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Kevin Shea, MD

Health care is a team sport, and I work with families and patients to help them develop a team for their recovery and improvement. Patients and families are at the core of this team, and their 'teammates' include office staff, athletic trainers, physical therapists, coaches, teachers and more.

I am very fortunate to work in a healing profession and to be part of a process that improves the lives of our patients and families. It is a privilege to get to know patients and families and be part of the community.

Before going to medical school, I worked as a teacher. I was planning to be a high school teacher and football, soccer and wrestling coach. My high school biology teacher convinced me to become a physician and to work with athletes, much like a coaching. Specializing in orthopedics has allowed me to continue to teach, work with athletes, and watch kids and teens grow and develop. It is a great privilege to care for my patients, and I continue to learn from them every day.

Especialidades médicas y/o especialidades quirúrgicas

Orthopaedic Surgery

Trabajo y educación

Educación

UCLA David Geffen School Of Medicine Registrar, Los Angeles, CA, 06/01/1991

Primeros años de residencia

University of Utah General Surgery Residency, Salt Lake City, UT, 6/30/1992

Últimos años de residencia

University of Utah - Dept of Orthopaedics, Salt Lake City, UT, 6/30/1997

Subespecialidad

Rady Childrens Hospital Pediatric Orthopedic Fellowship, San Diego, CA, 7/30/1998

Certificado(s) de especialidad

Orthoped Surg/Sports Med, American Board of Orthopaedic Surgery

Todo Publicaciones

Pediatric Type II Tibial Spine Fractures: Addressing the Treatment Controversy With a Mixed-Effects Model ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Adams, A. J., O'Hara, N. N., Abzug, J. M., Aoyama, J. T., Ganley, T. J., Carey, J. L., Cruz, A. I., Ellis, H. B., Fabricant, P. D., Green, D. W., Heyworth, B. E., Janicki, J. A., Kocher, M. S., Lawrence, J. R., Lee, R., McKay, S. D., Mistovich, R., Patel, N. M., Polousky, J. D., Rhodes, J. T., Sachleben, B. C., Sargent, M., Schmale, G. A., Shea, K. G., Yen, Y., Tibial Spine Res Grp 2019; 7 (8): 2325967119866162

Abstract

Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative.To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures.Cross-sectional study.A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient's sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon's decision, as well as surgeon training background, years in practice, and risk-taking behavior.The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P < .001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by 3.5 mm. Significant variation in surgeon's propensity for operative treatment of this fracture was observed (P = .01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent's preference for surgical treatment.There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.

View details for DOI 10.1177/2325967119866162

View details for Web of Science ID 000483466800001

View details for PubMedID 31489334

View details for PubMedCentralID PMC6713965

Editorial Commentary: Anterolateral Ligament-Anatomy, Evaluation, and Future Applications to Knee Stability. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Shea, K. G., Musahl, V., Stavinoha, T. J. 2019; 35 (7): 214345

Abstract

Magnetic resonance imaging evaluation of anterolateral ligament injury may be reliable for individuals experienced and trained to identify it, but it does not reference a diagnostic gold standard. The structural anatomy and radiographic diagnosis may differ from those of more traditional ligaments, which should influence concepts of reconstruction.

View details for DOI 10.1016/j.arthro.2019.04.007

View details for PubMedID 31272634

Patellar-Trochlear Morphology in Pediatric Patients From 2 to 11 Years of Age: A Descriptive Analysis Based on Computed Tomography Scanning. Journal of pediatric orthopedics Richmond, C. G., Shea, K. G., Burlile, J. F., Heyer, A. M., Ellis, H. B., Wilson, P. L., Arendt, E. A., Tompkins, M. A. 2019

