Development and Assessment of Novel Multiligament Knee Injury Reconstruction Graft Constructs and Techniques.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: J.P.S. reports grants and personal fees from Arthrex, Inc., grants from DePuy Synthes, other from Journal of Knee Surgery, grants from National Institutes of Health (NIAMS & NICHD), personal fees and other from Thieme, grants from U.S. Department of Defense, other from AO Foundation, other from American Orthopaedic Association, other from AO North America, grants from Coulter Foundation, other from Mid-America Orthopaedic Association, personal fees from Orthopedic Designs North America, personal fees from Smith & Nephew, outside the submitted work. Authors J.L.C. and C.R.C. are husband and wife. J.L.C. reports grants and personal fees from Arthrex, Inc., personal fees from CONMED Linvatec, grants, personal fees and other from Musculoskeletal Transplant Foundation, grants from Zimmer-Biomet, outside the submitted work. All the other authors report no conflict of interest. 17. J Pediatr Orthop. 2024 May-Jun 01;44(5):e433-e438. doi: 10.1097/BPO.0000000000002657. Epub 2024 Mar 8. Acetabular "Fleck" Sign: Outcomes of Surgical Repair. Chen S(1), Tulchin-Francis K(2), Gaines D(3), Kadado A(3), Smith C(2), Klingele K(2)(4). Author information: (1)Campbell Clinic, Memphis, TN. (2)Department of Orthopedic Surgery, Nationwide Children's Hospital. (3)Department of Orthopaedics, The Ohio State University, Columbus, OH. (4)Valley Children's Healthcare, Madera, CA. BACKGROUND: Traumatic, posterior hip dislocations in the pediatric population are typically managed by closed reduction to achieve a concentric hip joint. The presence of an acetabular "fleck" sign, despite concentric reduction, has been shown to signify significant hip pathology. The purpose of this study was to evaluate the outcomes of open labral repair through a surgical hip dislocation (SHD) in a consecutive series of patients with an acetabular "fleck" sign associated with a traumatic hip dislocation/subluxation. METHODS: A retrospective review of patients between 2008 and 2022 who presented to a single, level 1 pediatric trauma center with a traumatic posterior hip dislocation/subluxation was performed. Patients were included if they had an acetabular "fleck" sign on advanced imaging and underwent open labral repair through SHD. Medical records were reviewed for sex, age, laterality, mechanism of injury (MOI), and associated orthopaedic injuries. The modified Harris hip score (mHHS) was utilized as the primary clinical outcomes measure. Patients were assessed for the presence of heterotopic ossification (HO) and complications, including implant issues, infection, avascular necrosis (AVN), and post-traumatic dysplasia. RESULTS: Twenty-nine patients (23 male, average age: 13.0±2.7 y; range: 5.2 to 17.3) were identified. Eighteen injuries were sports related, 9 caused by motor vehicle accidents, and 1 pedestrian struck. All patients were found to have an acetabular "fleck" sign on CT (26 patients) or MRI (5 patients). Associated injuries included: femoral head fracture (n=6), pelvic ring injury (n=3), ipsilateral femur fracture (n=2), and ipsilateral PCL avulsion (n=1). At the latest follow-up (2.2±1.4 y), all patients had returned to preinjury activity/sport. Three patients developed asymptomatic, grade 1 HO in the greater trochanter region. There was no incidence of AVN. One patient developed post-traumatic acetabular dysplasia due to early triradiate closure. mHHS scores showed excellent outcomes (n=21, 94.9±7.4, range: 81 to 100.1). CONCLUSIONS: The acetabular "fleck" sign indicates a consistent pattern of osteochondral avulsion of the posterior/superior labrum. Restoring native hip anatomy and stability is likely to improve outcomes. SHD with open labral repair in these patients produces excellent clinical outcomes, with no reported cases of AVN. LEVEL OF EVIDENCE: Level IV-therapeutic. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPO.0000000000002657