AIAS can be used for meniscus tear surgical repair with less damage to peri-meniscus tissues.

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