Abstract

BACKGROUND: Despite the critical role the trochlea plays in patellofemoral (PF) pathology, the development of the trochlea is poorly understood. The purpose of this study was 2-fold: (1) Describe quantitative osseous and soft tissue anatomy of the patella and trochlea in skeletally immature cadaveric specimens utilizing known measurements used in PF instability, and (2) evaluate additional measurement techniques in the sagittal plane as they relate to PF morphologic development.METHODS: Thirty-one skeletally immature fresh frozen cadaveric knees between the ages of 2 and 11 years old were evaluated using 0.625mm computed tomography scans. In the axial plane, measurements included condylar height asymmetry, trochlear facet asymmetry, trochlear depth, osseous sulcus angle, cartilaginous sulcus angle, patella sulcus angle, and tibial tubercle-trochlear groove distance. In the sagittal plane, measurements included previously undescribed measurements of trochlear length and condylar height asymmetry which are based on the anterior femoral cortex.RESULTS: Analysis of trochlear morphology using condylar height asymmetry (both axial and sagittal), trochlear facet asymmetry, and trochlear depth and length demonstrated an increase in the size of the medial and lateral trochlea as age increased. There was more variability in the change of size of the medial trochlea (height, length, and facet length) than the lateral trochlea. The osseous sulcus angle, cartilaginous sulcus angle, and patella sulcus angle decreased (became deeper) with age until after 8 years and then plateaued.CONCLUSIONS: This cadaveric analysis demonstrated that there is an increase in the medial and lateral trochlear height as age increased by all measurements analyzed. The findings also demonstrate that the shape of the patella and trochlea change concurrently, which suggests that there may be interplay between the 2 during development. These new sagittal measurement techniques evaluating the medial, central, and lateral trochlear height and length with respect to age may help guide clinicians when investigating patellar instability in skeletally immature patients.LEVELS OF EVIDENCE: Level IV.

View details for DOI 10.1097/BPO.0000000000001405

View details for PubMedID 31107711

Mechanical and Microstructural Properties of Native Pediatric Posterior Cruciate and Collateral Ligaments ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Schmidt, E. C., Chin, M., Aoyama, J. T., Ganley, T. J., Shea, K. G., Hast, M. W. 2019; 7 (2)
Mechanical and Microstructural Properties of Pediatric Anterior Cruciate Ligaments and Autograft Tendons Used for Reconstruction ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Schmidt, E. C., Chin, M., Aoyama, J. T., Ganley, T. J., Shea, K. G., Hast, M. W. 2019; 7 (1)
The Position of the Popliteal Artery and Peroneal Nerve Relative to the Menisci in Children: A Cadaveric Study. Orthopaedic journal of sports medicine Shea, K. G., Dingel, A. B., Styhl, A., Richmond, C. G., Cannamela, P. C., Anderson, A. F., Ganley, T. J., Hill, A., Yen, Y. M. 2019; 7 (6): 2325967119842843

Abstract

Meniscal injury in skeletally immature patients is increasingly reported. During meniscal repair, all-inside devices may protrude beyond the posterior limits of the meniscus, putting the neurovascular structures at risk.The purposes of this study were (1) to examine the relationship between the popliteal artery and the posterolateral and posteromedial aspects of the menisci, (2) to examine the relationship of the peroneal nerve to the posterolateral meniscus, and (3) to develop recommendations for avoiding neurovascular injury during posterior meniscal repair in pediatric patients.Descriptive laboratory study.A total of 26 skeletally immature knee cadaveric specimens (7 females and 19 males) were included. Specimens were divided into age groups: 2-4, 5-8, and 9-11 years. The most posterior extent of the lateral and medial menisci was identified via sagittal and axial views on computed tomography (CT) scans. The shortest distance from the most posterior aspect of the lateral and medial menisci to the popliteal artery and the shortest distance from the posterior aspect of the lateral menisci to the anterior rim of the peroneal nerve were measured, and 3-dimensional models of representative specimens were re-created through use of CT scans.For the age groups 2-4, 5-8, and 9-11 years, the mean minimum distance from the posterolateral meniscus to the popliteal artery was 5.2, 6.7, and 8.2 mm, respectively, and the mean minimum distance from the posteromedial meniscus to the popliteal artery was 12.7, 15.4, and 20.3 mm, respectively. In all groups, the distance between the posteromedial meniscus and the popliteal artery was greater than that between the posterolateral meniscus and the popliteal artery. The mean distance from the peroneal nerve to the lateral meniscus was 13.3, 15.0, and 17.9 mm for the respective groups.Many all-inside meniscal repair devices have sharp tips that penetrate posterior to the meniscus and capsule. This study demonstrated that the distance between the posterior meniscus and popliteal artery is relatively small in pediatric patients, especially for the lateral meniscus region.Because of the higher potential for meniscal healing, meniscal repair is more likely to be performed in pediatric patients. The data in this study regarding the proximity of the lateral meniscus and neurovascular structures may be used to guide safe surgical repair of posterior meniscal tears during the use of all-inside meniscal repair devices in these patients.

