Introduction: The treatment of Anterior Cruciate ligament (ACL) reconstruction in skeletally immature athletes is still a topic of debate. Methods: This was a retrospective study., Thirty Four athletes who underwent transphyseal ACL reconstruction using a hamstring tendon graft with a minimum follow-up of 3 years were included in the study. All patients were evaluated for functional outcomes and deformities at the final follow-up. Results: Mean age at the time of the surgery was 13.8±0.79 years. Mean follow-up of 64.88± 23.91 months. The mean Lysholm score was 96.47± 5.04 and mean tegner activity score was 8.1 (pre-injury was 8.3). 79% of patients returned to same level of sports, with mean time to return to sports was 7.20±6.79 months. 3/34 patients had re-injury of graft and none of the patients had any angular deformity or limb length discrepancy. Conclusions: Transphyseal ACL reconstruction shows satisfactory results without any growth disturbances in skeletally immature athletes having ACL tear.

Introduction: Anterior knee symptoms are a recognised complication of ACL reconstruction. Aim of this study was to compare anterior knee symptoms after ACL reconstruction using Hamstring auto graft and patellar BTB graft with two incision technique. Methods: We performed a review of prospectively collected data on patients who underwent an ACL reconstruction between 2012 and 2016. Outcome of interest were prevalence of anterior knee pain and sensory disturbance in infra-patellar nerve distribution. Secondary outcomes were IKDC and Lysholm scores. Results: 82 patients were eligible for the study. 50 patients (av. Age 37.5 yrs) had patellar BTB graft while 32 patient (av. Age 35.6 yrs) had hamstring autograft. Anterior knee pain was reported in 2 patients in PBTB group as compared to 5 in HS group. Sensory disturbance was reported in 8 pts with PBTB in comparison to 4 in HS group. Knee walking test was normal in 14/50 pts with PBTB graft while 20/50 reported it as unpleasant. 13/50 and 1/50 reported difficult and impossible respectively. In Hamstring group 22/32 pts reported normal knee walking test while 7/32 felt it unpleasant, 1/32 difficult and 2/32 were unable to perform the test. There were no statistical difference in IKDC or Lysholm scores at 1 year. Conclusion: ACL reconstruction using patellar-BTB graft with 2 incision technique does not increase the risk of anterior knee pain during normal activities but should be used with caution in patients involved in significant kneeling activities.

Purpose: The aim of the study was to evaluate the effect of graft size on functional outcome, instability tests, and the risk of revision surgery following anterior cruciate ligament (ACL) reconstruction.

Methods: This is a prospective comparative study of 144 consecutive patients undergoing primary ACL reconstruction using hamstring auto-graft. All patients underwent graft harvesting and ACL reconstruction with the standard technique. Preoperative examination findings, Knee Injury and Osteoarthritis Outcome Score(KOOS), and Knee society score( KSS) were recorded. Graft diameter was recorded intraoperatively using a graft sizer. All patients were followed up with KOOS, KSS, and instability tests recorded at 6weeks, 6month, 1year, and 2 years and whether the patient underwent revision during this period.

Results: The mean KOOS and KSS of patients with ≤7mm were 80.5±13.1 and 79.5 ±13.1 which was significantly lower compared to those with graft >7mm of 88.3±8.5 and 88.5±6.5 respectively (p<0.001). The revision was required in 3 of 13 (23.4%) with graft ≤7mm, 5 out of 87( 5.7%) with graft 7.1 to 8, 1 of 38(2.6%) with graft 8.1-9mm, and 0 of 6 with graft diameter >9mm with statistically significant difference (p=0.027). 53.8% with patients graft ≤7mm had a positive anterior drawer and Lachman test when compared to 13.7% with >7mm at the end of 1 year.

