Newsweek, in partnership with Statista, evaluated leading hospitals across seven care specialties: cancer, cardiac, endocrine, gastrointestinal, neurological, orthopedic and pulmonary. Rankings are based on a comprehensive methodology that includes a nationwide survey of medical professionals and hospital managers, patient experience data, patient-reported outcome measures, and specialty-specific safety and quality measures.

In another newly released Newsweek ranking, Lerner Children’s Pavilion at HSS was named among “America’s Best Children’s Hospitals” for pediatric orthopedics.

“When faced with a complex medical challenge, choosing the right hospital and specialist is one of the most important decisions patients and families can make,” said Bryan T. Kelly, MD, MBA, HSS president, CEO and surgeon-in-chief emeritus. “This recognition reflects the extraordinary expertise and dedication of our HSS colleagues, who are committed to delivering the highest standards of evidenced-based, compassionate patient care.”

“This honor underscores the clinical excellence and collaborative approach that define care at HSS,” said Douglas E. Padgett, MD, surgeon-in-chief at HSS. “Our teams are continually advancing innovation, elevating patient outcomes, and providing highly individualized, expert care to every patient we serve.”

HSS is consistently ranked as a top hospital for the diagnosis and treatment of musculoskeletal conditions by leading ratings organizations. Patients travel to HSS from all 50 states and more than 100 countries, often seeking care for complex cases and specialized surgical procedures. The institution’s ongoing dedication to research, quality improvement, and knowledge-sharing continues to position HSS as a thought leader in musculoskeletal health.

What follows are highlights from these studies:

Use of Imaging to Identify Alignment Issues in Pre-Pubertal Children After ACL Reconstruction

A new multi-center prospective study from researchers at HSS evaluated two specialized surgical reconstruction techniques commonly used to treat ACL injuries by restoring knee stability while minimizing risks of growth disturbances in children with open growth plates (skeletally immature) and more than two years of growth remaining.

Researchers compared changes in lower extremity alignment among 112 pre-pubescent patients (girls younger than 12 and boys younger than 14) who had either a physeal-sparing combined intra/extra-articular reconstruction with iliotibial band (ITB) autograft (77 patients) or an all-epiphyseal reconstruction (35 patients). All patients had x-rays taken before surgery and again one year after surgery to measure and compare growth changes in both legs.

They found that approximately 25% of children in the study developed subtle postoperative changes such as differences in leg length and angular deformity that could raise their risk of reinjury in the future. However, there were fewer growth disturbances among older patients who had less than two years of growth remaining. 

“It’s important to make people aware that even though these procedures are safe overall and designed to respect the growth plates, there is still a risk of kids experiencing alignment issues afterward,” says Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS and senior author of the study.

An ACL injury is a painful tear or sprain of the ligament connecting the femur (thighbone) to the tibia (shinbone). These injuries have become common among physically active children, especially with year-round participation in sports and an increased level of competition.

In adult patients, the standard ACL reconstruction technique involves drilling tunnels in the femur and tibia to secure a new ligament. For children who are still growing, the growth plates—where the bones grow and gain length—are exactly where the surgeon would need to drill those tunnels. That is why alternative surgical techniques have been developed that reconstruct the ACL and minimize damage to the growth plate in young patients.

“If you injure the growth plate in a younger child who has many years to grow, there’s a lot of time during which that growth plate can grow abnormally,” explains Dr. Fabricant. “Prepubertal patients are the most vulnerable population for growth plate injury, so this study focused on that subset of patients to determine the incidence of developing deformity after surgery.”

This is the first multicenter study to rigorously assess leg alignment before and after surgery and compare the surgical leg to the uninjured leg to identify and monitor postoperative growth disturbances. Such changes may not be reliably measured with clinical examination alone.

“This study gives evidence to support the use of imaging to routinely check a patient’s alignment before surgery, check it after surgery, and monitor these kids for growth disturbances so that we can intervene in minimally invasive ways while they are still growing,” explains Dr. Fabricant. “This is important because only checking alignment when there is a concern is very subjective and there may be missed opportunities for early intervention.”

One minimally invasive surgical technique used to correct alignment issues is called implant-mediated guided growth. This involves placing implants around the growth plate that guide it to grow in a way that encourages realignment. The technique avoids the need for a much bigger operation (osteotomy) to realign the bone and a lengthy recovery, as would be the case for an adult.

“You can only do guided growth surgery when the growth plate is still actively growing, which for some of these kids is only a year or two after their surgery,” explains Dr. Fabricant. “If you aren’t routinely imaging to monitor alignment and you don’t realize it in time, then you’re beyond that window of being able to do that minimally invasive surgery.”

Use of Imaging to Identify Alignment Issues in Adolescent Children With Open Growth Plates After ACL Reconstruction

A second study led by researchers at HSS found that 15% to 30% of adolescent patients who had ACL reconstruction with soft-tissue autograft developed changes in leg alignment, but no patients developed growth-related complications requiring intervention.

For adolescent patients who still have open growth plates and less than two years of growth remaining, ACL reconstruction with soft-tissue autograft is often the technique of choice. This procedure involves drilling tunnels in the bone that would be similar to an adult ACL reconstruction, but the surgeon uses a graft and implants that don’t typically affect the growth plate.

“Even though this procedure is largely safe for adolescents, there is still a possibility of alignment changes after surgery,” notes Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS and senior author of the study. “This study adds more evidence to support the need to take x-rays before and after surgery and monitor this population until they reach skeletal maturity.”

The prospective multicenter study included 99 patients (50 boys and 49 girls with a median age of about 14 years) who had less than two years of growth remaining and underwent a primary transphyseal ACL reconstruction with soft-tissue autograft. Researchers used x-ray imaging before surgery and one year after surgery to measure and compare differences in leg alignment.

“We know that leg alignment is a vital factor in predicting injury, reinjury, and surgical failure, so measuring alignment preoperatively is extremely important because you gain the opportunity to address alignment issues at the same time as the ACL surgery with no additional risk,” explains Dr. Fabricant.

For example, if a patient is found to have a borderline alignment issue before surgery, some surgeons may be encouraged to perform an implant-mediated guided growth surgery at the same time as the ACL reconstruction because they know that there is a risk of potentially worsening post-operative alignment if they don’t.

“The logical next step is to strongly consider intervening on alignment problems when necessary in order to prevent reinjury,” says Dr. Fabricant.