View details for DOI 10.1177/2325967119842843

View details for PubMedID 31286001

View details for PubMedCentralID PMC6600506

Trends in Concomitant Meniscal Surgery Among Pediatric Patients Undergoing ACL Reconstruction: An Analysis of ABOS Part II Candidates From 2000 to 2016. Orthopaedic journal of sports medicine Cruz, A. I., Gao, B., Ganley, T. J., Pennock, A. T., Shea, K. G., Beck, J. J., Ellis, H. B. 2019; 7 (9): 2325967119869848

Abstract

Rates of anterior cruciate ligament (ACL) reconstruction among pediatric and adolescent patients are increasing. Limited knowledge exists about population-level rates of concomitant meniscal surgery in this age group.This study sought to examine trends in concomitant meniscal procedures and describe short-term complications in pediatric and adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing and that the likelihood of performing meniscal repair or meniscectomy is associated with patient- and surgeon-specific factors.Cross-sectional study.We queried ACL procedures in patients younger than 19 years reported by American Board of Orthopaedic Surgery (ABOS) part II examination candidates from 2000 to 2016. Regression models examined associations between patient and surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications.A total of 9766 cases were identified. Females represented 46% (n = 4468) of included cases. Mean patient age was 16.1 years (SD, 1.62 years; range, 0-18 years). The rate of concomitant ACL-meniscal procedures increased from the years 2000 to 2016 (49%-60%; P = .005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedic fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscal procedure (P = .003 and .006, respectively). Sports medicine-trained surgeons were more likely to perform meniscal repair compared with meniscectomy (+3.0%; P = .016). Younger patient age was associated with increased likelihood of undergoing meniscal repair compared with meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included infection (1.61%), arthrofibrosis (1.14%), and deep venous thrombosis or pulmonary embolism (0.11%). Sports medicine and pediatric orthopaedic fellowship training was associated with higher rates of reporting postoperative stiffness and/or arthrofibrosis.Among ABOS part II candidates, concomitant ACL-meniscal surgery has become more common than isolated ACL procedures. Procedures involving sports medicine fellowship-trained surgeons and younger patients were associated with increased rates of meniscal repair compared with meniscectomy. Pediatric orthopaedic and sports medicine training was associated with a greater likelihood of being involved in a concomitant ACL-meniscal procedure of any kind, and surgeons with such training also reported a higher incidence of postoperative stiffness and/or arthrofibrosis in patients.

View details for DOI 10.1177/2325967119869848

View details for PubMedID 31579682

View details for PubMedCentralID PMC6759752

Mechanical and Microstructural Properties of Pediatric Anterior Cruciate Ligaments and Autograft Tendons Used for Reconstruction. Orthopaedic journal of sports medicine Schmidt, E. C., Chin, M., Aoyama, J. T., Ganley, T. J., Shea, K. G., Hast, M. W. 2019; 7 (1): 2325967118821667

Abstract

Over the past several decades, there has been a steady increase in pediatric anterior cruciate ligament (ACL) tears, particularly in young female basketball and soccer players. Because allograft tissue for pediatric ACL reconstruction (ACLR) has shown high rates of failure, autograft tissue may be the best option for ACLR in this population. However, differences in the structure and mechanical behavior of these tissues are not clear.To characterize the mechanical and microstructural properties in pediatric ACLs and autograft tissues using a rare cadaveric cohort (mean age, 9.2 years).Descriptive laboratory study.ACLs, patellar tendons, quadriceps tendons, semitendinosus tendons, and iliotibial bands (ITBs) were harvested from 5 fresh-frozen pediatric knee specimens (3 male, 2 female) and subjected to a tensile loading protocol. A subset of contralateral tissues was analyzed using bright-field, polarized light, and transmission electron microscopy.Patellar tendons exhibited values for ultimate stress (5.2 3.1 MPa), ultimate strain (35.3% 12.5%), and the Young modulus (27.0 8.8 MPa) that were most similar to the ACLs (5.2 2.2 MPa, 31.4% 9.9%, and 23.6 15.5 MPa, respectively). Semitendinosus tendons and ITBs were stronger but less compliant than the quadriceps or patellar tendons. ITBs exhibited crimp wavelengths (27.0 2.9 m) and collagen fibril diameters (67.5 19.5 nm) that were most similar to the ACLs (24.4 3.2 m and 65.3 19.9 nm, respectively).The mechanical properties of the patellar tendon were almost identical to those of the ACL. The ITB exhibited increased strength and a similar microstructure to the native ACL. These findings are not entirely congruent with studies examining adult tissues.These results can be used to inform further clinical research. In particular, they justify a further examination of the biomechanical and microstructural properties of the ITB in the context of its role as an autograft tissue in pediatric ACL reconstruction.

