Objective: Compare nonoperative treatment options in juvenile osteochondritis dissecans (OCD) lesions of the medial femoral condyle. Design: Descriptive, retrospective cohort study. Setting: Single academic pediatric tertiary referral center. Patients (or Participants): Male/female patients ages 0 to 18 evaluated in the sports/orthopedic ambulatory setting who were found to have OCD lesions in the medial femoral condyle. Interventions (or Assessment of Risk Factors or Independent Variables): Cast immobilization, hinged knee brace locked into extension, and activity modification. Main Outcome Measures: Nonoperative treatment effectiveness between the 3 groups was evaluated by radiographic healing and symptom resolution, with failure defined as progression to surgery. Results: A total of 148 patients with 168 MFC JOCD lesions of the knee were identified. Median age was 11 years old. Patients were 65.5% male and 77% participated in sports. Sixty-two (37%) lesions were treated in a HKB locked into extension, 55 (32%) were casted in a cylinder cast, and 51 (31%) were treated with activity modification alone. Approximately 19% of HKB locked into extension, 22% of casted MFC JOCD, and 16% of activity-modified MFC JOCD lesions progressed to surgery. At 6 months, 76% of the HKB locked into extension, 71% of the cylinder cast, and 71% of the activity modification group had resolution of clinical symptoms and returned to activity. Conclusions: MFC JOCD lesions of the knee can be appropriately treated with a HKB brace locked in extension, cast, or activity modification with consistent success rates. Clinical Relevance: This study provides practical evidence regarding conservative management of MFC JOCD lesions. Level of Evidence: III.
Objective: To report a case of traumatic iliopsoas tendon avulsion with displacement exceeding the commonly cited 2-cm surgical threshold, managed successfully without surgery, and to systematically review the literature on optimal treatment and return-to-sport outcomes. Design: Case report combined with a PRISMA-compliant systematic review of PubMed, Cochrane Library, and Embase. Setting: Level I university trauma center; systematic review of published case reports and series. Participants: A 16-year-old male competitive soccer player (index case) and 58 additional patients from the literature, predominantly adolescent males with sports-related iliopsoas avulsion. Interventions: The index patient received conservative treatment with staged weight bearing and structured physiotherapy. Across the literature, 90% (52/58) were treated conservatively and 10% operatively. Main Outcome Measures: Clinical recovery, strength restoration, radiographic union on MRI, and return to sport. Results: Eighteen studies (58 patients; 59 including this case) were analyzed. A bony lesser-trochanter avulsion was present in 98% (57/58). Of at least 9 patients with displacement >2 cm, 5 recovered fully nonoperatively. The index patient was pain-free with full strength and unrestricted soccer return at 3 months; 6-month MRI showed radiographic nonunion despite complete functional recovery. Return to sport approached 100%, typically within 10 to 12 weeks. Conclusions: Available very low-certainty evidence suggests that nonoperative management can achieve favorable clinical recovery and return to sport after traumatic iliopsoas avulsion, including in some cases with displacement greater than 2 cm. Return-to-sport decisions may reasonably prioritize restored, pain-free function over radiographic union, but larger prospective studies are needed.
Objective: Patellofemoral pain syndrome (PFPS) is common among runners and is linked to biomechanical dysfunctions that increase patellofemoral joint stress. Gait retraining has been proposed to redistribute this loading, but the effectiveness of different retraining strategies and their long-term impact remain unclear. This scoping review synthesizes existing evidence on gait retraining strategies for PFPS, focusing on pain, function, and biomechanics. Data Sources: MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science were searched, following the methodological framework of the Joanna Briggs Institute for scoping reviews. Studies investigating gait retraining interventions in runners diagnosed with PFPS were included. Key outcomes were pain reduction, functional improvement, biomechanical adaptations, and adverse effects. Main Results: Three randomized controlled trials met the inclusion criteria, examining cadence modification, impact reduction, and foot strike adjustments. Intervention groups experienced significant pain reduction, with Visual Analog Scale scores improving by 2 to 4 points, alongside functional gains reflected by increased Kujala and Knee Outcome Survey of the Activities of Daily Living Scale scores. Biomechanical adaptations included decreased patellofemoral joint stress, lower impact forces, and improved load distribution. Some participants reported transient calf discomfort during the adaptation period, which resolved over time. Conclusions: Gait retraining is an effective intervention for runners with PFPS, showing sustained pain relief, functional improvement, and biomechanical benefits. Individualized protocols and gradual implementation are essential to optimize outcomes and minimize discomfort. Future research should address long-term retention of gait modifications, optimal training parameters, and applicability beyond runners.
Objective: To evaluate the association between skeletal maturity and the anatomical distribution of sports-related lower extremity overuse pain in young athletes. Design: Retrospective observational cohort study. Setting: Single-center sports medicine clinic. Patients/Participants: A total of 2565 clinical episodes of sports-related lower extremity overuse pain in athletes aged ≤22 years presenting between January 2017 and November 2025. Independent Variables: Skeletal maturity classified according to physeal status (open vs closed). Main Outcome Measures: Anatomical region of overuse pain at presentation. Anatomical distributions were compared between physeal groups, and multinomial logistic regression adjusted for sex and sport type evaluated associations between physeal status and anatomical presentation. Results: Overall anatomical distribution differed significantly according to skeletal maturity ( P < 0.001). Although the knee was the most common anatomical region in both groups, athletes with open physes demonstrated relatively greater knee, pelvic girdle, and foot involvement, whereas athletes with closed physes demonstrated relatively greater ankle and lower-leg involvement. In adjusted multinomial logistic regression analyses, open physeal status was independently associated with a greater relative likelihood of foot (relative risk ratio [RRR], 2.65; 95% confidence interval [CI], 1.95-3.61), knee (RRR, 2.45; 95% CI, 1.84-3.27), and pelvic girdle (RRR, 2.25; 95% CI, 1.59-3.20) presentations compared with ankle presentations. These associations remained consistent after additional adjustment for chronological age. Conclusions: Skeletal maturity was associated with differences in anatomical distribution of sports-related lower extremity overuse pain. These findings suggest that skeletal maturity may influence where repetitive sport-related loading becomes clinically expressed and may improve the clinical interpretation of regional overuse pain in young athletes. Clinical Relevance: Considering skeletal maturity when evaluating regional overuse pain may improve the clinical interpretation of sports-related lower extremity pain in young athletes.