What follows are highlights from these studies:

Surgery Unnecessary for Most Adolescent Athletes with Lumbar Spine Stress Fracture

A new study by researchers at HSS shows that 95 percent of adolescent athletes who are diagnosed with acute spondylolysis heal with just rest, bracing, and physical therapy. These findings support treating patients with a conservative, non-operative approach and reserving surgery as a last-resort option.

“These results are important because when we sit with families to discuss treatment options, we can confidently tell them that the vast majority of patients do have resolution of their pain and are able to return to sports without having to undergo surgery,” explains Jessica H. Heyer, MD, a pediatric orthopedic and spine surgeon at HSS and senior author of the study.

Spondylolysis is a stress injury or fracture of the pars (a bone structure in the vertebrae located at the bottom of the lumbar spine) that often causes lower back pain. It is prevalent among teenage and pre-teen athletes, especially those who repeatedly bend backwards (hyperextend or twist the lower back) such as soccer players, rowers, baseball players, gymnasts, and football players.

The retrospective review included 179 children and teenagers diagnosed with spondylolysis between February 2016 and August 2024. According to the findings, 95% of the patients were free of pain and able to return to their activities after three months of rest, bracing, and physical therapy. Only 5% of this group went on to require surgery, which can involve either a direct repair of the pars with a screw, or a fusion around the pars injury.   

“We saw an excellent rate of return to sports and resolution of pain among the patients in our study,” notes Dr. Heyer, adding that the protocols for non-operative management of spondylolysis vary across the country.

“These results support our recommendation to restrict activity for a full three months and initiate physical therapy after 4 to 6 weeks of rest,” she says. “This period of restricted activity is important to allow for clinical improvement of pain and healing before deciding on whether surgery is needed.”

Growth Hormone Therapy May Increase Risk of Fractures in Children and Teens

A new study by researchers at HSS shows a strong association between growth hormone (GH) therapy and an increased risk of physeal fractures, a pediatric bone injury affecting the growth plate near the ends of long bones such as the wrist, fingers, and lower legs. These fractures are responsible for 15% to 30% of all childhood fractures and are common among adolescents who are active in sports. 

“We found that GH therapy was associated with an increased rate of physeal fractures in the upper and lower extremities,” says Emily Dodwell, MD, MPH, a pediatric orthopedic surgeon at HSS and senior author of the study. “These findings are important because they provide more data to consider as we help families weigh the risks and benefits of GH therapy.”

Previous research has yielded contradictory findings about whether exposure to GH therapy increases the risk of physeal fractures.

“With prior studies being inconclusive, we wanted to investigate the potential association between GH and pediatric physeal fractures on a national basis,” explains Dr. Dodwell.

GH therapy is used to treat children who are diagnosed with GH deficiency[EN1] , certain genetic syndromes, short stature, and small for gestational age. GH therapy can help increase a child’s height, growth rate, and bone mineral density, and improve their body composition and key bloodwork parameters used to test for metabolic syndrome, diabetes risk, and overall cardiovascular health. However, it has also been linked to orthopedic complications, such as progression of scoliosis (curvature of the spine) and increased risk of slipped capital femoral epiphysis (a painful hip condition).

Dr. Dodwell and her colleagues used a nationwide insurance claims database to identify prevalence of pediatric physeal fractures in the upper and lower extremities with and without GH exposure. Their database search included 34,196 patients aged 4 to 18 years old who were given GH therapy for at least one month between 2010 and 2022 and were followed for two or more years. The researchers compared this group to the same number of patients who did not receive GH therapy during that time, taking into account age, sex, and weight.

The analysis found that GH therapy was associated with a higher rate of physeal fractures. These included fractures at the proximal humerus (arm near the shoulder), proximal radius (forearm near the elbow), distal radius (forearm near the wrist), distal ulna (wrist joint), distal femur (thigh bone above the knee joint), proximal tibia (upper shin bone below the knee), and distal tibia (lower shin bone near the ankle).

“This retrospective study was not designed to determine whether GH actually causes these fractures,” notes Dr. Dodwell. “Physicians should bear that in mind when counseling patients regarding the risks and benefits of GH therapy.”

Further research is needed to confirm these findings, she adds.

They participated through the Perry Initiative's Perry Outreach Program. “The goal of our program is to introduce students to all the exciting careers in orthopedics on both the surgical and engineering sides,” explained Amelia Knarr, PhD, executive director of the Perry Initiative. “Students get a real hands-on feel for the different types of procedures in orthopedics and also get to hear from successful surgeons and engineers. This benefits the students by showing them they are wanted, welcome, and capable of joining this exciting field.”

Under the guidance of HSS physicians, students participated in hands-on activities using plastic replicas of bones and tools of the trade such as drills and casts. They learned techniques that orthopedic surgeons use to repair broken bones, fix torn ligaments, apply a cast and suture a wound.

“The activities highlighted various biomechanical principles in orthopedics, demonstrating the integration of engineering in this field,” said Jessica Heyer, MD, a pediatric orthopedic surgeon at HSS and event organizer. “They were excited to use orthopedic tools and enjoyed casting each other and learning how to suture.”

In addition to hands-on learning, the students attended lectures to get an idea of what it takes to become an engineer or an orthopedic surgeon and what their jobs are like on a day-to-day basis. “The students demonstrated great enthusiasm, asking thoughtful questions,” Dr. Heyer said.

Aarti Shenoy, PhD, an instructor of applied biomechanics at HSS, delivered an engaging lecture, sharing key moments in her journey to become an engineer. She highlighted the collaborative nature of her work – describing how she and her colleagues in the Biomechanics Department partner with HSS surgeons to design research studies to advance the field of musculoskeletal medicine.

“The Perry Outreach workshop was a valuable experience for the participants, as they were able to gain insight into what a career in orthopedics might entail,” she said. “Students gained a sense of accomplishment from completing tasks that may have seemed challenging at first. Through the hands-on activities, they were encouraged to envision themselves as surgeons or engineers.”

“I learned how to use a drill today, and then we drilled a bunch of screws into different bone models,” said Lina Bernatska, a junior at Staten Island Technical School, who gave the event a thumbs up. “It really inspired me as a woman to want to go into these fields where women are underrepresented, and it's so refreshing to see all these educated young women tell their stories and tell us about their journeys…to get to where they are in life.”  

Her classmate, Ava Glatman, said it was cool to learn about different orthopedic procedures, such as total knee replacements, and how to fix a broken ankle. Reflecting on the event, she said, “I think it's really meaningful, especially understanding that this is such an underrepresented field for women. Being able to see so many women that have succeeded in their field is really inspiring and motivates me to do something like that in the future.”