View details for PubMedID 30719479

Mechanical and Microstructural Properties of Native Pediatric Posterior Cruciate and Collateral Ligaments. Orthopaedic journal of sports medicine Schmidt, E. C., Chin, M., Aoyama, J. T., Ganley, T. J., Shea, K. G., Hast, M. W. 2019; 7 (2): 2325967118824400

Abstract

Although anterior cruciate ligament (ACL) tears have received the most attention, the medial collateral ligament (MCL) is thought to be the most commonly injured knee ligament overall. The lateral collateral ligament (LCL) and posterior collateral ligament (PCL) are less frequently compromised but can be involved in severe multiligament injuries. The paucity of information on the native properties of these ligaments in the pediatric population hinders the overall optimization of treatment for these injuries.To characterize the mechanical and microstructural properties of pediatric MCLs, LCLs, and PCLs using a rare cadaveric cohort (mean age, 9.2 years).Descriptive laboratory study.MCLs, LCLs, and PCLs were harvested from 5 fresh-frozen pediatric knee specimens (3 male, 2 female) and were subjected to a tensile loading protocol. A subset of contralateral tissues from a single donor was analyzed using bright-field, polarized light, and transmission electron microscopy to measure collagen fiber morphology.The pediatric MCL exhibited values for ultimate stress (11.7 6.7 MPa), ultimate strain (18.2% 6.8%), and the Young modulus (93.7 56.5 MPa) that were similar to values for the LCL (11.4 11.5 MPa, 27.7% 12.9%, and 64.4 76.6 MPa, respectively). The PCL demonstrated decreased ultimate stress (4.2 1.8 MPa), increased ultimate strain (28.8% 11.9%), and a decreased Young modulus (19.8 10.4 MPa) when compared with the MCL and LCL. All 3 ligaments had similar mean crimp wavelengths (MCL, 32.8 3.6 m; LCL, 27.2 3.5 m; PCL, 25.8 3.5 m) and collagen fibril diameters (MCL, 88.0 26.0 nm; LCL, 93.3 34.6 nm; PCL, 90.9 34.0 nm); however, the fibril distribution profiles exhibited different modalities.The pediatric MCL and LCL possessed similar mechanical properties, while the pediatric PCL was weaker but capable of withstanding higher amounts of strain. All 3 of these pediatric structures were weaker than what has been reported in studies with adult cohorts.Results from this study can be considered preliminary mechanical and microstructural data for healthy pediatric collateral and posterior cruciate ligaments that can be used to guide further laboratory and clinical research.

View details for PubMedID 30775386

Anatomic Dissection and CT Imaging of the Anterior Cruciate and Medial Collateral Ligament Footprint Anatomy in Skeletally Immature Cadaver Knees. Journal of pediatric orthopedics Shea, K. G., Cannamela, P. C., Dingel, A. B., Fabricant, P. D., Polousky, J. D., Anderson, A. F., Ganley, T. J. 2019

