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Kocher, Mininder

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Kocher

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Mininder

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Kocher, Mininder
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    Comparison of Lower Extremity Recovery After Anterior Cruciate Ligament Reconstruction With Transphyseal Hamstring Versus Extraphyseal Iliotibial Band Techniques in Skeletally Immature Athletes
    (SAGE Publications, 2018) Sugimoto, Dai; Heyworth, Benton; Collins, Sara E.; Fallon, Ryan T.; Kocher, Mininder; Micheli, Lyle
    Background: The influence of graft type on recovery after anterior cruciate ligament reconstruction (ACLR) has not been adequately studied in pediatric patients. Purpose: To describe lower extremity functional recovery parameters at the 6-month mark after ACLR across 3 distinct groups of skeletally immature patients: pediatric male patients with transphyseal hamstring grafts (PM-HS), pediatric female patients with transphyseal hamstring grafts (PF-HS), and pediatric male patients with extraphyseal iliotibial band grafts (PM-ITB). Study Design: Cohort study; Level of evidence, 3. Methods: Thigh circumference, knee range of motion, lower extremity strength, dynamic balance, and hop test performance were assessed in all patients 6 months postoperatively. All participants were ≤15 years of age with open physes. The limb symmetry index was used to compare deficits between the operated and uninvolved limbs for all 3 groups (PM-HS, PF-HS, and PM-ITB). Analysis of variance with post hoc correction was employed. Results: A total of 93 pediatric patients who underwent ACLR (PM-HS: n = 21 [mean age, 13.6 ± 1.0 years]; PF-HS: n = 33 [mean age, 13.4 ± 0.7 years]; PM-ITB: n = 39 [mean age, 12.5 ± 1.3 years]) were examined. There was no statistically significant difference in thigh circumference, range of motion, dynamic balance, or hop test performance between the groups. Of the various additional comparisons analyzed, there were statistical differences in hamstring strength deficits among the 3 groups (P = .004). The PM-HS group showed a greater hamstring strength deficit (–32.2% relative to healthy limb) than the PM-ITB group (–5.4% relative to healthy limb) (P = .012). The hamstring strength deficit of the PF-HS group (–18.7% relative to healthy limb) was less than that of the PM-HS group and greater than that of the PM-ITB group but not statistically significant in either case. Conclusion: Significant hamstring strength deficits were detected in the PM-HS group compared with the PM-ITB group at 6 months following ACLR. Such findings may influence decisions regarding graft selection, timing of return to sports, and postoperative rehabilitation regimens.
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    The effects of medial synovial plica excision with and without lateral retinacular release on adolescents with anterior knee pain
    (Springer Berlin Heidelberg, 2016) Kramer, Dennis; Kalish, Leslie; Abola, Matthew V.; Kramer, Elizabeth M.; Yen, Yi-Meng; Kocher, Mininder; Micheli, Lyle
    Objectives: To describe the functional outcomes in patients aged ≤18 years with anterior knee pain treated with medial plica excision with or without lateral release. Methods: We identified 135 patients including 30 bilateral cases (165 knees) with a mean ± SD age of 15.1 ± 2.0 years. Patient and surgical information was recorded and a follow-up athletic questionnaire and an International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form were sent out. Statistical analysis evaluated predictors of residual pain, reoperation, return to sports, IKDC score and satisfaction with surgery. Results: At a final mean follow-up of 4.4 years (range 2–7.5), 36 % of patients were pain free, 46 % had mild residual pain and 18 % had pain not improved from surgery. Reoperation was more likely following isolated plica excision (7/41; 17 %) versus plica excision with lateral release (8/124; 6 %), although not statistically significant, P = 0.06. Mean IKDC score (107 knees) was 76.9 ± 17.8 (range 31–100). Most patients (86/99; 87 %) were satisfied with surgery and were able to return to sports (104/120; 87 %). Conclusions: While most patients were satisfied and able to return to sports following plica excision with or without lateral release, residual symptoms were common.
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    AOSSM Early Sport Specialization Consensus Statement
    (SAGE Publications, 2016) LaPrade, Robert F.; Agel, Julie; Baker, Joseph; Brenner, Joel S.; Cordasco, Frank A.; Côté, Jean; Engebretsen, Lars; Feeley, Brian T.; Gould, Daniel; Hainline, Brian; Hewett, Timothy E.; Jayanthi, Neeru; Kocher, Mininder; Myer, Gregory D.; Nissen, Carl W.; Philippon, Marc J.; Provencher, Matthew T.
    Background: Early sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits. Purpose: To review the available evidence on early sports specialization and identify areas where scientific data are lacking. Study Design: Think tank, roundtable discussion. Results: The primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success. Conclusion: Youth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired.