bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Properties of Pediatric Knee Ligaments and The Iliotibial Band
Authors: Sanchez Mark , Gupta Anshal , Rohde Matt , Storaci Hunter , Sherman Seth , Ganley Ted , Shea Kevin
Published: May 2022

Background:

Substantial research about the mechanical properties of adult knee ligaments exists, but comparatively little is known about the pediatric knee. Choosing a graft for ligament reconstruction in pediatric patients is limited by the lack of knowledge of the mechanical properties of those ligaments and potential graft options in the skeletally immature.

Purpose:

Describe the mechanical properties of the ACL, PCL, MCL, LCL, and iliotibial band (ITB) in pediatric patients.

Methods:

Skeletally immature fresh frozen whole knees from 18 human cadavers (mean specimen age = 10.4 years) were thawed and the ligaments grossly dissected with bone block attachments intact, and length, width, and thickness were measured. Specimens were tested as a single unit (for those containing multiple bundles) and hydrated throughout testing. Each specimen was secured in an MTS machine and underwent a tensile loading protocol to measure ultimate tensile strength, ultimate tensile strain, and linear modulus.

Results:

Under testing, the ACL exhibited ultimate tensile strength (8.7 +/- 4.1 MPa), ultimate tensile strain (54.4 +/- 20.8%), and linear modulus (31.0 +/- 22.8 MPa) that were similar to the PCL (9.8 +/- 6.6 MPa, 48.6 +/- 22.1%, and 47.9 +/- 53.5 MPa, respectively). The LCL ultimate tensile strength was 18.7 +/- 6.5 MPa, ultimate tensile strain was 57.2 +/- 22.2%, and linear modulus was 68.7 +/- 50.8 MPa, compared to the MCL (19.5 +/- 13.9 MPa, 38.9 +/- 15.7%, and 93.3 +/- 75.1 MPa, respectively). Finally, the ITB demonstrated an ultimate tensile strength of 11.8 +/- 4.4 MPa, ultimate tensile strain of 42.6 +/- 14.9%, and linear modulus of 55.5 +/- 27.7 MPa.

Conclusion:

The ITB demonstrated greater ultimate tensile strength and a higher linear modulus than the ACL and PCL, with a lower ultimate tensile strain. Conversely, the ITB demonstrated lower values for ultimate tensile strength and linear modulus than the LCL and MCL. The ITB may serve as a reasonable substitute for native ACL and PCL reconstruction due to similar ultimate tensile strengths. The ITB may be less well-suited to reconstruct the LCL and MCL due to more significant differences in ultimate tensile strength. [Table: see text][Figure: see text]
Patient Reported Outcome Measures in Pediatric Anterior Cruciate Ligament Reconstruction: Does Promis Correlate with Pedi-Ikdc?
Authors: Williams Brendan A. , Johnson Mitchell , Pridgen Eric , McNeely Lia W. , Ganley Theodore J.
Published: May 2022

Background:

The Pedi-IKDC is a well-established patient reported outcome (PRO) measure used in knee and sports surgery. Recently, the computer adaptive PROMIS test has emerged as an alternative measure of patient function in this realm, but it is unclear if it captures information similar to the Pedi-IKDC and other PROs.

Hypothesis/Purpose:

The purpose of this study was to evaluate the strength of correlation between PROMIS and Pedi-IKDC scores for pediatric anterior cruciate ligament reconstruction (ACLR) patients during the postoperative period.

Methods:

Pediatric (<18yo) patients undergoing primary ACLR at a single urban tertiary care children’s hospital were identified. Patients completing both PROMIS and Pedi-IKDC within 2 weeks of each other were included. PROMIS domains including Physical Function, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, and Pain Interference were compared with the Pedi-IKDC using Pearson or Spearman correlations. Correlations were performed between Pedi-IKDC and PROMIS domains within subgroups based on timing of survey completion post-operatively (<6 weeks, 6-12 weeks, 3-6 months, 6-9 months, and >9 months). Multivariable robust regression modeling was performed to generate an equation of best fit to calculate a patient’s projected Pedi-IKDC result from PROMIS subdomains.

Results:

Study criteria were met by 150 patients. The cohort averaged 15.0 ± 2.2 years of age, was 50.7% male and underwent predominantly quadriceps (55.3%) or hamstring (36.7%) tendon ACLR. Score correlations appeared stronger with increased follow-up (Table 1.1). Both PROMIS Physical Function and Pain scores demonstrated moderate correlation to IKDC scores at 6-9 months (R=0.689, p<0.001; R=-0.556, p<0.001) and >9 month (R=0.487, p=0.001; R=-0.429, p=0.003) post-operatively. Across all timepoints, Pedi-IKDC and PROMIS Physical function demonstrated a strong correlation (R=0.844, p<0.001) while PROMIS Pain interference showed a moderate correlation (R=-0.541, p<0.001). A conversion equation for predicting Pedi-IKDC score was generated from PROMIS Physical Function and Pain Interference subdomains based on forward stepwise variable selection for robust regression model. This model demonstrates strong predictive ability for Pedi-IKDC (R⁁2=0.752, p<0.001) (Figure 1.2).