Abstract

Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in skeletally immature patients are increasingly recognized and surgically treated. However, the relationship between the footprint anatomy and the physes are not clearly defined. The purpose of this study was to identify the origin and insertion of the ACL and MCL, and define the footprint anatomy in relation to the physes in skeletally immature knees.Twenty-nine skeletally immature knees from 16 human cadaver specimens were dissected and divided into 2 groups: group A (aged 2 to 5y), and group B (aged 7 to 11y). Metallic markers were placed to mark the femoral and tibial attachments of the ACL and MCL. Computed tomography scans were obtained for each specimen used to measure the distance from the center of the ligament footprints to the respective distal femoral and proximal tibial physes.The median distance from the ACL femoral epiphyseal origin to the distal femoral physis was 0.30cm (interquartile range, 0.20 to 0.50cm) and 0.70cm (interquartile range, 0.45 to 0.90cm) for groups A and B, respectively. The median distance from the ACL epiphyseal tibial insertion to the proximal tibial physis for groups A and B were 1.50cm (interquartile range, 1.40 to 1.60cm) and 1.80cm (interquartile range, 1.60 to 1.85cm), respectively. The median distance from the MCL femoral origin on the epiphysis to the distal femoral physis was 1.20cm (interquartile range, 1.00 to 1.20cm) and 0.85cm (interquartile range, 0.63 to 1.00cm) for groups A and B, respectively. The median distance from the MCL insertion on the tibial metaphysis to the tibial physis was 3.05cm (interquartile range, 2.63 to 3.30cm) and 4.80cm (interquartile range, 3.90 to 5.10cm) for groups A and B, respectively.Surgical reconstruction is a common treatment for ACL injury. Computed tomography scanning of pediatric tissue clearly defines the location of the ACL and MCL with respect to the femoral and tibial physes, and may guide surgeons for physeal respecting procedures.In addition to ACL reconstruction, recent basic science and clinical research suggest that ACL repair may be more commonly performed in the future. MCL repair and reconstruction is also occasionally required in skeletally immature patients. This information may be useful to help surgeons avoid or minimize physeal injury during ACL/MCL reconstructions and/or repair in skeletally immature patients.

View details for DOI 10.1097/BPO.0000000000001398

View details for PubMedID 31166245

Pediatric ACL Tears: Natural History. Journal of pediatric orthopedics Dingel, A., Aoyama, J., Ganley, T., Shea, K. 2019; 39 (Issue 6, Supplement 1 Suppl 1): S47S49

Abstract

Increased participation in youth sports is associated with increased rates of anterior cruciate ligament (ACL) tears in the skeletally immature. Historically, ACL reconstruction was avoided in the skeletally immature, or delayed until skeletal maturity, to avoid physeal injury and growth disturbance. Current practices and meta-analyses support early ACL reconstruction in some groups, to allow for return to activities and to avoid delayed cartilage/meniscus injury.The purpose of this article was to report on the natural history of ACL injuries in the skeletally immature.A review of published literature on pediatric, skeletally immature ACL tears and conservative, nonoperative treatment was conducted via Pubmed articles published from 1970 to 2018. The search criteria included the key terms "anterior cruciate ligament," "pediatric" and/or "adolescent," and "conservative" and/or "nonoperative treatment." A PRISMA workflow was used to narrow down the articles to those relevant to our analysis and available in full text format.Multiple articles on the nonoperative treatment of the ACL showed secondary meniscal and cartilage damage at the time of follow-up. Some articles showed no difference between the rates of secondary injuries between the surgical and nonsurgical treatment groups; however, the nonsurgical treatment groups were often on significant activity modification. Some articles concluded that nonoperative treatment of the ACL tear may be appropriate in low risk, lower level activity patients, and those that will comply with activity restrictions. Even with bracing and PT programs, active athletes treated without surgery appear to have a concerning rate of secondary meniscus injury after the primary ACL injury event.The natural history of the ACL tear shows nonoperative treatment for the skeletally immature may be a viable treatment pathway for those who are able to comply with the physical activity restrictions. For the general population of young, active adolescents, an ACL injury treated nonoperatively often leads to secondary meniscal and/or cartilage damage, which may lead to knee degeneration and functional instability.

View details for DOI 10.1097/BPO.0000000000001367

View details for PubMedID 31169648

The Pediatric Orthopaedic Society of North America (POSNA) Adopts a Member Health and Wellness Charter. Journal of pediatric orthopedics Goldberg, M. J., Shea, K. G., Weiss, J. M., Carter, C. W., Talwalkar, V. R., Schwend, R. M. 2019; 39 (4): e241e244

Abstract

The Pediatric Orthopaedic Society of North America took actions to address the well-being of its members. The epidemic of physician burnout interferes with the delivery of high-quality care that our patients and families need and deserve, and at the same time places the care-providers at an increased risk of depression and suicide. The actions taken by Pediatric Orthopaedic Society of North America serve as a model for other professional medical societies to emulate.