Students from high schools in New York City, New Jersey and Connecticut attended, including Bernards High School, Bronx High School of Science, Concord-Carlisle High School, Fairlawn High School, High School For Health Professions & Human Services, Newtown High School, Pascack Valley High School, Ridgefield High School, Saint Francis Preparatory School, Staten Island Technical School, Toms River High School South, Tottenville High School, University Heights Secondary School, Urban Assembly for Leadership and Empowerment.

Challenges of Pediatric MRIs

A typical MRI is not only loud and confining but also very sensitive to motion, requiring subjects to lie still during the 20- to 80-minute procedure, which is a major challenge for pediatric patients. Consequently, sedation is used in up to 28% of pediatric MRIs, and reports show this number is increasing.

While sedation can facilitate successful imaging—and is considered relatively safe—relying on this strategy for young MRI patients poses potential risks, including cardiopulmonary issues and allergic reactions. Additionally, the combination of MRIs and sedation can cause anxiety for children and their parents and prolong recovery.

Researchers found that avoiding anesthesia—and post-anesthetic recovery—through CCLS interventions improves the overall efficiency of the MRI process, benefiting both families and care teams.

“Without anesthesia, children can avoid the need for an IV, they don’t need to fast prior to the MRI, and they don’t need to extend their hospital-related experience to recover,” says lead study author Jessica H. Heyer, MD, pediatric orthopedic and spine surgeon at HSS. “And from a hospital perspective, it enables children to have an MRI even when an anesthesiologist is not available.”

The American Academy of Pediatrics stresses that these types of nonpharmacological interventions “must be considered as standard procedure in infants, children, and adolescents undergoing MRI,” supporting the approach taken in this study.

Benefits of Avoiding Sedation

For this retrospective cohort study, HSS researchers looked at 1,936 patients between the ages of 4 and 12 who, in total, received 2,319 MRI scans over an eight-year period. They found that no child who received CCLS intervention prior to and/or during the procedure required IV sedation during MRI.

Despite the study’s remarkable success rate, Dr. Heyer notes that there are always exceptions: “Sedation-free MRI may be more difficult for very young children, those who need longer scans, children with cerebral palsy, and for those who need a head, brain, or neck MRI."

While all children can greatly benefit from CCLS intervention, Dr. Heyer notes that children between ages 5 and 10 appear to show the strongest results. Study co-author Melissa Collins, MS, senior child life specialist at HSS, adds that this strategy is particularly valuable for children with sensory processing issues or those with a history of negative medical experiences. “For example, children who’ve been told a procedure wouldn’t hurt and then were held down or experienced pain are less likely to trust medical professionals and medical environments,” she says.

Effective Child Life Techniques

The researchers examined several CCLS techniques, including guided imagery, distraction strategies, and caregiver involvement, but the most helpful strategy is “appropriate preparation based on the patient's developmental age,” says Collins. “MRI anxiety typically stems from uncertainty, so it’s important to provide children with accurate expectations, so they’re able to prepare and cope more effectively.” Collins suggests showing children a video of an MRI that walks them through each step and what they’ll see, hear, and feel during the scan to help take away some of the fear of the unknown. “It also helps to reiterate that nothing is going to touch them or hurt them,” she says.

At the Lerner Children’s Pavilion, one or both parents are always encouraged to accompany their child into the MRI suite. Children are also invited to bring a favorite soft, metal-free toy into the MRI unit and are given mirrored glasses so they can see their caregiver or the technologist behind them throughout the MRI. To celebrate their bravery, each child receives a small reward at the end of the exam.

Looking Forward

“Our research demonstrates that with proper preparation and support, we can transform a potentially stressful medical procedure into a positive experience for children,” concludes Dr. Heyer. “By reducing the need for sedation, we’re not only reducing medical risks but also empowering children to actively participate in their healthcare journey, potentially making future medical encounters less intimidating.”

Reference:

Tracey OC, Zucker C, Wisch J, Adhiyaman A, Thakur A, Collins M, Parise J, Denneen J, Jaramillo D, Potter H, Ipp L, Heyer JH. Not Just Fun and Games: Certified Child Life Specialists Improve Success Rates of Young Children Undergoing MRI Studies without Anesthesia. Presented at: Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting, 2025

Thestrup J, Hybschmann J, Madsen TW, et al. Nonpharmacological interventions to reduce sedation and general anesthesia in pediatric MRI: a meta-analysis. Hosp Pediatr. 2023;13(10):e301-e313. Accessed May 14, 2025, at https://doi.org/10.1542/hpeds.2023-007289

Uffman JC, Tumin D, Raman V, Thung A, Adler B, Tobias JD. MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO. J Am Coll Radiol. 2017 July;14(7):924-930. Accessed May 14, 2025, at https://www.jacr.org/article/S1546-1440(17)30121-7/abstract

“A developmental milestone is a functional skill or a specific task that most children can accomplish by a certain age,” she explains. “They reach milestones in the way they move, play, learn, speak and act. In babies, these skills include sitting up, taking the first step and waving goodbye.”

Parents often receive a chart showing developmental milestones from the hospital after giving birth or from their pediatrician. The Centers for Disease Control and Prevention (CDC), considered the authoritative source, features a developmental milestone tracker on its website, as well as an app that can be downloaded to a smart phone. The CDC occasionally updates typical time frames for development, so Dr. Jones recommends that parents review it to stay current.  

“I always counsel families to not only identify a milestone, but to pay attention to how a child is achieving it,” she says. “For example, if they are crawling in a way that is not typical, this could signal a problem.”

Parent education and empowerment are essential to a child’s development, says Erin Neville, PT, DPT, PCS, a pediatric physical therapist at HSS. She explains that signs of a developmental  variation that might warrant a medical consultation include asymmetrical movement, in which the child favors one side of the body; regression in skills they had previously mastered; a lack of interest in movement and play; fear of engaging in a common age-appropriate activity; or not keeping up with one’s peers. 

Parents and caregivers should discuss all concerns with the child’s pediatrician, the HSS experts say. Dr. Jones advises families to make a video to show the doctor, if possible. “The more information they can gather before the appointment, the more productive the consultation will be,” she explains. “It is also critical to act quickly because early treatment leads to better outcomes. More often than not, a caregiver’s instincts are correct. At times, though, our job is to reassure nervous parents, reminding them that children develop at different rates.”

Dr. Jones’s goal is to get to the bottom of why a child is experiencing a developmental delay so she can develop a successful treatment plan. “Could it be genetic, or did something trigger it? Is it due to a neurological issue or underlying condition? Significant progress is being made in diagnosis, particularly in the field of genetic testing,” she says.