Conclusion:

The results from this study suggest that Pedi-IKDC demonstrates moderate to strong correlation with PROMIS physical function and pain interference domains following pediatric ACLR. Together, these two PROMIS domains also provide a reasonably strong prediction of a patient’s Pedi-IKDC score at a similar postoperative timepoint. These findings serve to facilitate cross-study outcome comparisons and can aid in the reduction of patient survey burden. Further work will be necessary to confirm these results across a broader patient cohort with longer periods of postoperative follow-up. [Table: see text]
Isolated Lateral Release is Inferior to Medial Patellofemoral Ligament Reconstruction for Surgical Management of Patella Instability in Pediatric Patients
Authors: Varshneya Kunal , Money Adam , Curtis Daniel , Ray Taylor , Shea Kevin , Abrams Geoffrey D. , Safran Marc , Sherman Seth L.
Published: May 2022

Background:

The optimal treatment for chronic patella instability remains controversial. Medial patellofemoral ligament reconstruction (MPFLR) has emerged as the “gold standard” for soft tissue stabilization. However, isolated lateral release (ILR) is still commonly performed to treat chronic patella instability despite growing evidence against this approach.

Hypothesis/Purpose:

Our purpose is to evaluate long-term revision rates and short-term post-operative complications in pediatric patients undergoing either MPFLR or ILR for recurrent patellar instability. The hypothesis is that MPFLR is a superior treatment option with reduced long term revision rates and comparable short-term complications.

Methods:

The MarketScan database was queried from 2007-2015 to identify patients who underwent MPFLR or ILR as their primary surgical treatment of their chronic patellar instability. Patients were excluded if they had incomplete records up to 5 years or if they underwent concomitant osteotomy or cartilage restoration during their index stabilization procedure. Baseline demographic data and patient co-morbidities were documented. Two and five year revision surgical stabilization rate and post-operative complications were reported. Results were analyzed statistically.

Results:

This study identified 471 patients (mean age 15.6 years, female 56.9%) who underwent MPFLR and 528 patients (mean age 15.5 years, female 70.5%) who underwent ILR for chronic patellar instability. Patients were stratified into two mutually exclusive groups: 1) MPFLR only or 2) ILR only. Patients who underwent MPFLR experienced higher rates of overall complications within 90 days of surgery (8.7% vs 4.9%, p = 0.0171). MPFLR had a higher rate of early wound complications (0.8% vs. 0%, p <.033) There was no difference in revision stabilization rate between MPFLR and ILR at 2 year follow-up. However, at 5 years of follow-up, 8.9% of patients who underwent ILR underwent revision surgery compared to 3.0% of patients who underwent MPFLR as their index surgery (p < 0.0001).

Conclusions:

Isolated lateral release is an inferior treatment option for surgical stabilization of chronic patella instability as compared to medial patellofemoral ligament reconstruction in pediatric patients. Despite slightly higher rate of short term complications in the MPFLR group and similar revision rates at 2 years, MPFLR has significantly decreased risk of revision stabilization at 5 year follow-up. [Table: see text][Table: see text]
Comparison of a Novel MRI Technique that Produces Equivalent Bone Contrast with 2D-CT for the Assessment of Glenoid Bone Loss
Authors: Alizai Hamza , Chen Diana , Chang Joseph , Ellis Henry B. , Wilson Phillip L.
Published: May 2022

Background:

Advanced imaging in patients with shoulder instability can be variable. MRI offers visualization of soft tissue injuries including capsulolabral injuries, however may not be ideal to assess osseous injuries. CT examination may often be desired as the accepted standard for assessment of glenoid and humeral bone loss, the extent of which can dictate surgical management in the adolescent age group in which bone loss is common.

Hypothesis/Purpose:

Our hypothesis, MRI bone sequence/method (FRACTURE: FFE Resembling A CT Using Restricted Echo-spacing) can provide measurements comparable to standard CT for glenoid bone loss. The objective of this study was to validate this technique in a cadaveric glenoid bone loss model using 2D-CT as the reference standard.

Methods:

Glenoid fractures of varying sizes were arthroscopically created in 10 cadaveric shoulders. 2D-CT and MRI FRACTURE on 3T Philips Ingenia; Philips Healthcare, Best, Netherlands) were performed on all 10 shoulders. FRACTURE is a 3D-gradient echo pulse sequence with restricted echo-spacing combined with an automated post-processing is a technical innovation which provides superior cortical and trabecular bone contrast on MRI. The CT and MRI were presented in a blinded fashion to 2 experienced musculoskeletal radiologists for independent measurement of the glenoid fracture length, width, as well as % glenoid bone loss using the best-fit circle method. Paired t-tests were performed to compare the measurements obtained on CT with those obtained on the MR FRACTURE images. Intraclass correlation coefficient was used to measure interobserver reliability.

Results:

There was no statistically significant difference between CT and MRI in terms of the measured glenoid fracture length(P-value=0.54) or fracture width(P-value=0.86). The mean length measured on CT was 23.40 mm ± 6.87 and on MRI was 22.96 mm ± 7.38. The mean width on CT measured 7.96 mm ± 3.51 and on MRI measured 7.89 mm ± 3.18. There was also no statistically significant difference between CT and MRI in terms of measured glenoid bone loss (P-value=0.65). Intraclass correlation coefficients for interobserver reliability ranged from 0.95 to 0.99 for measurements performed on CT and MRI.