Conclusions: Smaller hamstring autograft size is a predictor not only poorer KOOS and KSS but also significantly increases the risk of revision surgery.
Level of Evidence: Level II, prospective comparative study

Establishing the correlation of ACL injury with various anatomical factors could help in identifying at-risk individuals. The purpose of this study is to assess the correlation of tibial parameters such as medial posterior tibial slope(MPTS), lateral posterior tibial slope(LPTS), posterior tibial slope(PTS), and medial tibial plateau depth(MTPD)with ACL injuries.
Methods:
This randomized controlled consisted of 426 subjects with noncontact injury to the knee. By using stratified systematic random sampling, they were randomly divided into 2 equal groups of 60 each, i.e the ACL tear group, and the control or the ACL intact group based on clinical and MRI findings. The blinded assessor measured MPTS, LPTS, MTPD in MRI and PTS in lateral knee x-ray and compared between groups using appropriate statistical methods.
Results: The ACL tear group had a higher mean MPTS, LPTS, and PTS when compared to the control group (p<0.01). MTPD was lower in the ACL tear group when compared to the control (p<0.05). The ROC analysis of the parameters for predicting the ACL tear was done and the AUC for MPTS, LPTS, PTS, and MTPD was 0.883, 0.861, 0.885, and 0.152 respectively. The critical angle for MPTS, LTPS, PTS and MTPD was 8°,6.75°,8.32° and 2.5mm respectively which has sensitivity of 83.3%, 81.4%, 88.3% and 30%; specificity of 81.7%, 73.3%, 83.9% and 23.3% respectively.
Conclusion: MPTS, LPTS, and PTS are better predictors of identifying at-risk individuals predisposed to ACL injury than MTPD, and a multicentre study involving different races is recommended to use these parameters as screening tool.

Introduction: Pedicle screw malposiotion can lead to complications in severe deformity surgery. As intraoperative navigation is not always available, 3D printing technology can serve as an effective alternative. Materials and methods: A prospective study of surgical treatment of 76 patients with severe spinal deformities was performed. Patients were divided into 2 groups. Group I patients (N39) underwent standard preoperative planning, while in group II (N37) pre-manufactured full-scale 3D-models of the patients’ spines were used. For better visualization of screw trajectories, Kirschner wires were introduced into model pedicles with labels indicating pedicle and screw dimensions. The models were sterilized. Results: Analysis included data on speed of screw introduction and postoperative CT screw malposition assessment. Screw malposition was judged as follows: grade A – no malposition, B – <2 mm, C – 2-4 mm, D - >4 mm. In group I, a total of 736 pedicle screws were evaluated, of which 558 (75.8%) were introduced correctly, and 178 (24.2%) – with malposition: B – 76 (10.3%), C – 72 (9.8%), D – 30 (4.1%). In group II, out of 685 pedicle screws, 661 (96.5%) had intrapedical localization, and 24 (3.5%) were malpositioned: B – 18 (2.6%), C – 6 (0.9%), D – none. Group I average screw introduction time was 135 s, in group II – 79 s (p <0.05). Conclusion: 3D models in preoperative planning and intraoperative visualization allow to increase the speed and accuracy of freehand pedicle screw introduction, reducing the malposition risk and damage to neural structures.

Introduction: Scoliosis is a complex three-dimensional deformity involving the spine and pelvis. Sagittal parameters are unique to each individual and important for maintaining a stable posture. The impact of scoliotic deformity in the sagittal plane has not been fully investigated.
Objective: To analyze the parameters of coronal and sagittal balance in patients with adolescent idiopathic scoliosis requiring surgery.
Results: case series of 40 patients reviewed retrospectively at the Dr. José Renán Esquivel Children´s Hospital in Panama City with newly diagnosed adolescent idiopathic scoliosis requiring surgery. 87.5% were female. Mean age of 12.9 years. 40% were Lenke 1 with right thoracic curve pattern. Risser classification showed skeletal maturity (>4) in 57.5%. Thoracic Cobb angle: 55.46 ± 16.04 ° and lumbar cobb angle: 54.54 ± 15.26 °. Thoracic kyphosis: 22.1 ° ± 11.7 °. Pelvic obliquity: 2.2 ° ± 1.46 °. Pelvic incidence: 52.07 ° ± 7.19 °. Pelvic tilt: 8.24 ° ± 4.77°. Sacral slope: 38.38 ° ± 5.79 °. L4 tilt: 70% left type. No significant leg length discrepancy reported.
Conclusion: Sagittal balance in adolescent idiopathic scoliosis evaluation should play a key role in improving surgical planning. Patients with adolescent idiopathic scoliosis showed evidence of increased pelvic tilt and decreased thoracic kyphosis compared to normal pediatric population.
Key words: Sagittal balance, adolescent idiopathic scoliosis, coronal balance.

