bluuebunny/crossref_metadata_2025 huggingface dataset:
LATERAL ELBOW OVERUSE INJURIES IN PEDIATRIC FEMALE GYMNASTS: A COMPARISON OF RADIAL HEAD STRESS FRACTURES AND CAPITELLAR OCD
Authors: Wyatt Charles W. , Searls William C. , Zynda Aaron J. , Ellis Henry B. , Wilson Philip L.
Published: April 2020

Background:

Radial head stress fractures (RHSF) and capitellar osteochondritis dissecans (OCD) are rare and may be seen in pediatric gymnasts. Clinical and radiographic factors correlating with these differential lesions are unclear.

Purpose:

To describe the clinical presetantion of RHSF and compare the demographic, radiographic, and clinical characteristics of elbows in pediatric gymnasts presenting with RHSF to those presenting with OCD of the capitellum.

Methods:

An IRB-approved retrospective review of consecutive female gymnasts treated within a pediatric sports medicine practice for either RHSF or capitellar OCD over a 5-year period (1/2014-2/2019) was performed. Gymnasts <18 years old at the time of injury presenting with signs of a radial head stress fracture (Salter-Harris III or IV) or with diagnostic features of capitellar OCD were included. Those with congenital anatomic elbow abnormalities or prior ipsilateral elbow surgery were excluded. Patients were dichotomized into either the RHSF or OCD group; and demographic, radiographic, and clinical characteristics were compared. Statistical analysis was performed using a Mann-Whitney test for continuous variables and a chi-square test for categorical variables.

Results:

Forty-five patients (9 with bilateral OCD, 1 with bilateral RHSF, and 3 with each lesion in alternate elbows), contributing 58 elbows, met inclusion criteria. Thirty-nine elbows in the OCD group and 19 elbows in the RHSF group were studied. Average age for all gymnasts was 11.58 years (9-16 years), with no difference between groups (OCD: 11.47 vs RHSF: 11.78; p=0.34). No differences in height, weight, BMI, or laterality were noted. Gymnasts presenting with RHSF were competing at a higher level than those with OCD, with 94.74% of RHSF group competing at level 7 or greater compared to 66.67% of OCD patients (p=0.02). Compared to those with OCD, the RHSF group presented more acutely following onset of symptoms (p=0.014), reported significantly more pain with valgus stress (p<0.001), and concurrent medial elbow pain than those with OCD (p<0.01). The RHSF group demonstrated significantly smaller distal humeral width and decreased height of the proximal radial epiphysis, as well as increased valgus angulation of the radial neck shaft angles and distal humeral articular surface (p<0.05). No differences in olecranon or medial epicondyle hypertrophy, or avulsive changes were identified. (Table I)

Conclusion:

Gymnasts competing at a high competitive level and presenting more acutely may be at risk for RHSF. Additionally, differing anatomy in the lateral elbow may be a predisposing risk factor for RHSF as opposed to OCD and merits further investigation.

[Table: see text]
ASSESSMENT OF ACETABULAR COVERAGE IN BORDERLINE ACETABULAR DYSPLASIA: ARE PLAIN RADIOGRAPHIC PARAMETERS ACCURATELY ESTIMATES OF THREE-DIMENSIONAL COVERAGE?
Authors: Graesser Elizabeth , Schwabe Maria , Akers Sean , Pascual-Garrido Cecilia , Clohisy John C , Nepple Jeffrey J
Published: April 2020

Introduction:

Assessment of anterior acetabular coverage is commonly done with measurement of the anterior center edge angle (ACEA) or anterior wall index (AWI). This is particularly important in cases of borderline acetabular dysplasia where it may influence treatment decisions. However, the ACEA and AWI has been poorly validated.

Purpose:

The purpose of the current study was to investigate the correlation between plain radiographic measurements and three-dimensional femoral head coverage on low-dose CT in borderline acetabular dysplasia.