View details for PubMedID 30839471

The Safe Distance to the Popliteal Neurovascular Bundle in Pediatric Knee Arthroscopic Surgery: An Age-Based Magnetic Resonance Imaging Anatomic Study. Orthopaedic journal of sports medicine Schachne, J. M., Heath, M. R., Yen, Y. M., Shea, K. G., Green, D. W., Fabricant, P. D. 2019; 7 (7): 2325967119855027

Abstract

The close proximity of the popliteal neurovascular bundle to the posterior horn of the lateral meniscus puts it at risk of compromise during lateral meniscal repair. This is particularly important in smaller pediatric patients, who are commonly treated for lateral meniscal abnormalities in isolation (discoid meniscus) or concomitantly with anterior cruciate ligament reconstruction.To quantify the distance between the posterior horn of the lateral meniscus and the popliteal neurovascular bundle along the path of meniscal repair and to investigate for associations with age, sex, height, weight, body mass index (BMI), and skeletal maturity.Cross-sectional study; Level of evidence, 3.A total of 144 magnetic resonance imaging scans were evaluated in a cohort of patients aged 10 to 18 years without meniscal or ligament abnormalities. Measurements were made along a line from the anterolateral portal between the popliteal neurovascular bundle and the free edge, midpoint, and meniscocapsular junctions of the posterior horn of the lateral meniscus. In addition to descriptive statistics of these distances by age and sex, analyses of variance and linear regression analyses were performed to investigate for associations with age, sex, height, weight, BMI, and skeletal maturity.Male participants had a significantly larger mean free edge distance (14.4 2.5 vs 13.1 2.5 mm, respectively; P = .005) and midpoint distance (9.6 2.2 vs 8.9 1.8 mm, respectively; P = .011) than female participants but not a significantly larger meniscocapsular distance (5.2 1.6 vs 4.6 1.4 mm, respectively; P = .096). Linear regression analyses revealed significant associations between these distances and age, height, weight, and BMI (P < .001 for all). There were statistically significant pairwise differences for free edge and midpoint distances to the neurovascular bundle between patients with open and closed physes.The distance between the posterior horn of the lateral meniscus and the popliteal vasculature along a trajectory from the standard anterolateral arthroscopic portal increases linearly throughout development between the ages of 10 and 18 years. There were also significant associations between height, weight, BMI, and skeletal maturity and these anatomic distances. Knowing the safe distance to the popliteal vasculature will increase the safety of arthroscopic lateral meniscal repair in children, especially with all-inside devices that require setting the penetration depth for the advancement of a sharp delivery device beyond the posterior capsule.

View details for DOI 10.1177/2325967119855027

View details for PubMedID 31321247

View details for PubMedCentralID PMC6624919

Quadriceps Tendon Graft Anatomy in the Skeletally Immature Patient. Orthopaedic journal of sports medicine Shea, K. G., Burlile, J. F., Richmond, C. G., Ellis, H. B., Wilson, P. L., Fabricant, P. D., Mayer, S., Stavinoha, T., Troyer, S., Dingel, A. B., Ganley, T. J. 2019; 7 (7): 2325967119856578

Abstract

The quadriceps tendon (QT) is increasingly considered for primary and revision anterior cruciate ligament reconstruction in skeletally immature patients, as it may be harvested as a purely soft tissue graft with considerable tissue volume. Because of distinct rectus tendon (RT) separation from the QT complex, the potential for RT retraction exists and could lead to QT weakness after QT graft harvest.To describe the anatomy of the pediatric QT and clarify decussation of the RT and QT to avoid the risk of delayed RT retraction and QT weakness after QT graft harvest.Descriptive epidemiology study.Nine cadaveric knee specimens (aged 4-11 years) underwent gross dissection. Coronal-plane width and depth of the QT were measured at intervals proximal to the superior pole of the patella at distances of 0.0, 0.5, 1.0, and 1.5 times the length of the patella. The distance was measured from the superior patellar pole to the point of RT separation from the remainder of the deeper/posterior QT.The median patellar length was 28 mm (interquartile range, 26-37 mm). The coronal-plane width of the QT was larger superficially/anteriorly when closest to the patella but wider when measured deeper/posteriorly as the tendon extended proximally. The median distance between the superior pole of the patella and RT separation from the QT was 0.95 times the patellar length. The distance to widening of the deeper/posterior aspect of the QT was 1.14 times the patellar length proximal to the patella.The RT begins a distinct separation from the QT above the superior pole of the patella at a median of 0.95 times the patellar length in skeletally immature specimens. The deeper/posterior aspect of the QT begins to increase in coronal-plane width proximally after a distance of 1.14 times the patellar length above the knee, while the superficial/anterior aspect of the tendon continues to narrow. Awareness of the separation of the RT from the QT, and the coronal-plane width variation aspects of the QT proximally, is important for surgeons utilizing the QT as a graft to avoid inadvertent release of the RT from the rest of the QT complex.