Conclusion:

Measurements of glenoid fracture and associated % bone loss on CT were comparable with measurements obtained using the MR FRACTURE technique. Inter-observer reproducibility for these measurements was excellent. MRI FRACTURE technique may obviate preoperative CT in patients with anterior shoulder instability.
Recovery from Medial Patellofemoral Ligament Reconstruction with and Without Tibial Tubercle Osteotomy: An Assessment by Promis
Authors: Block Andrew M. , Ganapathy Aravinda , Nepple Jeffrey J.
Published: May 2022

Introduction:

Patellar instability is a common problem in the active pediatric and adolescent population. Medial patellofemoral ligament (MPFL) reconstruction with or without associated tibial tubercle osteotomy (TTO) are the most commonly utilized surgical treatment. Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in the pediatric orthopedic population. Currently, little is known about the relative recovery of isolated MPFL reconstruction compared to MPFL reconstruction with combined TTO.

Purpose:

To assess the outcomes of patients undergoing an isolated MPFL Reconstruction or MPFL with TTO utilizing PROMIS during post-operative recovery period.

Methods:

Patients undergoing patellofemoral surgery were prospectively given PROMIS assessments at each clinical visit. Inclusion criteria included a diagnosis of patellar instability, no prior MPFL procedures, <18 years old and follow up of at least 6 months. Additionally, subjects must have had a pre-operative evaluation and at least 3 FU visits within 6 months. Pediatric PROMIS domains assessed were Pain Interference and Mobility. Time points for PROMIS were labeled as pre-operative, 1 week, 1 month, 3 months, 6 months, and 1 year. Time points were then compared utilizing a mixed-linear regression model. Significance was set at p < 0.05. Ceiling or Floor Effects were present when ≥15% of study cohort had reached the maximum or minimum possible score.

Results:

A total of 58 patients were identified, 40 patients that underwent isolated MPFL and 18 patients that underwent MPFL + TTO. Both groups were relatively similar in terms of mean age (14.4 v. 15.3) and sex (62.5% v. 77.8% female). Changes in Mobility and Pain Interference were seen compared to baseline in both groups. For both Mobility and Pain interference, postoperative PROMIS changes were similar between isolated MPFL and MPFL + TTO groups (no significant differences at any timepoint) (Figure 1 and 2).

Conclusions:

MPFL reconstruction with or without TTO demonstrate improvements in PROMIS Mobility and Pain Interference after surgical treatment. The postoperative recovery of isolated MPFL reconstruction or MPFL reconstruction with TTO were very similar at all timepoints for PROMIS Mobility and Pain Interference. [Figure: see text][Figure: see text]
Pediatric Low-Grade ACL Sprains: Trends in Characteristics, Management, and Outcomes
Authors: Smith Caitlyn , Worrall Hannah , Ellis Henry B. , Wilson Philip L. , Jones Jacob C.
Published: May 2022

Background:

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in pediatric athletes. While much of the literature focuses on partial or complete tear of the ligament, there is little information on low-grade ACL sprains in either the adult or pediatric literature.

Purpose:

This study seeks to provide an analysis of grade 1 pediatric ACL sprains investigating injury characteristics, and report trends in management and outcomes.

Methods:

A retrospective review of patients, aged 8-19 years, presenting to a sports medicine clinic with a knee injury between January 2014-February 2021 was performed. Electronic medical records were queried for a diagnosis of low-grade ACL sprain based on radiology (MRI) reports that identified the injury. Charts were reviewed to collect data on demographics, sport history, injury details, clinical exam, return to play (RTP), and MRI findings. Descriptive statistics and comparisons within gender, age, and RTP were analyzed.

Results:

67 patients were diagnosed with a grade 1 ACL sprain based upon clinical assessment and MRI findings and treated for such. Average age at injury was 14.51±2.46 years (56.72% male), with a mean RTP of 8.77±6.67 weeks from date of diagnosis and 12.57± 8.04 weeks from date of injury. Most frequent activities when injured were soccer (23.88%), football (16.42%), and basketball (14.93%).0 patients underwent ACL surgical treatment; 2 patients underwent surgery for concomitant injuries (both meniscus tears). 55 patients (82.09%) sustained one or more concomitant injuries: bone contusion (50.91%), non-ACL ligamentous injury (30.91%), meniscus injury (25.45%), soft tissue/muscular injury (12.73%), other (31.48%). 23 patients (37.7%) had non-negative Lachman on clinical exam. Successful conservative interventions included therapy (95.45%), bracing (87.88%), and activity restrictions (86.15%). Females were more likely to be injured in their primary sport than males (82.14% vs. 59.46%, p=0.05). Analysis of bone contusion location vs. RTP clearance date was performed. Patients who took longer to RTP (16+ vs <16 weeks) were more likely to also have a lateral femoral condylar (LFC) contusion (75% vs. 16.67%, p=0.05).

Conclusion:

Given limited literature on the topic, this review provides presentation characteristics and initial RTP correlates for pediatric low-grade ACL sprains. While longer term follow-up is needed as we continue to learn about the injury, the success rate of conservative treatment indicates that therapy, bracing, and activity restrictions may be considered over surgical management for low-grade ACL sprains.
Non-Private Health Insurance Plans and Delayed Access to a Specialty Pediatric Concussion Clinic
Authors: Ellis Christine S. , Caze Todd J. , Burkhart Scott O. , Abt John P.
Published: May 2022

Background:

Delayed access to specialty concussion clinic results in a 5.5 times greater risk of protracted recovery and higher costs to the healthcare system. Previous research highlighting health equity disparities has shown that being female, of minoritized status, or having non-private health insurance doubles the risk of delayed access to specialty concussion clinic.