Methods:

Seventy consecutive hips with borderline acetabular dysplasia (LCEA 20-25°) were included in the current study. Radiographic evaluation was performed prospectively including LCEA, acetabular inclination, and AWI on AP pelvis radiographs, and ACEA on false profile radiographs. The mean LCEA was 22.1±1.4°, while the mean acetabular inclination was 10.3±3.3. All patients underwent low-dose pelvic CT assessment for preoperative planning. The radial acetabular coverage was calculated according to the standardized clock-face position [measured at 12:00 (lateral), 1:00, 2:00, 3:00 (anterior), and 4:00] as described by Larson et al. Statistical analysis determined the correlation between ACEA and radial coverage.

Results:

The mean ACEA in the group was 25.3±5.8° (range 10.1-43.9), with 16% having ACEA≤20° and 50% having ACEA≤25°. The mean radial coverages were 63.5%±1.7 (12:00), 60.7%±2.2 (1:00), 50.8%±3.2 (2:00), 37.0%±3.3 (3:00), and 27.9%±3.1 (4:00). The ACEA had poor correlation with radial coverage at all positions from 12:00 to 4:00 (range –0.068-0.173). The AWI had moderate correlation with radial coverage at 3:00 (PCC 0.499) and 4:00 (PCC 0.573). Comparing hips with an ACEA <20° versus >20°, there was no difference between the mean radial acetabular coverage at any position 12:00-4:00 (p=0.18-0.95). Comparing hips with an ACEA <25° versus >25°, there was no difference between the mean radial acetabular coverage at any position 12:00-4:00 (p=0.12-0.71). No significant difference in AWI was present between subgroups with normal and deficient radial coverage from 12:00 to 4:00 (p=0.09-0.72).

Discussion:

The current study demonstrates poor correlation of the ACEA measurement with true anterior femoral head coverage as evaluated at clock-face positions from 12:00 to 4:00. The AWI demonstrated moderate correlation for 3:00-4:00 coverage but fails to differentiate hips with normal and deficient coverage. In the setting of borderline acetabular dysplasia, anterior and anterolateral femoral coverage should be assessed via low-dose CT rather than ACEA or AWI.
DEFINING THE BORDERLINE HIP: HIGH VARIABILITY IN ACETABULAR COVERAGE AND FEMORAL DEFORMITY
Authors: Graesser Elizabeth , Schwabe Maria , Pascual-Garrido Cecilia , Clohisy John C , Nepple Jeffrey J
Published: April 2020

Introduction

Borderline acetabular dysplasia is radiographically defined as a lateral center edge angle (LCEA) of 20-25 degrees. It is well accepted that some borderline hips have instability while others have primarily impingement. The optimal management of borderline dysplasia is challenging and particularly complex due to the anatomic variability that exists among patients but has not been well characterized.

Purpose

The purpose of this current study was to investigate the variability in hip deformity present on low-dose CT in a cohort of patients with symptomatic borderline acetabular dysplasia.

Methods

Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. Radiographic evaluation included LCEA, acetabular inclination, anterior center edge angle (ACEA), and alpha angles on AP, Dunn, and frog views. All patients underwent low-dose pelvic CT for preoperative planning. Femoral deformity was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Radial acetabular coverage was calculated according to standardized clock-face positions [measured from 8:00 (posterior) to 4:00 (anterior)] and defined as normal, under-coverage, or over-coverage relative to 1 SD from the mean of normative values.

Results

The mean LCEA was 22.1±1.4, while the mean acetabular inclination was 10.3±3.3. The mean ACEA in the group was 25.3±5.8 (range 10.1-43.9), with 16% having an ACEA ≤ 20 and 50% having an ACEA ≤ 25. The mean femoral version was 17.9° (range -4° to 59°). The mean maximal alpha angle was 57.2° (range 43° to 81°) with 61.4% greater than 55°. Lateral coverage (RAC at 12:00) was deficient in 74.1% of cases. Anterior coverage (RAC at 2:00) was highly variable with 17.1% under-coverage, 72.9% normal, and 10.0% over-coverage. Posterior coverage (RAC at 10:00) was also highly variable with 30.0% under-coverage, 62.9% normal, and 7.1% over-coverage. The three most common patterns of coverage were: isolated lateral under-coverage (31.4%), normal coverage (18.6%), and lateral and posterior under-coverage (17.1%).

