Sports Medicine and Arthroscopy Review最新文献

Patellar instability presents diagnostic and treatment challenges despite advances in imaging and surgical techniques. Given the link between patellar instability and trochlear dysplasia, the key to understanding instability may lie in subtle morphological variations in the trochlea. Traditional 2-dimensional methods of understanding instability can suffer from issues of geometric alignment. As a result, 3-dimensional analysis has an emerging role in understanding the pathogenesis of patellar instability. One 3-dimensional metric, the entry point-transition point angle, is used to quantify the degree of lateralization of dysplastic trochlear grooves. This angle is measured on 3-dimensional reproductions of computed tomography scans and can be used for surgical decision-making in instability patients. Further research should investigate how to best incorporate 3-dimensional metrics in surgical decision-making.

Similar to other fields, there is growing evidence of disparities in pediatric sports medicine. For children and adolescents with knee injuries, disparities persist along the lines of sex, gender, race, ethnicity, insurance, socioeconomic status, and other determinants. These factors influence the evaluation, treatment, and outcomes for a variety of knee pathologies, including anterior cruciate ligament ruptures, meniscus tears, osteochondritis dissecans, cartilage injuries, and tibial spine fractures. Inequities in care may have long-term functional and psychosocial implications. Additional research is necessary to further elucidate the etiology of these disparities, raise patient and community voices, and design interventions so that equitable care is delivered to every patient.

Tibial spine fractures (TSFs) are a relatively uncommon knee injury that most commonly occurs in skeletally immature pediatric patients following a sports or bicycle-related injury. Treatment of TSFs is guided based on fracture displacement on radiographs and associated injuries. Surgical treatment is recommended for displaced TSFs with arthroscopic or open reduction and fixation. Arthroscopic reduction and suture fixation can be utilized for all tibial spine fractures, regardless of comminution, and allows for treatment of both the TSF and concomitant meniscal and/or chondral injuries. Stable fixation and early motion are important to minimize the risk of arthrofibrosis.

Proximal tibia fractures in children pose challenges in management due to the complex anatomy in this region. The relationship between the proximal tibial physis, proximal tibial apophysis, extensor mechanism, and nearby vascular structures allows for potential injuries from toddler-aged children through adolescence. The most common injuries include tibial tubercle fractures, proximal tibia physeal fractures, and proximal tibia metaphyseal fractures; they may result from both low-energy and high-energy mechanisms. Nonoperative treatment is indicated for nondisplaced or adequately reduced fractures, while operative treatment is indicated for irreducible fractures or fractures with loss of adequate reduction. Complications of these injuries may include growth arrest, limb length discrepancy, angular deformity, vascular compromise, and compartment syndrome.

As pediatric youth sports involvement has increased, there has been an increase in meniscus tears associated with acute pediatric knee injuries. The meniscus of pediatric patients has a more robust blood supply which may help its healing potential. The discoid meniscus is an anatomical variant that is more prone to meniscal tears in pediatric patients. Meniscectomy and saucerization are usually the treatment of choice for the complex meniscus tear and the discoid meniscus tear. Meniscus repair should be attempted when at all possible due to the good outcomes associated with meniscus repair and poor results associated with meniscectomy in pediatric patients.

Anterior cruciate ligament (ACL) tears have become an increasingly prevalent problem in pediatric patients due to increased youth sports participation and early sports specialization. A high index of suspicion should be utilized for any young patient with an acute knee injury and an associated effusion or difficulty bearing weight. A thorough work-up should be performed that includes a careful assessment of growth remaining and concomitant injuries. While nonoperative management may be a consideration for select cases, most patients will benefit from early surgical management. ACL deficiency or delayed reconstruction can lead to early chondral degeneration and risk for further injury to the cartilage and menisci. The goal of ACL reconstruction is to create a stable knee and prevent secondary chondral or meniscal injury. Physeal-sparing and physeal-respecting transphyseal techniques have been developed that allow for safe and successful ligament reconstruction while minimizing the risk of growth arrest. Younger patients have a higher risk of reinjury and require a longer recovery period for a full return to sports than their older counterparts. Even though there have been advances in the safe and successful treatment of ACL tears in pediatric patients, it remains a devastating physical and psychological injury, and increased efforts should be made at prevention. Injury prevention programs have been shown to reduce the risk of ACL tears, and it is important to increase awareness and utilization of prevention strategies.

The identification, management, and prevention of concussion across all competitive sports and athletic populations has been a notable topic of research over the last decade. Soccer is no exception, with over a billion participants worldwide. In soccer, 3 distinct subsets of head injuries are often the contributors to concussion: head-to-equipment, head-to-surface, and head-to-player collisions. Recognition of concussion is crucial, and ideally made on the sideline during competitive play. Recently updated screening tools include the SCAT6 and ChildSCAT6, which are widely utilized at all levels of play. Management of concussion is divided into on-field and in clinic management. Initial management includes removal from the field of play. There is increased emphasis on earlier incorporation of exercise prescription as a means to improve recovery in the concussed athlete. While few objective diagnostic tests exist to identify concussion, many are in development, most notably advanced imaging and biomarker modalities.