Jeffrey Mikutis , DO Pediatric orthopaedic surgeon - PowerPoint Presentation

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Jeffrey Mikutis, DO

Pediatric orthopaedic surgeonExpertise in pediatric sports medicine and pediatric fracture careServed 21 years in the Air Force, with 12 years as an orthopaedic surgeon at Wright-Patterson Air Force Base,

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Bio:

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I've always enjoyed working with my hands and building things, from erecter sets to scale models of aircrafts, ships and buildings. I felt that I could translate my perfectionist tendencies in building things into fixing people.”

Lower Extremity PhysealInjuries in the Pediatric AthleteJeffrey L. Mikutis, D.O.Pediatric Orthopaedic SurgeryDayton Children’s Hospital

22nd Annual Pediatric Orthopaedic Symposium

disclosureI have no disclosures related to the following topic.3

Increasing number of pediatric patients participating in year-round single sportsThis group of patients susceptible to chronic repetitive stress of both upper and lower extremitiesAt the knee: well known conditions such asAnterior knee painOsgood-Schlatter’s DiseaseSinding-Larsen-Johnanssen Syndrome

Sports included:BasketballFootball (kicker)GymnasticsTennisSoccer5

Reports of physeal stress injuries at the knee in high level competitive sportsCincinnati Children’s in 2005 reported on six pediatric athletes ages 8 yr to 15 yr with chronic knee pain and radiographic physeal widening of the femur and/or tibia per x-ray and MRI (Laor

et al, 2005)6

Lateral

Physis

MRI’s showed:Chondrocyte invade metaphysis5 out of 6 children were compliant with rest/immobilization and improved symptomatically and radiographically at 3 months1 out of 6 – Non-compliant patient continued to have pain and developed genu varum at 50 months (patient had distal femur and proximal tibial involvement)

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2 cases of rapidly progressive knock-kneed deformity without injury or disease history (Zhang, et al, 2008)Both patients were overweight adolescent femalesPlain films, MRI’s revealed growth disturbance of distal lateral femoral physesUnlike juvenile Blount’s disease that affects the medial tibial

physis during growth spurts and causing genu varumBoth of these patients showed similar MRI’s to Blount’s and patients in previous article of cartilage invasion of the metaphysis9

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Treatment in both cases required corrective osteotomy and epiphysiodesis to prevent further deformity11

Holloway et al in 2017 reported on “An unusual cause of genu valgum and persistent instability” in a 16 year old football playerInitial injury was a valgus force to his knee during a tackleMRI demonstrated an MCL injury and patient was treated with bracing and PT12

After return to football, patient sustained another valgus injury and was unable to return to sportsPatient gradually developed a valgus right knee and progressive medial instability13

MRI revealed finding consistent with Salter V injury of distal lateral femoral physis (crush injury of physis)14

15Patient was treated with osteotomy and medial reconstruction with excellent functional result

Demperwolf et al in the current JAAOS Global Research ReviewReported on three year-round kicking athletes, mean age 14.2, with knee pain in the kicking leg and unilateral genu valgumAll three had x-rays and MRI abnormalities in the distal lateral femoral physis

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All patients had surgery with medial tension band plates with 2 out of 3 attaining correction and the oldest patient requiring osteotomy17

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SummaryIt is necessary for physicians, coaches, trainers and parents to be aware of risk factors for chronic physeal injuries, particularly in the year-round/kicking athlete or an athlete who has sustained a significant knee injuryNon-athletic overweight adolescent patients need to be monitored for lower extremity deformity from chronic physeal injury

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ReferencesLaor, T. et al. Physeal Widening in the Knee Due to Stress Injury in Child Athletes. AJR:186, May 2006; 1260-1264Zhang, A; Exner, U; Wenger, D. Progressive Genu Valgum Resulting from Idiopathic Lateral Distal Femoral Physeal Growth Suppression in Adolescents. Journal of Pediatric Orthopaedics

. Vol 28:7, October-November 2008; 752-756Holloway E, et al. An Unusual Cause of Genu Valgum and Persistent Instability. Journal of Surgical Case Reports, 2017;8, 2-4Dempewolf, M. et al. Youth Kicker’s Knee: Lateral Distal Femoral Hemisphyseal Arrest Secondary to Chronic Repetitive Microtrauma. JAAOS Glob Res Rev 2009;3:e079

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