Discussion

Patients with borderline acetabular dysplasia demonstrate highly variable three-dimensional deformities including anterior, lateral, and posterior acetabular coverage, femoral version, and alpha angle. Comprehensive deformity characterization in the population is important to guide diagnosis and treatment decisions.
SHOULD WE FEAR THE BORDERLINE DYSPLASTIC HIP?: EXTERNAL VALIDATION OF THE FEAR INDEX IN THE SETTING OF BORDERLINE ACETABULAR DYSPLASIA
Authors: Schwabe Maria , Clohisy John C , Pascual-Garrido Cecilia , Graesser Elizabeth , Nepple Jeffrey J
Published: April 2020

Introduction:

The Femoro-Epiphyseal Acetabular Roof (FEAR) index has recently been proposed as a useful tool in identifying hips with instability in the setting of borderline acetabular dysplasia. Beck et al. were the first to describe this parameter and demonstrated a FEAR index as the angle between a line connecting the most medial and lateral part of the sourcil and a line connecting the most medial and lateral part of the straight central third of the physeal scar.

Purpose:

The purposes of the current study were 1) external validation of intra-observer and inter-observer reliability and 2) to determine the correlation/association of FEAR with a clinical diagnosis of instability.

Methods:

The current study was a retrospective review of patients diagnosed with borderline acetabular dysplasia by a single surgeon. The study period included January 2008-April 2017 and identified patients with LCEA 20°-25°, via prospectively collected radiographic measurements in a hip preservation database. Inclusion criteria were treatment with either hip arthroscopy or PAO, LCEA of 20°-25°, and 14-40 years of age. Patients were excluded if they had a Tӧnnis grade ≥2, prior ipsilateral hip surgery, residual deformities from SCFE or Perthes. Demographics and radiographic measurements were recorded. Two individuals read all radiographs after obtaining an intra observer reliability of 97% and inter observer reliability of 88%. Sensitivity and specificity were calculated for FEAR predicting instability. A t-test was used to assess correlation of LCEA, acetabular inclination (AI), and ACEA with FEAR.

Results:

A total of 186 patients were included, FEAR was unable to be assessed in 5% of hips because of inability to visualize the proximal femoral physeal scar. Of the remaining 176 hips, 18% of hips had a FEAR index >5°. FEAR positive mean was 7.6°±2.8° (range=5.1°-17.5°) and FEAR negative mean was –6.9°±6.4° (range=-29.4°-3.7°). Results of FEAR predicting instability was sensitivity=33% (23/70), specificity=92% (98/106), PPV=74% (23/31), and NPV=67% (98/145). The mean AI was significantly high in FEAR(+) hips (AI mean=11.2° and FEAR(-) AI mean=9.5°; p=0.005). No difference in LCEA or ACEA was seen relative to the presence of FEAR.

Discussion:

In the current study, a positive FEAR index was generally indicative of the presence of clinical instability. However, the FEAR index was poorly sensitive to hip instability with 67% hips diagnosed with instability having a negative FEAR index.
PEAK LOWER EXTREMITY SOCCER INJURIES OCCUR IMMEDIATELY FOLLOWING GROWTH IN ADOLESCENTS: AN EPIDEMIOLOGIC REVIEW OF EMERGENCY DEPARTMENT VISITS
Authors: Wright Aidan P. , Zynda Aaron J. , Chung Jane S. , Wilson Philip L. , Ellis Henry B. , Miller Shane M.
Published: April 2020

BACKGROUND:

Soccer has become the most popular youth sport in the world. Within the last decade, there has been limited epidemiologic research on pediatric soccer-related injuries based on sex and age.

