Clinical Features and Evaluation

Physical examination of the pediatric knee follows the same general guidelines as that of the adult. Observation should document any skin injury and should record the presence and relative size of an effusion. Active and passive range of motion should be recorded. Stability should be evaluated with anterior and posterior drawer, Lachman, pivot-shift, and dial tests and varus/valgus stress at 0 and 30 degrees. A complete neurovas-cular examination should be performed.

Imaging studies should include a plain radiographic series to identify the occasional tibial spine fracture presenting as an intrasubstance ACL injury. Varus or valgus stress radiographs may be useful, as femoral physeal fractures can mimic ligamen-tous injuries to the knee. MRI has been criticized for high false-positive and false-negative rates in pediatric populations, but with modern techniques, MRI can be valuable in confirming a clinical diagnosis of ACL rupture, identifying osteochondral injury, and diagnosing concomitant meniscal pathology.23,36

The most important part of the pediatric workup is determination of skeletal maturity. Multiple methods can be used, including Tanner staging, radiographic bone age using the radiographic atlas of Greulich and Pyle, and determination peak height velocity.29,37,38 Additionally, onset of menses is an important historical component when treating adolescent females, as it heralds an end to skeletal growth. As no single method is 100% accurate, it may be best prudent to use more than one technique prior to making establishing a definitive treatment plan.

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Fire Up Your Core

Fire Up Your Core

If you weaken the center of any freestanding structure it becomes unstable. Eventually, everyday wear-and-tear takes its toll, causing the structure to buckle under pressure. This is exactly what happens when the core muscles are weak – it compromises your body’s ability to support the frame properly. In recent years, there has been a lot of buzz about the importance of a strong core – and there is a valid reason for this. The core is where all of the powerful movements in the body originate – so it can essentially be thought of as your “center of power.”

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