Treatment aims to maximize a child’s given potential so they can catch up with their peers and live the fullest and most well-rounded life possible, Dr. Jones explains. It’s an interdisciplinary effort that may involve a physical therapist, occupational therapist, speech therapist, developmental pediatrician, neurologist, psychologist or orthopedic surgeon. At HSS, the team also includes a prosthetics and orthotics department that makes braces for children who need them and a 3D motion analysis laboratory to address gait issues.

“Being able to identify a delay or an issue early so we can provide high-quality services before the age of three — when the brain has the greatest ability to adapt — can completely change a child’s developmental trajectory,” says Katie Ross, MS, OTR/L, ATP, pediatric occupational therapist at HSS. “It can help prevent potential problems in a child’s behavior, learning and social interactions.”

She notes that parents are a child’s best advocates and should be persistent when seeking answers about their development. “We’ve seen families who were not aware of services that their children were eligible for, or they were not familiar with how pediatric occupational therapy could help them. But it can make a big difference,” says Ross.

Both physical and occupational therapy use play to help children meet developmental goals. Therapists seek to gain their patients’ trust and build their confidence so that they are willing to engage in exercises not only in the rehab setting, but at home as well.

“We may only see a child once or twice a week, so the family plays a vital role. They have the best insights about what will motivate their child so they can integrate therapeutic activities into their daily life,” explains Neville, the pediatric physical therapist. “Every patient is different, but with timely and appropriate treatment in a supportive environment, many children can make significant progress, reach their milestones, and achieve their goals and dreams.”

The HSS investigators found that the odds of taking human growth hormone therapy were 15 times higher among children who experienced a fracture to the growth plate of the upper shinbone compared with a matched comparison group who experienced midshaft tibia fractures, according to a new study published December 21 in the Journal of Bone and Joint Surgery. 

In children, human growth hormone therapy has been used for decades to treat growth hormone deficiency due to underlying medical conditions such as Turner syndrome, very small weight at birth, Prader-Willi syndrome and chronic renal insufficiency. However, in 2003, its use became more widespread in children, when the U.S. Food and Drug Administration approved it for the treatment of short stature with no known cause, called idiopathic short stature. Since then, an increasing number of children have been taking growth hormone therapy to boost their height.

Fractures to the growth plate at the top end of the shinbone, or tibia, are called proximal tibia physeal avulsion fractures. “We have been seeing more cases of tibia growth plate fractures in our emergency room and outpatient offices,” says senior author Peter D. Fabricant, MD, MPH, a pediatric orthopedic surgeon at HSS. “While kids are still growing, the tibia growth plate is structurally weaker than the patellar tendon. When a child or adolescent lands awkwardly or forcefully contracts their quadriceps muscle, instead of the patellar tendon rupturing, it pulls off a piece of bone from the growth plate because the growth plate is weaker.”

“At HSS, a big part of what our pediatric orthopedic service does is treat children with significant fractures and orthopedic injuries,” says study co-author Daniel W. Green, MD, MS, FAAP, FACS, chief of the Pediatric Orthopedic Service at HSS. “Parents frequently ask our pediatric orthopedic surgeons if human growth hormone caused their children’s fractures. Given the volume of patients we treat, we were able to investigate the relationship between tibia growth plate fractures and growth hormone therapy in pediatric patients.”

The study is the first to formally quantify this concerning relationship. The researchers analyzed hospital records for two groups of pediatric patients treated at HSS between February 2016 and May 2023—66 patients who experienced proximal tibia physeal avulsion fractures and a comparison group of 66 patients who had midshaft tibia fractures, which involve the same bone but not the growth plate area. Patients in both groups were 13 years of age on average, with similar body mass indices. The percentage of males in each group was 82 percent.

The analysis revealed that seven, or 11 percent, of patients with a proximal tibia physeal avulsion fracture reported taking human growth hormone, whereas zero patients in the comparison group were taking growth hormone. Therefore, the odds of taking growth hormone therapy were 15 times higher among patients with proximal tibia physeal avulsion fractures than the comparison group. Most patients, 86 percent, were taking growth hormone for increasing stature.  

“Tibia growth plate fractures are rare but serious injuries. They account for less than 3 percent of pediatric fractures, but more than 40 percent of patients with these fractures require surgical repair,” says Dr. Fabricant. “Moreover, whether a patient requires surgery or not, these fractures require a long recovery period—12 weeks for healing the break and regaining range of motion, plus several more weeks to months to recover strength and endurance before resuming normal activities.”

“We hope families deciding whether their children should start or continue growth hormone therapy consider our new evidence as they carefully weigh the pros and cons of therapy in consultation with their pediatric endocrinologists,” Dr. Green says. “Further research is required to tease out whether limiting specific high-impact sports will mitigate the risk of tibia growth plate fractures in active children and adolescents.”

The newly named Penny Doerge Adaptive Academy (PDAA) honors the memory of HSS patient Penny Doerge and will continue to offer trips and recreational and creative activities such as rock climbing, surfing, skiing, dancing and other exciting adventures to pediatric patients at no cost, as it has for the past decade. The activities aim to build self-confidence, encourage independence, reinforce therapy goals and increase physical activity, creativity and mobility. Penny, a longtime patient of Roger Widmann, MD, chief of Pediatric Orthopedics at HSS, embodied the spirit of the program for kids and teens with a range of disabilities.

“Penny was an independent spirit who had a force of personality and a drive to do everything that her peers and her brothers would and could do,” Dr. Widmann said. “She also had an incredible artistic sense and style that defined her from early on. We miss her very much.”

The Penny Doerge Adaptive Academy focuses on three themes that are central to how Penny lived her life: motion, expression and inclusion, explained Kate Doerge, Penny’s mother and member of the HSS Board of Trustees, Pediatric Council, and Co-Chair of the HSS Board of Advisors. “Her resiliency, positivity and courageousness are all qualities that the Academy works to promote in its participants,” she said.

Penny was diagnosed with neurofibromatosis as an infant but never let her diagnosis hold her back. She lived a life full of purpose, passion and joy, according to HSS staff who knew her.

The renaming of the Academy will be celebrated at the 2023 Hospital for Special Surgery Benefit for Pediatrics on November 8. The event, which will take place at The Lighthouse at Chelsea Piers, raises funds for the Lerner Children’s Pavilion at HSS, which offers the Academy’s programs. Additional support will enable the Academy to expand its offerings to all HSS patients ranging in age from 3 to 22.  

