Biomedical subjects

Lyle J Micheli

Publications and source records attributed to Lyle J Micheli.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation.

PURPOSE: Procedures aimed at biologically repairing cartilage injuries may have the greatest potential benefit in young patients because of their long-life expectancy and high-functional demands. Most cartilage-repair studies focus on older patient populations. This study assesses the outcomes of patients who were treated with autologous chondrocyte implantation before the age of 18. STUDY DESIGN: This is a Registry-based, multicenter, observational, cohort study of 37 patients from whom follow-up data was prospectively collected. Patient-rated assessments of overall condition, pain, and swelling were measured using modified, 10-point scales of the Cincinnati Knee Rating System. RESULTS: Mean age was 16 years (11-17); 22 boys and 15 girls. Twenty-three patients underwent at least 1 cartilage repair procedure before the cartilage harvest, including 11 who had a marrow stimulation procedure. Fourteen patients were diagnosed with osteochondritis dessicans lesions. Thirty-five patients had single defects (mean size, 5.4 cm). Thirty-two patients completed self-evaluations at a minimum of 2 years after implantation (mean follow-up = 4.3 years). The mean change in scale scores measuring overall condition, pain, and swelling were 3.8, 4.1, and 3.4 points, respectively. One patient had an implantation that failed. CONCLUSIONS: Results highlight significant clinical improvements from baseline to follow-up for 32 patients who submitted follow-up data, including 28 patients who reported a minimum 1-point improvement in the overall condition score. CLINICAL RELEVANCE: These results suggest that autologous chondrocyte implantation may be an effective option for children and adolescents with large symptomatic chondral lesions of the distal femur.

Adolescent↗

PubMedDate not supplied

Partial tears of the anterior cruciate ligament in children and adolescents.

BACKGROUND: The functional outcome after partial anterior cruciate ligament tears in children and adolescents treated without reconstruction has not been established. HYPOTHESIS: Nonreconstructive management of partial anterior cruciate ligament tears can be effective in certain pediatric patients. STUDY DESIGN: Prospective cohort study. METHODS: We studied 45 skeletally mature and immature patients 17 years of age or less who had an acute hemarthrosis, magnetic resonance imaging signal changes, grade A or B Lachman and pivot shift result, and an arthroscopically documented partial anterior cruciate ligament tears. All patients were treated without reconstruction, underwent a structured rehabilitation program, and were followed up for a minimum of 2 years. RESULTS: Fourteen patients (31%) underwent subsequent reconstruction. Significant associations with subsequent reconstruction included tears that were greater than 50%, predominantly posterolateral tears, a grade B pivot shift test result, and older chronologic and skeletal age. Among patients who did not require reconstruction, those with tears that were greater than 50% or predominantly posterolateral had significantly lower Lysholm, satisfaction, and Cincinnati Knee Scale scores. CONCLUSIONS: Nonreconstructive management is recommended for partial anterior cruciate ligament tears in children and adolescents 14 years of skeletal age or younger with normal or near-normal Lachman and pivot shift results. Reconstruction is recommended in older athletes or in those with greater than 50% or predominantly posterolateral tears.

Adolescent↗

PubMedDate not supplied

Tibial eminence fractures in children: prevalence of meniscal entrapment.

BACKGROUND: Meniscal entrapment under a displaced tibial eminence fragment may be a rationale for arthroscopic or open reduction in type 2 and 3 tibial eminence fractures. PURPOSE: To determine the prevalence of meniscal entrapment in children with type 2 and 3 tibial eminence fractures. STUDY DESIGN: Case series. METHODS: Records of a consecutive series of 80 skeletally immature patients (mean age, 11.6 years; range, 5 to 16) who underwent arthroscopic (71), open (5), or combined arthroscopic and open (4) reduction and internal fixation of type 3 tibial eminence fractures (57) or type 2 fractures that did not reduce in extension (23) from 1993 to 2001 were reviewed. RESULTS: Entrapment of the anterior horn of the medial meniscus (36), intermeniscal ligament (6), or anterior horn of the lateral meniscus (1) was seen in 26% (6 of 23) of type 2 fractures and 65% (37 of 57) of type 3 fractures. An associated meniscal tear was seen in 3.8% of patients (3 of 80). CONCLUSIONS: Meniscal entrapment is common in patients with type 2 and 3 tibial eminence fractures. Arthroscopic or open reduction should be considered for type 3 fractures and for type 2 fractures that do not reduce in extension to remove the incarcerated meniscus, allowing for anatomic reduction.

Adolescent↗

PubMedDate not supplied

Anterior cruciate ligament injury versus tibial spine fracture in the skeletally immature knee: a comparison of skeletal maturation and notch width index.

Both midsubstance anterior cruciate ligament (ACL) injury and tibial spine avulsion fracture occur in the skeletally immature knee. The purpose of this study was to determine whether there are differences in skeletal maturation or notch parameters between these two groups. A retrospective case-control study of 25 skeletally immature patients with tibial spine fractures compared with 25 age- and sex-matched skeletally immature patients with midsubstance ACL injuries was performed. Bone age and notch width index were determined from preoperative radiographs. There were no significant differences between the tibial spine fracture group and the ACL injury group with respect to skeletal maturation, comparing bone age to chronological age (-0.5 vs. -0.3 years; P = 0.617). The ACL injury group had narrower notch indices than the tibial spine fracture group (0.230 vs. 0.253; P = 0.020). Thus, in a comparison of age- and sex-matched skeletally immature patients, those with midsubstance ACL injuries had a significantly narrower notch index than those with tibial spine fractures. This association may account for some of the variation in injury patterns in the skeletally immature knee.

Adolescent↗