Purpose:

The purpose of this project was to better characterize those with non-private insurance receiving care at a specialty concussion clinic and examine factors potentially contributing to delayed access to specialty care.

Methods:

Medical records of 231 patients with non-private insurance were reviewed. Patients were divided into two categories (Equivocal, Unequivocal) based on handbook language requiring PCP referral. Equivocal were insurance plans with ambiguous language requiring PCP referral. Unequivocal were insurance plans with a specific statement requiring a referral. Access to clinic was defined as early (0-7 days) or delayed (8-20 days). Descriptive stats were run to determine the number of males/females, providers previously seen, and if previously seen in the Emergency Room (ER). A one-way analysis of variance (ANOVA) was run along with Tukey post hoc to determine if there were any significant differences between number of previous providers seen and previous ER visit in the average number of days to specialty care.

Results:

Most patients, 97% (n=224) were in the equivocal category. The equivocal category was mostly male (n=145, 64.7%) and of minoritized status (n=177, 79%) with over 35% (n=80) being delayed to clinic (M=6.8 days, SD=4.7). The majority of those in the equivocal category (n=157, 67.9%) saw at least one previous provider, 53% being evaluated first in an ER (n=119). Those with a previous provider visit took longer to seek specialty care (F(2,230) = 3.54, p = 0.03). Those seeing two previous providers (M=9.4 days) on average took more days to get to initial specialty care compared to seeing one previous provider (M=6.8 days) or going straight to clinic (M=6.2 days).

Conclusion:

Patients with a non-private health insurance plan experience delayed access to specialty concussion care. Those with equivocal insurance plan language were delayed to clinic, seen by multiple providers, and first evaluated in the Emergency Room. Non-private insurance is often financially subsidized, yet the equivocal language in these policies could be a detriment contributing to overall increases in health care costs and quality of care for those who have sustained a concussion.
Achilles Tendon Tears in Adolescents and Young Adults
Authors: Kramer Dennis E. , Beck Jennifer J. , Sanborn Ryan M. , Miller Patricia E. , Yen Yi-Meng , Park Howard Y. , Heyworth Benton E.
Published: May 2022

Background:

Achilles tendon tears are rare in adolescents and young adults, and management of these injuries remains controversial.

Hypothesis/Purpose:

To describe long-term limitations and physical activity levels following full or partial Achilles tears in adolescents and young adults, and report rates of surgical management, complications, re-tears, and time to return to sports (RTS).

Methods:

We conducted a descriptive study of young patients (8-22 years old) who were treated for a partial or full Achilles tear at two pediatric hospitals between 2004-2018. Demographic, imaging, and treatment data were retrospectively collected. Patient reported outcomes were obtained including the Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Tegner Activity Scale (TAS), and separate questions about reinjury and return to sport.

Results:

Of the 41 eligible patients with Achilles injuries, 25 (61%; mean age 18.9 years; 40% male) had a minimum one year of follow-up data and were further analyzed. Twenty-three patients (92%) underwent surgical repair. Twenty patients (80%) returned questionnaires at a median 6.3 years (IQR, 3.4 to 9.7 years), while the other 5 patients were followed for a median of 1.8 years (IQR, 1.1 to 2.5 years). Twenty-two (88%) injuries were full tears, 53% (10/19) with reported location occurring mid-tendon. Median ATRS score was 96 (IQR, 82-100) and median TAS score was 6 (4-8). Median FAOS scores were excellent for symptoms (91), pain (100), ADL (100), and sports (98), and were good for QOL (88). The 6-month RTS probability was 47% (95% CI, 19-66%) and at 12 months was 95% (65-99%). The median time to RTS for partial tears was 5.6 months vs. 6.6 months for full tears (p=0.05). One surgical patient (4%) had a retear which required revision repair while 2 others needed additional surgery (1 - arthroscopy for ankle impingement, 1 - surgery for haglund’s deformity). In addition to the 3 surgical patients requiring re-operation, 8 patients experienced other complications (11/25 total complications, 44%), which included minor wound/scar complications (4), scar formation necessitating hydrodissection (1), Achilles tendonitis (2), and persistent pain following conservative treatment leading to surgical repair (1). Females were more likely to experience a complication (9/15, 60%) compared to males (2/10, 20%), but this difference was not statistically significant (p=0.10).

Conclusion:

Adolescents and young adults surgically treated for an Achilles injury reported satisfactory long-term outcomes.
Pediatric Hurdle Injuries in Track and Field: A Descriptive Epidemiologic Study
Authors: Radel LC , Jones JC , Garcia KS , Soma DB , Sugimoto D
Published: May 2022

Background:

Track & field has more combined participants compared to any other high school sport in the United States. Hurdling is a track event that is unique due to a combination of running and jumping over an apparatus. As a result, this puts athletes at risk for various musculoskeletal injuries. However, there has been a paucity of studies describing the epidemiology of pediatric hurdle injuries

Purpose:

To examine hurdle-related injury types, body locations, injury mechanisms, and injury settings in children and adolescents.

Methods:

This was a retrospective review of data that was extracted from the National Electronic Injury Surveillance System (NEISS), which represents emergency room visits. Injury data involving hurdle injuries was searched during a 10-year period (2008-2017) involving patients 18 and under. Injuries were then classified based upon injury type, body locations involved, injury mechanisms, and injury settings. Descriptive statistics were used including mean ± standard deviation and frequency (N) was expressed as percentages (%).