The Academy organizes trips and recreational experiences to enable young patients with cerebral palsy or another physical condition affecting movement, muscle control or balance to participate in athletic or recreational activities they may have never dreamed possible. Many of the participants have had surgery at HSS. Adaptive activities are geared toward people with differing abilities. Sometimes rules and equipment are modified to meet the needs of participants.

“Patients who participate in the Academy gain greater confidence in their physical capabilities, and they carry that with them to school and beyond,” said Lisa Ipp, MD, chief of Pediatric Medicine at HSS and co-executive director of the Academy. “It has become a very special part of HSS, bringing comfort, excitement and joy to our youngest patients.”  

Dr. Mayman will succeed Mathias P. Bostrom, MD, who, along with sports medicine surgeon Answorth A. Allen, MD, was recently appointed Associate Surgeon-in-Chief at HSS after serving as ARJR chief for the past four years. Dr. Green will succeed Roger F. Widmann, MD, who has led the Pediatric Surgical Service since 2004. Dr. Widmann will continue to care for pediatric patients with spine and limb deformities and will lead a new center of excellence dedicated to robotic-assisted surgery at HSS. Both appointments will go into effect September 5.

“We are grateful to Drs. Bostrom and Widmann for their steadfast leadership over the years,” said Bryan T. Kelly, MD, MBA, president, surgeon-in-chief and medical director of HSS. “Drs. Mayman and Green are not only talented surgeons, they are collaborative leaders who bring a wealth of expertise and experience to their new roles. These appointments will allow us to continue to advance excellence for our joint replacement and pediatric surgical patients.”

In their new roles, Drs. Mayman and Green will each lead highly integrated multidisciplinary teams. The ARJR service is comprised of programs focused on hip and knee osteoarthritis and other problems requiring joint replacement in adults, while Pediatrics covers the spectrum of conditions requiring orthopedic surgery in children, ranging from sports medicine injuries and trauma to congenital issues of the spine and hip.

David Mayman

David J. Mayman, MD, is an orthopedic surgeon specializing in hip and knee replacements. A member of the Hip and Knee Societies, Dr. Mayman is a leader in the field of robotic and navigated joint replacement surgery. His primary research interest lies in incorporating new technologies into arthroplasty, with the goal of achieving more favorable outcomes for patients.

“I’m honored to take on this new role, leading and collaborating with a deeply talented team of surgeons in order to deliver scientific breakthroughs and address joint pain challenges,” said Dr. Mayman. “HSS is recognized as the leader in joint replacement, and by harnessing the power of our musculoskeletal expertise, we will advance the overall health and wellness of generations to come.” 

Daniel Green

Daniel W. Green, MD, MS, is a pediatric orthopedic surgeon specializing in knee surgery.

A holder of the Mary Kathryn and Alexander Navab Chair for Pediatric Orthopedic Research at HSS, Dr. Green’s clinical research has focused on surgical outcomes and techniques used to treat patella dislocation, osteochondritis dissecans, discoid meniscus and pediatric ACL tears.

“I am honored to be asked to represent such a talented group of pediatric orthopedic surgeon leaders dedicated to taking care of children at the hospital ranked no. 1 in the world for orthopedics,” said Dr. Green. “We are positioned to maintain our leadership position as national and international thought leaders and dedicated to increasing access to our care.”

“HSS is home to an unparalleled number of talented and knowledgeable experts who specialize in caring for patients with various conditions throughout the lifespan,” said Louis A. Shapiro, CEO of HSS. “These appointments highlight the depth of leadership and experience across each area of the organization.”
 

Spine specialists at HSS have been using a 30-camera array, called 3dMD, in the lab for several years, but the new study shows that the system produces clinically meaningful information. Because 3dMD does not rely on ionizing radiation, the technology may help adolescents with scoliosis avoid many of the repeated and potentially harmful x-rays that conventional care requires.

“Determining spinal range of motion is a lot more difficult than it sounds,” said Roger Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS and co-principal investigator on the new study. The conventional gold standard has been the use of x-ray imaging; however, x-ray tests are expensive, and long-term exposure to radiation from the scans has been linked to cancers.

The new technology provides a “safe, repeatable, inexpensive measurement of spinal range of motion that can be used in both a research and clinical setting,” Dr. Widmann said.

Information from the 3dMD scans can help spine surgeons determine the optimal approach to operative treatments and allow them to better track the progress of scoliosis patients following surgery. “The technology gives you objective measures of range of motion so you can improve your surgical decision-making,” Dr. Widmann said.

The HSS team presented their findings today at the 2023 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) in a poster titled “3D Surface Topographic Optical Scans Yield Highly Reliable Spine Range of Motion Measurements in Adolescents.”

The 30-camera array can generate a whole-body image of a standing person in under 2 milliseconds – fast enough to eliminate any blurring from even the slightest movement in any direction.

In previous studies, the HSS team and their colleagues have shown that images generated with the ultrafast cameras match the anatomy beneath the skin. That alignment is critical for 3dMD to be useful in the clinic as a way to guide treatment for scoliosis, which affects between 2% and 3% of youth in the United States, or 6 to 9 million people.

Treatment for scoliosis frequently involves physical therapy or the use of braces to correct the curvature of the spine – a measurement called the “Cobb angle” – but in the most severe cases, surgery may be necessary.

For the new study, Dr. Widmann’s group used 3dMD to image 254 boys and girls with scoliosis and 53 without the spinal deformity as they underwent several exercises designed to work the torso in various directions.

“This is teaching us which parameters are more useful and which are not,” says Howard Hillstrom, PhD, a biomechanical engineer at HSS, senior director of the Leon Root, MD Motion Analysis Laboratory and co-principal investigator on this project.

The new study found two movements that were reliably able to differentiate youth with scoliosis from those with normal spines: bending as far to the left and right as possible while standing, and bending toward the floor as if to touch the toes.

In the first case, patients with scoliosis show significant asymmetry between one side and the other in terms of how far to each side they can bend. Meanwhile, scoliosis patients are not able to bend as far toward the floor – as measured from a point on their collarbone – as those with unaffected spines, Dr. Hillstrom said. “That’s good enough to distinguish healthy kids from those with scoliosis because most kids are so flexible they can get to the floor and those with scoliosis probably can’t.”

Although the assessments make sense both intuitively and clinically, the latest study shows that they are also an objective measure of scoliosis. The entire process, from the start of the scan to the generation of results, takes under 10 minutes, Dr. Hillstrom added.