View details for DOI 10.1177/2325967119856578

View details for PubMedID 31321249

View details for PubMedCentralID PMC6624918

Identification of Areas of Epiphyseal Cartilage Necrosis at Predilection Sites of Juvenile Osteochondritis Dissecans in Pediatric Cadavers. The Journal of bone and joint surgery. American volume Toth, F., Tompkins, M. A., Shea, K. G., Ellermann, J. M., Carlson, C. S. 2018; 100 (24): 213239

Abstract

BACKGROUND: The pathogenesis of human juvenile osteochondritis dissecans (JOCD) remains poorly understood, with multiple factors implicated, including ischemia, repetitive trauma, and genetic predisposition. Similarities in the predilection site and the diagnostic and clinical features of JOCD to the well-characterized veterinary counterpart, osteochondrosis dissecans, suggest that, similar to the animal disease, the pathogenesis JOCD may also be initiated in the first few years of life, when disruption of blood supply to the epiphyseal growth cartilage leads to failure of endochondral ossification. To gather data in support of the hypothesis that JOCD and osteochondrosis dissecans have a shared pathogenesis, biopsy specimens obtained from predilection sites of JOCD in juvenile human cadavers were histologically examined to determine whether they contained lesions similar to those found in animals diagnosed with subclinical osteochondrosis dissecans.METHODS: In this descriptive laboratory study, 59 biopsy specimens (6 mm in diameter) were harvested from the central aspect (i.e., the notch side) of the femoral condyles of 26 human cadavers (1 month to 11 years old). Specimens were histologically evaluated for the presence of areas of cartilage necrosis and the morphology of cartilage canal blood vessels.RESULTS: Locally extensive areas of necrotic epiphyseal cartilage were identified in 4 specimens obtained from 3 donors (ages 2 to 4 years). Areas of cartilage necrosis accompanied by focal failure of endochondral ossification or surrounded by subchondral bone were identified in biopsy specimens from 4 donors (ages 4 to 9 years).CONCLUSIONS: The identification of epiphyseal cartilage necrosis identical to that described in animals with subclinical osteochondrosis, found in biopsy specimens obtained from femoral predilection sites of JOCD in pediatric cadavers, suggests a shared pathogenesis of JOCD in humans and osteochondrosis dissecans in animals.CLINICAL RELEVANCE: These findings imply that the pathogenesis of human JOCD likely starts 5 to 10 years prior to the development of clinical symptoms. Enhanced understanding of the temporal features of JOCD pathogenesis provides an opportunity for earlier diagnosis and treatment, likely resulting in improved outcomes for this condition in the future.

View details for PubMedID 30562294

Demographics and Epidemiology of Osteochondritis Dissecans of the Elbow Among Children and Adolescents ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Kessler, J. I., Jacobs, J. C., Cannamela, P. C., Weiss, J. M., Shea, K. G. 2018; 6 (12)
Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study. Journal of experimental orthopaedics Yen, Y., Fabricant, P. D., Richmond, C. G., Dingel, A. B., Milewski, M. D., Ellis, H. B., Wilson, P. L., Mayer, S. W., Ganley, T. J., Shea, K. G. 2018; 5 (1): 50

Abstract

PURPOSE: Meniscal repair has become increasingly common in a pediatric and adolescent population. All-inside repair techniques are utilized more often given their ease of insertion and decreased operative time required. However, there are possible risks including damage to adjacent neurovascular structures. The purpose of this study to was examine the proximity of the neurovascular structures during lateral meniscus repairs in pediatric specimens simulating a worst-case scenario.METHODS: Ten pediatric cadaveric knees (age 4-11) were utilized and simulated lateral meniscal repair through the posterior horn of the lateral meniscus and both medial and lateral to the popliteal hiatus through the body of the lateral meniscus was performed with an all-inside meniscal repair device. The distance to the popliteal artery or peroneal nerve was measured.RESULTS: During posterior horn repair, the average distance from the all-inside device to the popliteal artery was 1.9mm1.1mm. There was penetration of the artery in one specimen. During repair on the medial side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 3.2mm2.0mm. During repair on the lateral side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 12.4mm3.7mm.CONCLUSIONS: This study demonstrates that the proximity of the neurovascular structures to the lateral meniscus in children is extremely close and at high risk during meniscal repair with all-inside devices. This study gives important data for the proximity of these structures during these repair techniques.LEVEL OF EVIDENCE: Level 5 Cadaveric Study.