Results:

A total of 749 hurdle related injuries were found from 333 males (44.5%) and 416 females (55.5%). Their mean ages were 14.0±2.2 years. The top 3 commonly recorded injury types were traumatic fracture (N=218, 29.1%), joint sprain (N=191, 25.5%), and contusion/hematoma/bruise (N=78, 10.4%). The overall top 3 injured body locations were ankle (N=140, 18.7%), knee (N=120, 16.0%), and wrist (N=69, 9.2%). Most injury mechanisms were trips, falls, and landings involving the hurdle (N=594, 79.0%). The rest of the mechanisms included ground involvement only (N=47, 6.3%) and other equipment (N=7, 0.9%). Finally, injury settings consisted of track & field practices (N=469, 62.6%), track & field meets (N=96, 12.8%), and other settings including gym, physical education class, recess, school activities, and camps (N=49, 6.5%).

Conclusion:

In pediatric hurdle athletes, most injuries seen in the emergency room are due to involvement of the hurdle and most occur during track practices. Although most injuries occur in the lower extremity, upper extremity injuries are also common. This information could be helpful in playing a role in targeted event-specific injury prevention initiatives.
Regulation and Selective Utilization of Peripheral Nerve Blocks Decrease Residual Neurological Symptoms After Pediatric Knee Surgery
Authors: Xu Amy L. , Lee R. Jay
Published: May 2022

Background:

Peripheral nerve blocks (PNBs) are an essential tool for reducing postoperative pain, but they have recently been associated with a higher incidence of complications than previously thought.

Hypothesis/Purpose:

We compared 1) incidence of PNB-related postoperative neurological symptoms and 2) patient selection, operative practices, and anesthetic practices regarding PNBs for pediatric patients who underwent knee surgery before and after changes in administration of PNBs at our institution.

Methods:

We compared data from pediatric patients who underwent knee surgery with PNBs at our institution during 2 periods: 2014–2016 (Cohort 1; 100 patients) and 2017–2019 (Cohort 2; 104 patients). Cohort 1 was described in a previous study, and Cohort 2 consisted of consecutive patients treated by 1 orthopaedic surgeon after recognition of the higher rate of complications and limiting use of PNBs to an anesthesia service at our institution. We compared cohorts using Student t-tests and chi-squared tests. P < 0.05 was considered significant.

Results:

The incidence of PNB-related neurological complications was significantly lower in Cohort 2 (0.96%; n = 1) than in Cohort 1 (6%; n = 6) (p = 0.045). The 1 patient in Cohort 2 had numbness proximal to the knee, which resolved by 9.5 weeks postoperatively. Of the 6 patients in Cohort 1, 5 also had numbness proximal to the knee, and 1 had shooting pains down the leg upon palpation of the femoral block site. Three of these patients had unresolved symptoms at final follow-up. There was a greater proportion of female patients in Cohort 2 (57%) than in Cohort 1 (36%) (p = 0.01), with no significant differences in age or BMI. The Cohort 2 surgeries also had significantly longer average operating times and a higher proportion using tourniquets (p<0.01). More fellows (67% vs. 55%) and fewer residents (6.9% vs. 16%) performed PNBs in Cohort 2 than in Cohort 1 (p = 0.01). The most common anatomical site for PNBs was the femoral nerve (51%; n = 85) in Cohort 1 and the saphenous nerve (51%; n = 90) in Cohort 2 (p < 0.01).

Conclusions:

The incidence of PNB-related complications after pediatric knee surgery was significantly lower after our institution implemented changes in the regulation of PNB use. This reduction may be explained by a shift toward more experienced providers administering PNBs and preference for distal anatomic sites, which may suggest actionable items for other institutions aiming to lower their PNB complication rate. [Table: see text][Table: see text]
Epidemiology of Overuse Injuries in U.S. Secondary School Athletics from 2014-2015 to 2018-2019 Using the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program
Authors: Post Eric G. , Simon Janet E. , Robison Hannah , Morris Sarah N. , Bell David R.
Published: May 2022

Background:

Large-scale injury surveillance systems such as the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) allow for the investigation of injury rates in national samples of high school athletes. The most recent studies examining overuse injury rates in high school sports reported data from 2012-2013 and therefore may not reflect current overuse injury rates in high school sports.

Hypothesis/Purpose:

To 1) determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014-2015 to 2018-2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location. We hypothesized that TL overuse injury rates would be greater than those previously reported from earlier data (1.64/10,000 athletic exposures (AEs) and 1.50/10,000 AEs). We also hypothesized that overall overuse rates would be greater in girls’ sports compared to boys’ sports and would differ between injury types (TL vs. NTL) and injury location.

Methods:

During the 2014-2015 through 2018-2019 school years, NATION-SP documented TL and NTL injuries from 222 high schools. This study included 23 high school sports during preseason, regular season, and post-season competitions and practices. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

Results:

The overall overuse injury rate was 6.6/10,000 AEs (95%CI=6.3, 6.9), the NTL overuse injury rate was 4.0/10,000 AEs (95%CI=3.8, 4.3), and the TL overuse injury rate was 2.6/10,000 AEs (95%CI=2.4, 2.8). The overuse injury rate was greater in girls’ sports compared to boys’ sports (IRR=1.8; 95%CI=1.6, 1.9). The highest rates of overuse injury regardless of sport gender were reported in girls’ cross-country (20.0/10,000 AEs; 95%CI=15.7, 25.1), girls’ field hockey (17.6/10,000 AEs; 95%CI=12.3, 24.5), and girls’ track and field (17.5/10,000 AEs; 95%CI=14.9, 20.4). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.45; 95%CI=4.76, 6.27) and for the lower extremity compared to the trunk and spine (IRR=11.08; 95%CI=9.21, 13.45).