“And now we have this system that acquires these variables and doesn’t require ionizing radiation to do so,” he said, noting that this is critically important because scoliosis patients have a significantly greater incidence of cancer, breast cancer, and cancer mortality than those without the condition – an increase many experts attribute to the radiation they receive from x-rays and CT scans.

The process of diagnosing scoliosis starts early. “The first time someone notices that a child may have scoliosis is usually when the school nurse sees it during a routine examination,” Dr. Hillstrom said. “The nurse tells the parent to take the child to a doctor, and the first thing a physician will do is order an x-ray.”

The HSS team now has imaging studies of more than 300 adolescent patients with scoliosis in its 3dMD database. “Of those, approximately 50 are a year out from surgery and 30 are two years out, providing the ability to look at the long-term benefits of the technology on range of motion and other parameters [such as angle of trunk rotation, back surface rotation, and asymmetry in lateral bending and twisting”, Dr. Widmann said. 

Authors: Alon Wolf, PhD; Ankush Thakur, MS,BS (HSS); Benjamin N. Groisser, BA, (Technion); Caroline C. Gmelich, BA; Don Li, MD,PhD; Hila Otremski, MD; Howard J. Hillstrom, PhD; Jessica H. Heyer, MD; Kira Page, BA; Kyle Morse, MD; Matthew E. Cunningham, MD, PhD, FAAOS, (HSS); Michael T. Hresko, MD,FAAOS, (Boston Children's Hospital); Roger F. Widmann, MD, FAAOS, (HSS); Ron Kimmel, DPHIL (OXON)

“Surgery to utilize the implant for graft fixation is more efficient and effective than previous methods and has been shown to result in more successful outcomes,” said Frank A. Cordasco, MD, MS, a sports medicine surgeon at Hospital for Special Surgery (HSS) in New York City. Dr. Cordasco and an HSS colleague, pediatric orthopedic surgeon Daniel W. Green, MD, MS, FAAP, FACS, have partnered in this effort and are among the nation’s leaders in using the approach in the operating room. These physicians, who are dedicated to improving outcomes for pediatric and young adolescent athletes with ACL tears both clinically and through research and education, helped evaluate the clinical effectiveness of the device through a collaboration with Arthrex that started approximately 15 years ago. Drs. Cordasco and Green also developed pediatric- and young-adolescent-specific instrumentation guides to address an increasing population of injured high-risk young athletes. Previously, only adult instrumentation guides were available for use and are inadequate in the surgical management of this cohort of pediatric and young adolescent athletes.

Tears of the ACL, a structure that is essential for knee stability during lateral movement, have become increasingly common in children and young adolescents over the past two decades, largely as a result of greater participation of both boys and girls in competitive team sports.

Until relatively recently, however, surgeons were reluctant to operate on children whose growth plates in the legs had not fused. Doing so carries the risk of permanent deformities to the long bones (femur and tibia) that meet at the knee, explained Dr. Green. Historically, the solution for most of these patients was to treat them with a brace and hope for the best until their bones had matured. But in the majority of cases, the non-operative approach led to serious problems, including further damage to the joint, as well as psychosocial effects by limiting the young athletes’ participation in sports until they reached skeletal maturity a few years later.¹

The Cordasco-Green technique of all-epiphyseal ACL reconstruction was developed in collaboration with Arthrex for use in the youngest athletes with more than three years of remaining growth.² This approach involves the use of pediatric-specific instrumentation guides to drill sockets for the ACL graft and avoid the growth plate and thereby diminish the potential for growth disturbance.^2,3,4

The complete transphyseal technique is indicated in young adolescent athletes who are approaching skeletal maturity. This approach drills across the growth plates with a small socket to perform an ACL reconstruction using a quadriceps autograft (taken from a piece of the athlete’s quadriceps tendon). Based upon their research, Drs. Cordasco and Green have found that of the two all-soft tissue autografts available for ACL reconstruction, quadriceps autografts have superior outcomes compared to hamstring autografts in this high-risk young adolescent athletic population.^5,6,7

Unlike previous iterations of the approach, the newly cleared technique uses Adjustable- rather than Fixed-Loop buttons. This feature improves surgeons’ ability to adequately tension the quadriceps autograft tendon while the patient is on the operating table and to reduce “creep,” slack in the tissue that leads to residual instability in the knee. “The stronger and greater the fixation at the time of surgery, the better the outcome for the athletes,” said Dr. Cordasco. In addition, the implant eliminates the need for ligament interference screw fixation, which may increase the potential for growth plate injury and growth disturbance.

These techniques have also provided superior outcomes in terms of the need for revision surgery and return to sports. “Our research has demonstrated that more than 90 percent of children who have undergone the surgery with this implant at HSS have returned successfully to sports without the need for additional surgery,” said Dr. Cordasco.^5,6,7

“The ideal patient for the procedure is, in general, a child between the ages of 12 and 15 to 16, depending upon the athletes’ skeletal maturity, at which point the growth plates are effectively closed,” said Dr. Green. This group has seen an “epidemic” of ACL tears over the last 20 years, he added.

Dr. Green concluded that the youngest children may not good candidates for this approach, because their bones are not large enough to hold the sockets. The youngest children benefit from a different physeal-sparing approach using a combined intra- and extra-articular surgery utilizing the iliotibial band as a graft.

References:

1.       James EW, Dawkins BJ, Schachne JM, Ganley TJ, Kocher MS; PLUTO Study Group; Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. Am J Sports Med. 2021 Dec;49(14):4008-4017. doi: 10.1177/0363546521990817. Epub 2021 Mar 15.PMID: 33720764

2.       Fabricant PD, Jones KJ, Delos D, Cordasco FA, et al: Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Athlete: A Review of Current Concepts: AAOS Exhibit Selection. J Bone Joint Surg 2013, 95:e28(1-13). PMID: 23467876.

