Arthroscopic surgery in children.

Arthroscopic surgery for children and adolescents is developing fast, thanks to technical progress in adult arthroscopy, improved knowledge of child joint disorders, and instrument miniaturization. The specificity of arthroscopy in children lies, on the one hand, in the small joint size and, on the other, in the presence of neighboring growth plates. There also exist specific pathologies as well as differences in indications in pathologies common to children and adults. These specificities need to be known, and adapted techniques and equipment require to be used, given which arthroscopy is feasible even in infants. Growth plate must be respected, and the residual growth of the operated segment (e.g., in knee ligament reconstruction) needs to be known. Joint decoaptation often does not require traction, and any stress maneuvers (valgus/varus) need to be gentle. The knee is by far the most frequently implicated joint in child arthroscopy, partly due to a rise in sports injuries. There is a variety of traumatic pathologies (osteochondral or meniscal/ligament tears, etc.) and of indications. Arthroscopy in children is safe, given awareness of these indications and respect of certain precautions. The advantages over conventional open surgery are the same as in adults: simpler postoperative course, faster functional recovery and better esthetic result. Arthroscopy will continue to develop in pediatrics in coming years. Copyright 2010 Elsevier Masson SAS. All rights reserved.