Conclusions:

Using NATION-SP data collected over five consecutive school years, overuse injury rates among high school athletes were much greater than previously reported earlier in the decade. Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes. [Table: see text][Figure: see text]
Pediatric Tibial Spine Fractures: Exploring Case Burden by Age and Sex
Authors: DeFrancesco Christopher J. , Wilson Lauren , Mackie Alexandra T. , Lebrun Drake , Memtsoudis Stavros G. , Fabricanta Peter D.
Published: May 2022

Background:

Pediatric tibial spine fractures (TSFs) are a well-known clinical entity, but the epidemiology of these injuries is not fully understood. Further, there is limited data on outcomes after TSF treatment, specifically the proportion of patients that go on to require subsequent ACL reconstruction after completing their initial treatment course.

Purpose/Hypothesis:

To describe the distribution of TSF case burden by age and sex, and to determine the proportion of patients who undergo subsequent ACL reconstruction or develop ACL insufficiency.

Methods:

The Truven Marketscan database was queried to identify patients aged 7-18 years with TSFs during the time period of 2016-2018. Diagnosis and initial treatment (surgical vs. nonoperative) was recorded based on database coding. Case burden by age and sex was calculated. The database, which includes longitudinal data, was then queried for subsequent diagnoses of ACL insufficiency as well as subsequent ACL reconstruction procedures performed among the subjects.

Results:

We found 876 cases of TSF, 71.3% of which were treated nonoperatively. The male:female ratio for case burden was 2.2. Cases peaked at age 13-14 for males and age 11-12 for females (Figure 1). Of all cases identified, 3.7% also had either a diagnosis code for ACL laxity entered in a delayed fashion into the database or a later procedure code for ACL reconstruction (considered together to represent subsequent “ACL insufficiency”). Only 15 subsequent ACL reconstructions were found; all of which were among males, and 9 of which were among males 13-14 years old (Figure 2).

Conclusion:

This longitudinal study is the largest epidemiologic analysis of pediatric TSFs to date. We found low rates of subsequent ACL insufficiency and ACL reconstruction in general, with males aged 13-14 accounting for the most cases and exhibiting the highest rates of subsequent ACL insufficiency and ACL reconstruction. Rates of subsequent ACL reconstruction were lower than previously reported. Males accounted for about twice as many cases as females. [Figure: see text][Figure: see text]
Saccadic Latency Measures on Oculomotor Tracking and King Devick Testing Performance Measures in Pediatric Concussion Patients
Authors: Sarva Saikaashyap , Thirunagari Prem Kumar , Rieiro Hector , Bell Matthew , Streeter Leslie , Minor Jon , Balaji Arvind , Dusenberry Brett , Mortazavi Mo
Published: May 2022

Background:

King-Devick (KD) testing has been a reliable clinical tool used to identify changes in rapid eye movements between fixation points (saccades) after concussion. Other clinical tools such as oculomotor tracking (OMT) devices have been used to assess the extent of visual dysfunction in concussion patients to aid diagnosis, subtyping, and symptom management.

Purpose:

To compare trends in OMT saccadic motion analysis data to KD times/performance in concussed patients.

Methods:

Retrospective study of 66 pediatric patients (ages 12 to 21) with concussion. KD testing was conducted using standard 3 card protocol with a series of numbers which the patient reads aloud in a specific pattern as fast and accurately as possible without head movement. The length of time to complete each card was noted and the three KD times were averaged, resulting in one mean KD value for each patient. Patients were categorized into either a “Fast” (average KD time from 0 - 20 seconds), n=56, or “Slow” group (average KD time above 20 seconds), n=10. Each patient underwent testing with an OMT device during the same visit (250 Hz video-eye tracker), which measured vertical and horizontal saccadic latencies. Statistical analysis using a paired two sample t-test assuming equal variances compared the OMT data between the slow and fast groups. Exclusion criteria included history of visual disorders, learning disorders, seizure disorder, or intracranial hemorrhage.

Results:

The slow KD group had an average vertical saccadic latency of 248.88 ms and a horizontal saccadic latency of 214.66 ms (Table 1). The fast KD group had an average vertical saccadic latency of 217 ms and a horizontal saccadic latency of 196.64 ms. A t-test of vertical latency showed a statistically significant difference between slow and fast groups (p value = 0.002). A T-test of horizontal latency resulted in a p value = 0.069, which may support a statistically significant difference with a larger sample size.

Conclusion:

A potential relationship between patients with slower KD test times and slower horizontal/ vertical saccadic latencies on OMT saccadic analysis may be present. However, these trends will need more testing under larger sample sizes in order to make definitive conclusions. [Table: see text]
An Analysis of the Increased Risk for Lower Extremity Injury Within 12 Months After Concussion and Utilization of Lower Extremity Measures for Return to Sport
Authors: Switzer Claire , Melfi Nicole , Mitchell Katy , Hofschulte Robert , Vora Purvi
Published: May 2022

Background:

According to the Concussion Clinical Practice Guidelines, the typical recovery timeline post-concussion is about 7-14 days. However, recent research has shown an increased risk for lower extremity (LE) injury as early as 90 days and up to 1 year post-concussion.