3.       McCarthy MM, Graziano J, Green DW, Cordasco FA: All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients. Arthrosc Tech 2012, 1(2):e231-e239. PMID: 23767001

4.       Cordasco FA, Mayer SW, Green DW: All-Inside, All-Epiphyseal ACL Reconstruction in Skeletally Immature Athletes: Return to Sport, Incidence of Second Surgery and Two-Year Clinical Outcomes. Am J Sports Med. 2016 Dec 1:363546516677723. doi: 10.1177/0363546516677723. [Epub ahead of print] PMID: 28027452

5.       Cordasco FA, Black SR, Price M, Wixted C, Asaro L, Heller M, Nguyen J, Green DW: Return to Sport and Re-Operation Rates in Athletes Under the Age of 20 Following Primary Anterior Cruciate Ligament Reconstruction: Risk Profile Comparing Three Patient Groups Predicated Upon Skeletal Age.  Am J Sports Med. 2019 Jan 15:363546518819217. Doi:10.1177/036354651882917. [Epub ahead of print] PMID: 20645948

6.       Aitchison AH, Schlichte LM, Green DW, Cordasco FA. Open Full-Thickness Quadriceps Tendon Autograft Harvest With Repair for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2020 Sep 15;9(10):e1459-e1465. doi: 10.1016/j.eats.2020.06.006. eCollection 2020 Oct.PMID: 33134047

7.       Aitchison AH, Alcoloumbre D, Mintz DN, Hidalgo Perea S, Nguyen JT, Cordasco FA, Green DW. MRI Signal Intensity of Quadriceps Tendon Autograft and Hamstring Tendon Autograft 1 Year After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes. Am J Sports Med. 2021 Nov;49(13):3502-3507. doi: 10.1177/03635465211040472. Epub 2021 Oct 6.PMID: 34612708

According to Cynthia A. Kahlenberg, MD, MPH, an orthopedic surgeon at HSS and a coauthor of the study, TKA is rarely performed in patients under 21 years old but may be done in this population due to conditions such as inflammatory arthritis or juvenile idiopathic arthritis (JIA), malignant or non-malignant tumors, or trauma. However, the number of patients under the age of 21 undergoing TKA in the U.S. is unknown. In one of the largest U.S. studies of an institutional arthroplasty registry, only 19 TKAs were performed in patients under the age of 21 out of approximately 30,000 primary TKAs over 34 years—a majority of which were for JIA.

The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years old in approximately 4,200 hospitals in 46 states. The researchers used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. Descriptive statistics such as means and percentages, along with their 95% confidence intervals (95% CI), were calculated using the appropriate sample weights as recommended by the Agency for Healthcare Research and Quality for use with the KID dataset.

The total weighted number of TKAs performed in patients younger than 21 from 2000-2016 was 1,331; the number of TKAs performed per year in this age group remained relatively stable. The mean age of patients undergoing TKA was 14.8 years (95% CI, 14.4-15.2); 48.8% of the cohort was female. Among tumor patients, a higher proportion identified as Hispanic (22.1%) or other race (12.6%) compared to the non-tumor cohort; 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / JIA decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis / JIA patients. The majority of TKAs were performed in urban teaching hospitals and in facilities with a large bed size, which likely reflects the complexity and rarity of these procedures.

“This was one of the first studies to take an in-depth look at TKA in this very young population,” said Dr. Kahlenberg. “Our study was able to confirm that tumors were the most common reason for knee arthroplasty in this population.”

“I think the biggest takeaway as a rheumatologist is that we are doing a good job treating these patients and over the years the treatments for inflammatory arthritis are really working well in this young population,” said Bella Mehta, MBBS, MS, rheumatologist at HSS and senior study author.

“We strive to provide the most advanced, comprehensive and compassionate care for our young patients and are honored to be recognized as one of the nation’s very best hospitals in pediatric orthopedics,” said Louis A. Shapiro, president and CEO of HSS. “This achievement validates the commitment of our team of pediatric specialists to provide personalized care to meet the specific needs of every patient and family.”

The annual U.S. News Best Children's Hospitals edition, now in its 16th year, offers guidance to parents seeking the best place for a child in need of expert care. Pediatric orthopedics is among 10 ranked specialties, which also include pediatric cancer and pediatric cardiology & heart surgery.

Fifty hospitals were ranked in pediatric orthopedics for the treatment of conditions such as scoliosis and spina bifida and injuries such as complex fractures or other sports injuries. Rankings are based on clinical data and on an annual survey of pediatric specialists. Factors under consideration include patient outcomes, compliance with best practices, nursing staff and resources for patients, such as services to ease the anxiety of a child’s hospital stay.

“Choosing a hospital is one of the most important decisions parents will ever make, and everyone wants what's best for their child. Our goal is to provide the highest quality, family-centered care in a supportive setting,” said Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS. “Our pediatric orthopedic surgeons are highly specialized in areas such as spine, sports medicine, hip disorders and cerebral palsy. They work alongside a team of pediatric anesthesiologists and non-surgical specialists to ensure the best and safest care.”

“We are dedicated to maintaining the highest standards in quality and safety, recognizing that a ‘one-size-fits-all’ approach does not work in health care,” said Bryan T. Kelly, MD, surgeon-in-chief and medical director at HSS. “As the leading academic medical center specialized in musculoskeletal health, we are able to offer advanced care for the most complex problems with a healing environment specifically designed for children and teenagers.”

There were over 56,000 physician visits and more than 48,000 rehabilitation visits to the HSS Lerner Children’s Pavilion last year. A low dose X-ray system that exposes patients to only 10 percent of the radiation of standard X-rays and the Leon Root, MD Motion Analysis Laboratory are among the diagnostic tools that benefit patients.

The study evaluated the safety and efficacy of performing a lateral extra-articular tenodesis (LET) using a modified Lemaire technique (MLT) in conjunction with an ACL reconstruction in children and adolescents who are at an increased risk for a failed ACL reconstruction. Findings revealed the technique was associated with favorable patient-reported outcomes, high return to sports participation and low ACL re-tear rate.

Research has long demonstrated that young adolescents (typically in eighth and ninth grades) who return to a pivoting or high-risk high school sport have the highest re-tear rate after an ACL reconstruction.

In the New York City metro area alone, over 80 percent of ACL injuries in adolescents stem from participation in sports such as basketball, soccer, lacrosse, skiing and football.

The ACL, one of four major ligaments in the knee joint, helps maintain the knee’s rotational stability and prevent the shinbone (tibia) from slipping in front of the thighbone (femur). It is especially vulnerable to injury from impact or athletic activities.

Currently, the standard-of-care surgical treatment for ACL tears is reconstruction. This involves placing a graft in the knee using a minimally invasive incision. Approximately 300,000 ACL reconstructions are performed annually in the United States. If the surgery fails, a revision procedure is necessary, which may result in higher rates of failure and lower rates of return to sport.

“Reconstruction alone has not been sufficient for kids who haven’t finished growing yet and want to stay active in sports,” said Daniel W. Green, MD, MS, FAAP, FACS, senior author and pediatric orthopedic surgeon at HSS.