Introduction: Accurate prediction of operative duration is necessary for efficient operating room scheduling, minimizing surgical cancellations, shortening surgical waitlists, better risk stratification and effective preoperative counselling.
Materials and Methods: Hospital records of 130 AIS patients who underwent PSF at a single centre were retrospectively reviewed. All cases were operated upon by a single surgeon. Various patient-specific, procedure-specific and surgeon-specific variables – deemed to be possibly affecting the operative duration – were documented and analysed. The association between each variable and the operative duration was assessed as a part of bivariate analysis. A multivariate regression model was used to identify independent predictors of operative duration. The association between operative duration and selected early postoperative outcome measures was determined.
Results: The final model obtained from the multivariate regression analysis included the following factors: experience of the chief surgeon (β = -0.36; β = standardized regression coefficient), Cobb angle of the major structural curve (β = 0.35), number of screws inserted (β = 0.28), coronal deformity angular ratio (C-DAR) (β = 0.20) and extension of the construct to pelvis (β = 0.15). The model could explain 41% of variability in the operative duration (R2 = 0.41). The operative duration had a significant correlation with estimated blood loss, need for perioperative blood transfusion and LOS.
Conclusions: A set of variables which predict the variability in operative duration during PSF for AIS was identified - with experience of the chief surgeon and severity of the curve being the strongest predictors.

Aim of study was to determine 3D-prototyping technology significance use for the surgical correction of congenital spinal deformities and the treatment of patients with spinal injuries. Materials and methods: prospective sequential comparative study was performed in Belorussian Scientific-Practical Center of Traumatology and orthopedics in 2018-2020 years. The first experience of using the method of 3D-design and prototyping is presented for twelve patients with spine injuries and congenital spine deformities. During the diagnosis and preoperative examination, we used the created models of the deformed spine in the form of copies, made according to the data of spiral X-ray computed tomography on a 3D printer from a plastic material.
Results: The use of the created models of the deformed and injured parts of the spine made it possible to additionally visualize and touch pathological objects in their natural sizes, to realistically assess the anatomical features and parameters of the interested vertebral segments and the altered spinal canal, which provided significant constructive assistance in planning surgical intervention and its immediate technical implementation.
Conclusions: The first experience gained during the use of 3D prototyping at the stage of preoperative diagnosis of patients with spine injuries and congenital spine deformities allowed visually assess the anatomical features and parameters of the vertebrae with the spinal and radicular canals, as well as to clarify the necessary parameters of the instrumentation with the definition of a safe zone of their implantation, thereby reducing operational risks and optimizing the surgical treatment of patients with injuries and congenital spine deformities.

Introduction: The aim of the study was to analyze the clinical, functional and radiological outcomes of lumbosacral fusion in patients affected by scoliosis with lysis or/and listhesis and prognosticate the scoliotic behaviour based on them.

Methods: Clinical profile, Radiographic measurements and Functional outcomes were analysed and compared between preoperative and post-operative indices calculated at 2 years following the procedure. The outcomes were analysed amongst 3 groups (Olisthetic-Group-1, Sciatic-Group-2, and Idiopathic-Group-3).

Results: 18 adolescent patients were enrolled in the study (16 females, 2 Males). The study groups included Olisthetic (7 Females), sciatic (4 Females) and Idiopathic (7 patients- 5 Females: 2 Males). Preoperative Lumbar curve severity, Coronal decompensation and Lumbar lordosis were significantly different between the groups. The mean preoperative lumbar curve of 51.14±15.49 (Group-1) reduced to 41.157±18.96 following lumbosacral fusion. The mean preoperative lumbar curve of 31±7.78 (Group-2) reduced to 16±3.91 and increased from 36.33±10.65 (Group-3) to 44.66±9.97 following lumbosacral fusion. The mean preoperative ODI scores were 50.8±6.8% (olisthetic group), 27.5±9.57% (sciatic group) and 46.57±11.42% (idiopathic group) and a significant difference was noted between sciatic and other groups (p-value =.016). The mean postoperative scores were 6.57±2.22% (olisthetic group), 1.5±1.91% (sciatic) and 6±3.26% (idiopathic) with a significant difference between sciatic and other groups (p value=0.027).

Conclusion: Three specific patterns of scoliosis need to be identified to prognosticate progression/regression of scoliosis following lumbosacral fusion. Not all patterns behave in the same way following lumbosacral fusion. Sciatic curves respond well compared to moderate reduction in olisthetic curves whereas idiopathic curves show progression.