Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database

BACKGROUND

Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy.

PURPOSE

To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete).

RESULTS

In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair.

CONCLUSION

To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.

Prediction of outcome after rectus femoris surgery in cerebral palsy: the role of cocontraction of the rectus femoris and vastus lateralis

Rectus femoris surgery was performed on 70 patients with cerebral palsy and stiff-knee gait. Fifty-three patients underwent distal rectus transfer, and 17 patients had distal rectus release with complete muscle mobilization. Gait analysis was performed preoperatively and postoperatively at a minimum of 1 year. Swing-phase peak knee flexion (PKF) was improved in the transfer group, allowing improved foot clearance and more efficient gait (p = 0.04). PKF in swing deteriorated slightly in the release group (p = 0.04). The presence of abnormal swing-phase electromyogram (EMG) activity in the rectus alone or abnormal combined rectus and vastus lateralis activity did not influence the PKF results in either surgery (p < 0.05). The Ely test had no predictive value in identifying patients with abnormal EMG activity (p > 0.05). Preoperative knee range of motion was not a significant variable in determining relative success of rectus surgery. No deleterious effects were observed in stance phase in either group (p > 0.05).

A biomechanical comparison of open and thoracoscopic anterior spinal release in a goat model

STUDY DESIGN

A biomechanical assessment of anterior release and discectomy in the thoracic spine was performed on an animal model using thoracoscopic and open thoracotomy techniques.

OBJECTIVES

To compare the relative efficacy of these two techniques of release in achieving increased spinal mobility.

BACKGROUND DATA

The clinical use of video-assisted thoracoscopy in the correction of spinal deformity is increasing. The effectiveness of thoracoscopic anterior spinal release with discectomy has not been evaluated biomechanically.

METHODS

Anterior release with discectomy was performed on six midthoracic motion segments in five mature goats. The thoracoscopic technique was used for three levels on one side, and an open thoracotomy was used for the alternating three levels of the contralateral side. The duration of surgery for disc excision and the amount of blood loss for each technique were recorded. The intact cranial and caudal motion segments served as controls. The motion segments were individually subjected to nondestructive biomechanical testing. Torsional, sagittal, and coronal bending torques were applied, and the resulting angular displacement was measured.

RESULTS

The duration of surgery to remove a disc thoracoscopically decreased as experience was gained by the surgeon. The amount of intraoperative blood loss was comparable using the two methods. There was significantly increased flexibility in the released segments with both techniques, compared with the flexibility in the intact levels for all three loading directions. There was no difference in the motion obtained after release between the two techniques.

CONCLUSION

Open and thoracoscopic anterior release and discectomy have been demonstrated, through biomechanical in vitro testing, to increase the flexibility of the spine to a similar extent.

Proximal fibular osteochondroma with associated peroneal nerve palsy: a review of six cases

Osteochondroma of the proximal fibula is relatively common, but reports of this lesion in conjunction with peroneal nerve palsy have been scarce. Six patients with peroneal nerve palsy and fibular exostosis are presented with the results of electrical studies, radiographic evaluation, physical examination, and operative treatment. A wide variation in presentation and outcome was observed. Preoperative and postoperative electromyography and nerve-conduction studies are useful in evaluation. A heightened awareness of this entity is required to avoid permanent damage in an otherwise treatable condition.