Latest pediatric orthopedics research

New pediatric orthopedic evidence from the weekly pipeline — hottest first.

Journal of Pediatric Orthopaedics IF 1.7 Jul 22 2026 LoE III Full text read

Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care

This retrospective cohort study from a single pediatric tertiary center compared 65 children under 16 who needed surgery for relapsed clubfoot after initial Ponseti treatment, 14 of whom received presurgical serial casting versus 51 who went straight to surgery. The casting group had a larger drop in surgical complexity from waitlist to actual surgery (40.0% reduction) versus the non-casting group (1.9% reduction, P=0.001), and fewer high-complexity surgeries (53.3% vs 80.6%, P=0.004). The study also found Indigenous children were overrepresented among relapse cases and lived far from the treatment center, and orthosis noncompliance was common.

AI summary · from the full text

Why it mattersRelapse surgery for clubfoot is a common, burdensome pediatric orthopedic problem, and this hypothesis-generating cohort suggests presurgical casting might reduce surgical extent, but the small nonrandomized sample means it cannot yet change practice.

CohortPedsn = 123DOI ↗

Presenting this at rounds? Start here

?Given that casting group assignment was based on unstandardized surgeon preference and the two groups differed in waitlist complexity and physiotherapy involvement, how much of the observed complexity reduction could be due to selection or regression to the mean rather than a true casting effect?
?If you were setting up a relapsed clubfoot pathway, would this preliminary retrospective data be enough to justify adding presurgical serial casting for all patients, given the added time to surgery and resource burden?

Rigor × clinical importance

Rigor16Clinical54

Weak29

The American Journal of Sports Medicine IF 4.5 Sep 9 2026 LoE III Full text read

Patella Alta and Trochlear Dysplasia as a Determinant of Patellar Tendon Lateralization and Inclination: A Cross-sectional MRI Study in Adolescents With Patellofemoral Instability

This retrospective case-control MRI study compared 142 adolescent knees with surgically treated patellofemoral instability (PFI) to 142 age/sex-matched controls, measuring two soft-tissue-based markers of patellar tendon alignment: the previously described patellar tendon-lateral trochlear ridge distance (PT-LTR) and a newly proposed patellar tendon inclination angle (PTIA). Both measures were markedly higher in PFI knees than controls (PT-LTR 9.76 vs 0.61 mm; PTIA 22.76° vs 11.09°, both P<.001), correlated with established risk factors like patella alta, trochlear dysplasia, and TT-TG distance, and showed good diagnostic accuracy (AUC 0.90 and 0.87, respectively) for distinguishing PFI from controls.

AI summary · from the full text

Why it mattersIntroduces a new, easily measured MRI angle (PTIA) that may add diagnostic information about patellar tendon malalignment beyond standard bony measurements like TT-TG in adolescents being worked up for patellofemoral instability.

CohortPedsn = 20DOI ↗

Presenting this at rounds? Start here

?If PTIA and PT-LTR are elevated in a patient with a normal TT-TG distance, should that change how aggressively you counsel about surgical stabilization versus bracing/physical therapy for patellofemoral instability?
?Given that patella alta and trochlear dysplasia both independently raise PT-LTR and PTIA, how might these tendon-based measurements influence your choice of concomitant procedures (e.g., tibial tubercle osteotomy, trochleoplasty) alongside MPFL reconstruction?

Rigor × clinical importance

Rigor22Clinical50Editorial48

Weak22