Purpose:

The primary purpose of this study was to determine the prevalence of youth athletes who sustained a LE injury within 1 year post-concussion at Texas Children’s Hospital. The secondary purpose of this study was to describe the prevalence and utilization of LE functional testing performed by Physicians (MDs), Physical Therapists (PTs), and Athletic Trainers (ATs) as part of return to sport (RTS) clearance post-concussion.

Methods:

A retrospective chart review was completed consisting of patients diagnosed with a concussion by a Sports Medicine Physician from September 2018 to September 2020. The inclusion criteria were as follows: male or female, ages 8-21, and active participation in 1 or more sports. The data was collected in Microsoft Forms. Additionally, a Microsoft Forms survey was sent to Sports Medicine MDs, PTs, and ATs to assess utilization of LE functional tests. SPSS 25.0 was used for analysis with alpha level at .05. A one-sample chi-square test was utilized to compare re-injury rate to the known rate of 1%. Other proportional comparisons were run using two-sample chi-square analyses.

Results:

A total of 635 charts were reviewed with 527 patients participating in at least 1 sport. 12.7% (N=54) of those who sustained a concussion had either a musculoskeletal injury or another concussion within 1 year, with the highest proportion of injuries being a second concussion (33.3%) or ligament sprain (35.2%). Of the providers polled, 52.8% do not currently use a LE functional measure as part of RTS criteria. The most commonly reported reasons that providers do not use LE measures were as follows: not included in their standard of practice, lack of time, and lack of knowledge.

Conclusion:

The results suggest a LE test battery may be beneficial to assess LE injury risk post-concussion. Additionally, the majority of providers do not currently use LE functional measures when assessing RTS criteria. Considering the increased risk for LE injury and lack of LE functional testing completed by providers, further education about current, available LE functional testing should be provided to decrease the prevalence of LE injury after concussion. Future studies should analyze the effects of LE strengthening and functional testing on subsequent LE injury risk post-concussion.
Return to Sport Testing After Arthroscopic Shoulder Surgery in Adolescent Patients
Authors: Anderson Kathryn G. , Roman Dylan , Varakitsomboon Shing , Weaver Adam , Saper Michael G.
Published: May 2022

Background:

Readiness for return to sport (RTS) after surgery can be assessed using strength and functional performance testing. However, data regarding RTS testing after arthroscopic shoulder stabilization in adolescent patients is limited.

Purpose:

To investigate the results of strength and functional RTS testing following arthroscopic stabilization in adolescent patients with shoulder instability.

Methods:

A retrospective review of medical records was performed to identify adolescent patients who underwent arthroscopic shoulder stabilization and subsequent RTS testing between April 2017 and April 2020. Surgeries were performed by a single sports medicine fellowship-trained surgeon; RTS assessments were performed at the primary institution’s sports rehabilitation clinic by a licensed physical therapist. Patient demographics, operative details, patient-reported outcome measures (PROMs) (VAS, Tegner, ASES, QuickDASH), and RTS testing results were collected. PROMs were obtained at the time of the RTS test. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences between the involved and uninvolved limbs were analyzed. Correlations between RTS testing results and PROMs were examined.

Results:

24 patients (62.5% male) were identified with mean age of 15.5 years (range, 13-21 years). Football was the most common primary sport played (33.3%). 58.3% of patients underwent surgery on their dominant shoulder. 21 patients had isolated anterior repairs, two had combined anterior/posterior repairs, and one had an isolated posterior repair. RTS testing was performed at a mean of 6.02 ± 0.64 months postoperatively. All PROMs improved significantly from pre-operative to the time of RTS testing (p<0.0001). All patients (n=24) failed at least one component of the RTS testing (Table 1). Pre-operative Tegner scores were positively correlated with involved isokinetic external rotation symmetry (r=0.383, p<0.05) and with closed kinetic chain upper extremity stability test (CKCUEST) performance (r=0.577, p<0.005). Post-operative Tegner and ASES scores were positively correlated with involved isometric internal rotation LSI (r=0.418, p<0.05) and CKCUEST performance (r=0.383, p<0.05), respectively. Isometric External Rotation LSI was positively correlated with the Isokinetic External Rotation LSI at 180°/sec for the surgical limb (r=0.57, p<0.01).

Conclusion:

At 6-months postoperative, shoulder strength and stability deficits persist in the surgical limb of adolescent patients. PROMs improve significantly from pre-operative to time of RTS testing. Tegner and ASES scores may be associated with objective shoulder strength and stability measurements. [Table: see text]
How Many Americans Change Their Racial Identification over Time?
Authors: Agadjanian Alexander
Published: May 2022

Despite long-standing assumptions about racial identity as a fixed characteristic, social scientists have increasingly recognized its fluidity and examined the origins of micro-level race change. However, knowledge regarding the prevalence of race change is limited. This data visualization fills this descriptive gap by providing a comprehensive account of recent levels of racial self-identification change among Americans. The author uses five high-quality panel surveys in which race is asked of the same nationally representative adult samples several years apart. Among all respondents, race change rates range from 5 percent to 12 percent across surveys, averaging 8 percent. Original white identifiers (4 percent on average) are much less prone to change than initial nonwhites collectively (20 percent). Blacks have as stable identities as whites, while mixed-race (52 percent) and “other”-race (73 percent) Americans undergo substantial identity shifts over time. Results further cement a perspective of race as flexible for some in the United States.
Without a right to remain: Property’s limits on Portland’s self-governing houseless encampments
Authors: Przybylinski Stephen
Published: May 2022

