Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.

Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.

Background: The quadriceps tendon (QT) autograft has recently drawn attention for anterior cruciate ligament reconstruction (ACLR). Finding the best autograft option for adolescents after an ACL injury is essential to ensure them a high-quality active lifestyle. There are no studies comparing the all-soft-tissue QT autograft with the hamstring tendon (HT) autograft in such population. Methods: In this study, 68 patients younger than 18 years of age were assigned to the HT (38 patients) or the QT (30 patients) ACLR group. The groups were similar, allowing their comparison. The instrumented knee laxity was evaluated with a Genourob arthrometer. In total, 48 patients (27 HT and 21 QT) were tested 3 months post-op, and 45 patients (26 HT and 19 QT) were tested 6 months post-op. Results: We found that 3 months post-op, the side-to-side anterior tibial translation measurements (GNRB1) were worse in the HT than in the QT group (1.4 (0.2–5.2; 1.715) vs. 0.6 (0.1–2.1; 0.905) mm, p = 0.02). There was no difference in side-to-side anterior tibial translation at 6 months post-op (GNRB2) between the HT and the QT group (1 (0.2–5.3; 1.519) vs. 1.1 (0.3–3.4; 1.279) mm, p = 0.927). At 3 months post-op, the side-to-side anterior tibial translation (GNRB1) was worse in males than in females. irrespective of the graft choice (1.45 (0.1–5.2; 1.696) vs. 0.4 (0.1–3.4; 0.89) mm, p = 0.016). The displacement curve slopes 6 months post-op were better for females (3 (0–13.1; 3.335) vs. 5.3 (0–26.1; 7.848), p = 0.014). At 3 months post-op, the GNRB measurements showed that the side-to-side anterior tibial translation (GNRB1) was better for females when the HT autograft had been used (0.45 (0.2–3.4; 0.942) vs. 2.4 (0.3–5.2; 2.333) mm, p = 0.003). In general, both autografts provided excellent objective outcomes at early follow-up. Conclusions: The all-soft-tissue QT autograft should be considered as a reliable alternative for ACLR in adolescents. This autograft has at least the same properties as the HT autograft in the early stages after ACL reconstruction in adolescent athletes and, in some respects, seems superior to the HT autograft. Research should continue to find the best possible graft choice for the most active and willing-to-return-to-sport population.

Background/Objectives: LAS is common in adolescents, yet early management strategies differ. The traditional PRICE + NSAIDs protocol focuses on short-term symptom relief, whereas the PEACE and LOVE framework emphasizes education, early optimal loading, and progressive exercise. This study compared functional recovery between these two approaches. Methods: A prospective randomized study enrolled 76 adolescents (12–17 years) with first-time LAS, allocated to PRICE + NSAIDs or PEACE and LOVE using a computer-generated randomization sequence with concealed envelope allocation; 65 completed follow-up (PRICE n = 32; PEACE and LOVE n = 33). Functional performance was assessed at 1–2, 5–7, and 12–15 weeks using Biodex isokinetic dynamometry and the Y-Balance Test composite score (YBT-CS). Outcomes were expressed as side-to-side deficits (uninjured − injured limb) and analyzed using two-way mixed repeated-measures analysis of variance, with Group (PRICE + NSAIDs vs. PEACE and LOVE) as the between-subject factor and Time (1–2, 5–7, and 12–15 weeks) as the within-subject factor. Results: Significant main effects of time were observed for IN strength at 60°/s (F = 5.73, p = 0.006) and 120°/s (F = 10.15, p < 0.001), EV strength at 120°/s (F = 6.82, p = 0.003), ankle ROM at 60°/s (F = 12.79, p < 0.001) and 120°/s (F = 13.09, p < 0.001), and YBT CS (F = 6.91, p = 0.002), indicating progressive recovery across follow-up. No significant group effects or time × group interactions were detected for any outcome (all p > 0.05). Conclusions: Both rehabilitation protocols were associated with progressive functional recovery following adolescent LAS. No statistically significant between-group differences or differential recovery trajectories were detected over 12–15 weeks. These findings suggest that an active, education-focused rehabilitation approach yields functional outcomes comparable to traditional PRICE + NSAIDs management in the short term. Larger studies with longer follow-up are required to determine whether clinically meaningful differences exist between protocols. Trial registration: ClinicalTrials.gov: NCT07287020; registered 3 December 2025 (retrospectively registered).

Background and Objectives: A prominent area of research in adolescent ACL reconstruction (ACLR) involves graft selection, with particular interest in the quadriceps tendon (QT) as an alternative to hamstring tendon (HT) autografts, although comparative studies on muscle strength outcomes and patient satisfaction in adolescents remain limited. This study aims to evaluate the influence of QT and HT autografts on muscle strength and satisfaction outcomes post-ACLR in adolescents. Methods: This prospective study was conducted at the Lithuanian University of Health Sciences, enrolling 68 patients aged 12–17. ACLRs were performed using QT or HT autografts. Muscle strength was assessed using an isokinetic dynamometer (Biodex), while patient satisfaction was evaluated through IKDC, Lysholm, and ACL-RSI surveys preoperatively and 12 months postoperatively. Results: 54 patients (24 QT and 30 HT) completed the study. The data are non-parametric and are presented as median (IQR). Isokinetic measurements indicated that QT harvesting led to significantly lower extension strength compared to HT 6 months (p = 0.019) and 12 months post-op (p < 0.001) but showed better H/Q ratios 6 months (p = 0.019) and 12 months post-op (p < 0.001). There was no significant difference between the QT and HT groups in ACL-RSI and Lysholm scores. IKDC scores were significantly higher in the HT group (p = 0.009). Conclusions: QT autografts provide favorable H/Q ratios, yet they exhibit weaker extension strength and lower satisfaction outcomes compared to HT. These results suggest a need for individualized rehabilitation protocols and further research to optimize ACLR graft selection for adolescents.