Bilateral osteochondritis dissecans of the knee in pediatric and adolescent patients presenting with unilateral symptoms: An epidemiological and radiographic analysis.

Purpose: This study aims to determine the prevalence and characteristics of bilateral osteochondritis dissecans of the knee in patients presenting with unilateral symptoms and compare this cohort to patients with unilateral disease. Methods: Records of patients ≤18 years old from 2003 to 2016 with a diagnosis of osteochondritis dissecans of the knee and strictly unilateral knee pain were identified. Contralateral (asymptomatic) knee imaging within 1 year of initial presentation was required. Lesion characteristics were evaluated by assessing size, location, and Hefti staging. Both surgical and nonoperative treatments were recorded. Patients with unilateral osteochondritis dissecans were compared to those with bilateral disease. Results: Eighty patients, 63 males (79%) and 17 females (21%), with an average age of 13.1 years old, were included. Twenty (25%) of the presenting/symptomatic lesions were deemed stable on magnetic resonance imaging. A positive correlation between lesion size and Hefti classification was appreciated. Twelve patients (15%) were found to have bilateral osteochondritis dissecans on contralateral imaging. There was no significant difference in skeletal maturity between patients with bilateral versus unilateral disease. Fifty-two patients (77%) with unilateral disease underwent surgical intervention, while 9 (75%) of those with bilateral disease underwent surgery on either knee. In patients with an asymptomatic contralateral lesion, 67% ultimately underwent surgical intervention on the contralateral knee. Conclusions: In patients presenting with unilateral osteochondritis dissecans symptoms, there was a 15% prevalence of bilateral disease, with no difference in age, sex, physeal status, or lesion characteristics between patients with unilateral vs bilateral osteochondritis dissecans lesions. Given the prevalence of asymptomatic contralateral lesions and the required intervention, this study supports early bilateral radiologic knee evaluation. Level of evidence: IV, Retrospective Case series.

Common Injuries in Female Competitive Softball Players.

The popularity of softball is rising among female athletes with more than two million players between the ages of 12 and 18 competing per year. As participation rates increase, the frequency of injuries related to softball is on the rise. Softball injuries can differ from baseball injuries, and only a small amount of current literature focuses exclusively on softball injuries. Orthopaedic surgeons need to be prepared to evaluate, diagnose, and treat common injuries sustained while playing softball. The purpose of this study is to investigate the mechanisms of injury that are commonly encountered by female athletes in competitive fast-pitch softball and review current safety initiatives that have been implemented to aide in injury prevention.

Intraobserver and Interobserver Measurement Variability of the Rib-Vertebral Angle Difference.

BACKGROUND: The rib-vertebral angle (RVAD) differentiates between progressive and resolving infantile idiopathic scoliosis (IIS) curves. Those with a RVAD<20 degrees often resolve without treatment, whereas those >20 degrees often progress and require treatment. The mathematical magnitude of RVAD measurement variability has not been described, and was thus the purpose of this study. It is important to know the reliability of RVAD measurements so as to understand changes that can be attributed to observer error alone. PURPOSE: The purpose of the study was to mathematically determine the intraobserver and interobserver measurement variability of the RVAD difference in IIS. METHODS: A convenience sample of 50 patients with IIS was selected. The RVAD was measured twice by 7 different observers separated by a minimum of 3 weeks. The 7 different readers chosen to measure the RVAD were 2 orthopaedic residents, 1 pediatric radiologist, and 4 attending pediatric orthopaedic surgeons. The same goniometer was used for all measurements. Intraobserver and interobserver measurement variability was determined using 3 well known used statistical methods. RESULTS: The 3 different methods used to determine intraobserver and interobserver variability using 95% prediction/confidence limits gave very similar results. Intraobserver variability was ∼24 degrees and the interobserver variability was ∼23 degrees. DISCUSSION: The utility of the RVAD in medical decision-making and counseling of patients with IIS should be approached with caution when used in isolation due to the large measurement variability. LEVEL OF EVIDENCE: Level 3.