“The risk of re-injury has been too high, leading to devastating consequences for a young athlete,” added Frank A. Cordasco, MD, MS, lead author and sports medicine surgeon at HSS, who noted that this continues to be an important area of clinical research for sports medicine surgeons worldwide.

About a decade ago, surgeons in France innovated on the standard ACL reconstruction procedure after identifying elite soccer players as high risk for re-tear. They added the LET to the reconstruction and successfully demonstrated that this combination decreased the re-tear rate in adult soccer players by nearly 50 percent.

Drs. Cordasco and Green are two of the first physicians to apply this European technique to teenage athletes in North America. The physicians are dedicated to improving outcomes for adolescent athletes with ACL tears both clinically and through research.

“We are proud to have published one of the first surgical-technique papers describing how this procedure can be safely performed in young patients who still have open growth plates,” said Dr. Green, who explained that this study is also unique in that it reports on two-year clinical outcomes in children who underwent this particular procedure.

“Not only does this technique not disturb children’s growth plates or cause post-operative stiffness, but we also found that this demonstrates a remarkably low re-tear rate in this high-risk group,” said Dr. Cordasco.

The study followed 61 patients between 11 and 19 years old who underwent simultaneous ACL reconstruction and LET with a minimum two-year follow-up; 97 percent of the patients participated in organized sports, with soccer being the most popular. These patients were identified as high risk when one or more of the following factors occurred: the patient participated in high-risk competitive sports such as football, lacrosse, soccer or basketball or that involved grade 3 pivot shift; had hyperlaxity; recurvatum; revision ACL reconstruction; contralateral ACL reconstruction; or chronic ACL insufficiency.

Depending on the patient’s skeletal maturity, the ACL reconstruction was performed either by using full-thickness quadriceps tendon, bone-patellar tendon-bone autograft, all-epiphyseal or complete transphyseal techniques.

At a minimum two-year follow-up, the researchers looked at patient-reported outcome measures as well as data on returning to sports and any potential additional surgeries. The results were overwhelmingly positive, with a median Single Assessment Numeric Evaluation (SANE) score of 95%, where 100% represents normal function. The mean Pediatric International Knee Documentation Committee (Pedi-IKDC) score was 91, where 100 is interpreted to mean no limitations on daily living or sports activities. Patients also reported a median score of 27/30 on the HSS Functional Activity Brief Scale (HSS Pedi-FABS), which is a validated eight-item instrument to quantify the activity of children.  

Nearly 92 percent of patients were able to return to sport. One patient had a revision ACL surgery and three had subsequent contralateral ACL reconstructions.

This study expanded upon work that Drs. Cordasco and Green published in 2020 that showed LET can be performed safely in skeletally immature athletes who underwent a quadriceps autograft ACL reconstruction.

The findings, presented today at the American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting, shows that the ultrafast cameras produce scans of the surface of the body that complement internal images generated by low-dose x-ray. Because 3dMD does not rely on ionizing radiation, the investigators believe the technology may help scoliosis patients avoid many of the repeated and potentially harmful x-rays that conventional care require.

Surface topography and internal imaging work together to provide a much fuller picture of how scoliosis affects the body, according to Roger F. Widmann, MD, chief of the Pediatric Orthopedic Surgery Service at HSS and the senior researcher on the study. “When you see someone with a spinal deformity, you’re not necessarily visualizing the shape of the spine underneath,” he said. “Three-dimensional (3-D) surface scanning is analogous to what you see visually, whereas x-rays or MRI are often much different from what you see on the surface. Both approaches are important, but the information they provide is quite different.”

Howard J. Hillstrom, PhD, a biomechanical engineer at HSS and co-principal investigator on the project, says the 30-camera array can generate a full image of a standing person in under two milliseconds—fast enough to eliminate any blurring from even the slightest movement in any direction. “It gives us very accurate information to begin with, and it’s important to start with sound data,” Dr. Hillstrom noted.

What was previously unknown was how well these images of the body’s surface conform to the anatomy beneath the skin. This relationship is critical for 3dMD to be useful in the clinic as a way to guide treatment for scoliosis, which affects between 2% and 3% of youth in the United States, or 6 to 9 million people.

Treatment for scoliosis frequently involves the use of braces to correct the curvature of the spine—a measurement called the Cobb angle—but in the most severe cases, surgery may be necessary.

Dr. Hillstrom, who describes the image as a “large, 3-D selfie,” said these results “give us the green flag to study spinal pathology and the effects of treatments for different severities of scoliosis” in ways that weren’t possible previously.

For clinicians, he added, “It’s great to have objective tools to support the patient-reported outcomes that we use.”

For the study, the researchers compared images gathered by 3dMD with those produced by a next-generation x-ray system called EOS. A total of 46 youths participated in the study, 26 of whom had been diagnosed with adolescent idiopathic scoliosis (mean age, 14.7 years; 14 female, 12 male) and 20 who did not have the condition (mean age, 14.6 years; 9 female, 11 male).

The 3dMD images demonstrated extremely high reliability, particularly for linear geometric measurements of the surface of the subjects. “The measurements generated from the 3-D scans were used to create unique volumetric measures of truncal asymmetry, which demonstrated very high correlations with patient-reported self-image,” Dr. Widmann said.

Dr. Hillstrom noted the post-processing software that employs artificial intelligence (AI) is the secret behind the accuracy of the camera array. “AI fills in the blanks very quickly. It helps to identify anatomical regions and provide a mathematical approach to organizing the topographic data showing you the head, neck, trunk and pelvis—from outside of the body. You can uncover details you wouldn’t normally be able to see with the naked eye or with the use of conventional radiology.”

As the 3dMD system moves into the clinic, the technology will help surgeons better predict both the cosmetic and functional outcomes of the various procedures for scoliosis. “You can use the system to assess the efficacy of different surgical techniques based on how well you’re creating symmetry of the surface of the torso,” Dr. Widmann said. “This technology offers a quick and easy way to objectively assess surface symmetry as well as global spine range of motion, and both measures are really important to assess after scoliosis surgery.”

Authors: Alon Wolf, PhD; Ankush Thakur, MS, BS, (HSS), Benjamin N. Groisser, BA (Technion), Howard J. Hillstrom, PhD (HSS), Kyle Morse, MD, Matthew E. Cunningham, MD, PhD, FAAOS (HSS), Michael T. Hresko, MD, FAAOS (Boston Children's Hospital), Roger F. Widmann, MD, FAAOS (HSS), Ron Kimmel, DPHIL (OXON).