View details for PubMedID 30564981

The Pediatric Orthopaedic Society of North America (POSNA) Adopts a Member Health and Wellness Charter. Journal of pediatric orthopedics Goldberg, M. J., Shea, K. G., Weiss, J. M., Carter, C. W., Talwalkar, V. R., Schwend, R. M. 2018

Abstract

The Pediatric Orthopaedic Society of North America took actions to address the well-being of its members. The epidemic of physician burnout interferes with the delivery of high-quality care that our patients and families need and deserve, and at the same time places the care-providers at an increased risk of depression and suicide. The actions taken by Pediatric Orthopaedic Society of North America serve as a model for other professional medical societies to emulate.

View details for PubMedID 30418384

Management of Osteochondritis Dissecans of the Femoral Condyle: A Critical Analysis Review. JBJS reviews Chan, C., Richmond, C., Shea, K. G., Frick, S. L. 2018; 6 (3): e5

View details for PubMedID 29557795

Incidence of Meniscal Entrapment and Associated Knee Injuries in Tibial Spine Avulsions Journal of Pediatric Orthopaedics Rhodes, J. T., Cannamela, P. C., Cruz, A. I., Mayo, M., Styhl, A. C., Richmond, C. G., Ganley, T. J., Shea, K. G. 2018; 38 (2): e38-42

Abstract

Osteochondritis dissecans (OCD) of the elbow is a disorder of subchondral bone and articular cartilage, of which the incidence among children is not clearly known.To assess the demographics and epidemiology of OCD of the elbow among children.Cross-sectional study; Level of evidence, 3.A retrospective chart review of an integrated health system for the years 2007 through 2011 was performed for patients with elbow OCD aged 2 to 19 years. Lesion location, laterality, and all patient demographics were recorded. OCD incidence was determined for the group as a whole as well as by sex and age group (2-5, 6-11, 12-19 years). Patient differences based on age, sex, and ethnicity were analyzed, and multivariable logistic regression models were used to assess the risk of elbow OCD by group.A total of 37 patients with 40 OCD lesions fit the inclusion criteria. No lesion was found among 2- to 5-year-olds. A majority of lesions (n = 39, 97.5%) were in the capitellum, and 1 (2.5%) was in the trochlea. Twenty-five patients (67.6%) had right-sided lesions; 9 (24.3%), left-sided; and 3 (8.1%), bilateral. The incidence of elbow OCD for patients aged 6 to 19 years was 2.2 per 100,000 overall and 3.8 and 0.6 per 100,000 for males and females, respectively. The majority of OCD cases were seen in those aged 12 to 19 years, with an incidence of 3.4 per 100,000 versus 0.38 among 6- to 11-year-olds. Multivariable logistic regression analysis revealed a 21.7-times increased odds ratio of elbow OCD among patients aged 12 to 19 years versus 6 to 11 years, and males had a 6.8-times greater odds ratio of elbow OCD than females (P < .0001 for both). Based on race and ethnicity, non-Hispanic whites had the highest incidence of elbow OCD as compared with all other ethnic groups.In this population-based cohort study of pediatric elbow OCD, males had almost 7 times the risk of elbow OCD as compared with females, and 12- to 19-year-olds had nearly 22 times the risk of elbow OCD versus 6- to 11-year-olds. In keeping with many prior studies, the majority of patients had right-sided lesions.

View details for PubMedID 30622996

All-Epiphyseal Double Bundle PCL Reconstruction- Femoral Tunnel Drilling J ISAKOS Richmond, C. G., Cannamela, P. C., Polousky, J. D., Ganley, T. J., Shea, K. G. 2018

View details for PubMedID 28973607

Avoiding Tibial Physeal Injury During Double Bundle Posterior Cruciate Ligament Recontruction J ISAKOS Troyer, S., Anchustegui, N., Richmond, C. G., Cannamela, P., Dingel, A., Stavinoha, T., Ganley, T., Anderson, A., Shea, K. G. 2018; 3 (1)

View details for DOI 10.1080/00913847

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