With the rise of organized houseless encampments or “tent cities” around the U.S., scholars have begun to address the social-spatial effects of encampments on houseless peoples’ lives. This scholarship has primarily explained the development of organized encampments as an effect of neoliberal modes of governance as municipalities have sought to offload responsibility for caring for the houseless or to discipline houseless people by containing them through the regulative force of the state. Such explanations address the culpability of the state in relation to capital which shapes houseless peoples’ lives. Yet, they leave unaddressed one critical component of houseless encampments: that relations surrounding property ensure that houseless encampment residents remain property-insecure and without a guaranteed right to remain. Through a case study of self-governing houseless encampments in Portland, Oregon, the article advances a relational analysis of property and citizenship to show how self-governing houseless communities are denied key privileges of citizenship that democratic self-governance is intended to realize. In doing so, the case study examines the very tradeoffs houseless encampment residents must make when living in an encampment. The paper ends suggesting that Portland’s encampment model allows us to more clearly see the consequences of establishing collective rights to access property within liberal property systems, and from this, where political and scholarly attention ought to be placed to better protect houseless people through a more democratic right to remain.
Happiness and international migration – The spatial dimension of a relationship
Authors: Kincses Aron , Tóth Géza
Published: May 2022

The relationship between international migration and happiness is evident and has long been studied in international literature ( Brailovskaia et al., 2017 ; Shamsuddin and Katsaiti, 2020 ; William, 2019). In this study, we examine the relationship between countries’ levels of happiness and net migration rates relative to their neighbours. The question arose as to whether high happiness is, in any case, associated with a positive migration balance, and whether an unfavourable happiness situation is associated with high emigration. Are there any countries that deviate somewhat from this simple assumption?
Contested estuary ontologies: The conflict over the fairway adaptation of the Elbe River, Germany
Authors: Hein Jonas , Thomsen Jannes
Published: May 2022

The ongoing fairway adaptation of the Elbe Estuary is one of the most contested infrastructure projects in Germany in recent years. After a 17-year, highly contested planning process, delayed by a number of court proceedings, the dredging works started in 2019. The dredging aimed to establish a depth of at least 17.40 m below mean sea level, permitting the port to handle larger container vessels independent of the tide. Environmental NGOs, fishers and the riverine municipalities claim that the dredging will lead to habitat destruction, terminate the fishery in the estuary, and that it violates the European Water Framework Directive. The conflict illustrates that knowledge production, political economy and power are closely intertwined and provides evidence that some planning conflicts go even deeper than this. They are ultimately rooted in different ‘estuary ontologies’, in the different ways in which nature is enacted, and in different imaginations of possible futures for the Elbe estuary and its riverine population. Based on qualitative interviews with the actors who are involved in, observe or fight against the intervention, and on a content analysis of press articles and webpages, we unravel the complex relations between political economy, knowledge production and the different performances of reality which characterize the ongoing conflict over the fairway adaptation. We relate competing narratives, knowledge claims and ontologies to the actors promoting and challenging the fairway adaptation. Finally, we identify multiple estuary realities, which are enacted by specific practices performed by fishers, port authorities and environmental NGOs.
Multiple comorbid conditions and healthcare resource utilization among adult patients with hyperkalemia: A retrospective observational cohort study using association rule mining
Authors: Dai Dingwei , Sharma Ajay , Alvarez Paula J , Woods Steven D
Published: May 2022

Objectives

To estimate the prevalence of specific comorbid conditions (CCs) and multiple comorbid conditions (MCCs) among adult patients with hyperkalemia and examine the associations between MCCs and healthcare resource utilization (HRU) and costs.

Methods

This retrospective observational cohort study was conducted using a large administrative claims database. We identified patients with hyperkalemia (ICD-10-CM: E87.5; or serum potassium >5.0 mEq/L; or NDC codes for either patiromer or sodium polystyrene sulfonate) during the study period (1/1/2016–6/30/2019). The earliest service/claim date with evidence of hyperkalemia was identified as index date. Qualified patients had ≥12 months of enrolment before and after index date, ≥18 years of age. Comorbid conditions were assessed using all data within 12 months prior to the index date. Healthcare resource utilization and costs were estimated using all data within 12 months after the index date. Association rule mining was applied to identify MCCs. Generalized linear models were used to examine the associations between MCCs and HRU and costs.

Results

Of 22,154 patients with hyperkalemia, 94% had ≥3 CCs. The most common individual CCs were chronic kidney disease (CKD, 85%), hypertension (HTN, 83%), hyperlipidemia (HLD, 81%), and diabetes mellitus (DM, 47%). The most common dyad combination of CCs was CKD+HTN (71%). The most common triad combination was CKD+HTN+HLD (62%). The most common quartet combination was CKD+HTN+HLD+DM (36%). The increased number of CCs were significantly associated with increased ED visits, length of hospital stays, and total healthcare costs (all p-value < 0.0001).

Conclusions

MCCs are very prevalent among patients with hyperkalemia and are strongly associated with HRU and costs.