Faculty Bibliography

BACKGROUND:Current treatment for discoid meniscus includes arthroscopic saucerization, with meniscal stabilization additionally performed in patients with demonstrated instability. It is thought that unstable discoid menisci represent a more severe variant and are therefore at risk for poorer clinical outcomes. Our hypothesis was that there is no difference in clinical outcomes between patients undergoing discoid meniscal saucerization alone and those who additionally require stabilization. METHODS:A retrospective chart review was performed for all patients presenting to a single pediatric center for treatment of a symptomatic discoid meniscus. Data collected included sex, age, affected side(s), preoperative and postoperative range of motion (ROM), type of surgery, and the presence of postoperative complications. In addition, a subset of these patients was enrolled prospectively. These patients completed 3 self-assessment tools-the International Knee Documentation Committee questionnaire, Lysholm Knee Score, and Tegner Activity Scale-before and after surgical intervention. Outcomes measures included objective criteria (ROM and surgical complications) and subjective criteria (patient-reported functional outcomes). For all outcomes measures, the Fisher exact test was used to determine whether significant differences existed between the patients who had undergone saucerization only and those who had also required surgical stabilization. RESULTS:Fifty-seven knees in 51 patients were included in the study. Thirty-three patients (58%) underwent saucerization alone and 24 (42%) underwent saucerization and stabilization. Six surgical complications were identified. There was no significant difference between the groups regarding patient-specific factors (sex, age, and affected side) and postoperative outcomes measures (ROM and complication rate). Average patient follow-up was 15 months postoperatively. Seventeen patients (17 knees) additionally completed the 3 self-assessment questionnaires. In this subset of patients followed prospectively, there was no significant difference in self-reported outcomes detected between the meniscal saucerization and meniscal repair groups. CONCLUSIONS:Short-term results for patients with symptomatic discoid menisci requiring surgical intervention are favorable. The addition of a meniscal stabilization step to the saucerization procedure does not negatively affect either early clinical outcomes or complication rates in patients with demonstrated meniscal instability. LEVEL OF EVIDENCE/METHODS:Level III: Therapeutic Study, Retrospective, Comparative.

The number of children and adolescents participating in organised athletic activities worldwide is increasing. However, physical fitness levels among youth are lower today than in previous decades. The combination of increased exposure and decreased preparedness for sports participation has led to an epidemic of both acute and chronic sports-related injuries in this population. Poor physical fitness, in addition to having negative health consequences, seems to be a risk factor for sports-related injury. Accurate injury surveillance data are required to better define the magnitude of the problem of injury in youth sports, as well as to identify specific risk factors for injury. From these data, targeted intervention strategies incorporating fitness training may be developed with the goal of preventing sports-related injury. Preliminary experience with several specific injury patterns--anterior cruciate ligament injuries and ankle sprains--has demonstrated the efficacy of such targeted prevention strategies.

PURPOSE/OBJECTIVE:The goal of this study was to show that patient self-assessment of active shoulder range of motion (ROM) by use of a novel, diagram-based questionnaire is accurate when compared with physician-assessed shoulder ROM. METHODS:We designed a diagram-based self-assessment tool that enables patients to determine their own active shoulder ROM in 3 planes of motion: forward elevation, external rotation, and internal rotation. This questionnaire was administered to 100 consecutive English-speaking patients presenting to a university-based orthopaedic surgery practice for evaluation of a shoulder-related complaint. After completion of the questionnaire, the patients' actual shoulder ROM in each plane was measured by a single blinded investigator using a standard 12-inch goniometer. Direct comparison of patient and physician ROM assessments was performed, and logistic regression analysis was then applied to identify those factors affecting the patients' ability to accurately complete the questionnaire. RESULTS:Patients were able to properly quantify motion 85% of the time; they were able to qualitatively assess motion as impaired or unimpaired 93% of the time. Patients who were more likely to make errors in self-assessment were significantly older than the error-free subjects and expressed significantly more dissatisfaction with shoulder function. In addition, there was a weak inverse relation between education level and accurate self-assessment. Gender, exposure to physical therapy, and involvement in litigation or Workers' Compensation cases were not significantly correlated with accurate ROM self-assessment. Patients were significantly less accurate in their assessment of internal rotation than in their assessment of both forward elevation and external rotation. CONCLUSIONS:Using a diagram-based questionnaire, patients are able to accurately assess their own active shoulder ROM.

Initial attempts to replicate the success of open anterior shoulder instability procedures using arthroscopic procedures were associated with unacceptably high failure rates. The resultant focus on identifying clear surgical indications and improving both arthroscopic technique and instrumentation has culminated in arthroscopic success rates approaching those of established open procedures. Current experience shows that with careful patient selection, strict adherence to proper surgical technique, and the avoidance of common surgical errors, excellent clinical results can be achieved with arthroscopic instability repair.