PURPOSE:

To examine trends associated with soccer injuries presenting to emergency departments and to describe differences in injury pattern and location based on sex and age during periods of growth.

METHODS:

An epidemiologic study was conducted utilizing publicly accessible data from the National Electronic Injury Surveillance System (NEISS). The NEISS compiles Emergency Department (ED) data on all injuries presenting to the approximately 100 participating network hospitals in the United States. Information on all soccer-related injuries occurring in ages 7-19 from January 2009 – December 2018 was extracted and summary statistics were calculated.

RESULTS:

Approximately 54,287 pediatric soccer-related injuries were identified. The average age for all injuries was 13.3 years, and males (60.50%) presented more often than females (39.50%). Concussions and head injuries (15.57%) were most commonly reported overall, with a greater percentage occurring in females than males (17.44% vs. 14.35%). The ankle (15.3%) was the second most common injury location with females also presenting more commonly than males (18.71% vs. 13.62%). Age and sex-based evaluation noted peaks in lower extremity injuries in females younger than in males. Both ankle (F=13-15 years, M=15-17 years) and knee (F=14 years, M=16 years) injuries peaked at ages coinciding with recognized sex-based lower extremity skeletal maturity (Figure 1).

CONCLUSION:

Peak pediatric soccer-related ankle and knee injuries presenting to emergency departments occur at different ages in females and males and appear to, on average, coincide with maturation (age 14 in females and 16 in males). Lower extremity injuries significantly increase nearing the completion of lower extremity growth, and may indicate appropriate timing for differential sex-specific injury prevention programs within soccer.

[Figure: see text]
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN ≤21 YEAR OLDS: PATELLAR VERSUS HAMSTRING TENDON AUTOGRAFTS
Authors: Tauberg Brandon , Sever Ronen , Kirschner Noah , Hanstein Regina , Fornari Eric D.
Published: April 2020

Background:

Bone-patellar tendon-bone (BTB) and hamstring tendon (HS) are commonly used grafts for anterior cruciate ligament reconstruction (ACLR). The optimal graft choice for ACLR remains unclear. We evaluated clinical and self-reported outcomes of patients who underwent ACLR with use of a BTB autograft or double-bundle HS autograft/allograft-augmented HS autograft (HS hybrid).

Hypothesis/Purpose:

No significant differences in outcomes exist between graft choices.

Methods:

Retrospective review of prospectively collected data from patients aged ≤21 years who underwent primary ACLR with BTB or HS autograft/hybrid by one fellowship-trained orthopaedic surgeon and a minimum of 6 months follow-up. Demographics, injury characteristics, concomitant injuries, surgical and radiographic parameters were recorded. Clinical and patient self-reported outcomes (Tegner-Lysholm, pediIKDC, KOOSChild) were compared at 6-months, 1-year and latest follow-up.

Results:

A total of 109 subjects were included; 59 had a HS graft (55 HS autograft, 4 HS hybrid) and 50 a BTB autograft. Patients were between 13 and 21 years old at ACLR and had a follow-up of 1.5 ±1 year. Baseline comparison of demographic, injury and surgical parameters is presented in Table1.1. Graft rupture occurred in 10 patients (9.2%; 9 males and 1 female) at an average of 2 years after initial ACLR; 8 graft ruptures occurred in the HS group (13.6%, none in HS hybrids) and 2 in the BTB group (4%) (p=0.105). Parameters increasing the likelihood of a re-tear were older age at ACLR (HR: 2.348, p<0.005), a >1-year delay to surgery (HR: 4.105, p=0.048) and a concomitant chondral injury (HR: 5.476, p=0.038) (Cox proportional hazards model, Table1.2). Arthrofibrosis developed in 4 BTB patients (8%) at an average of 6 months after initial ACLR, but not in HS patients (p= 0.041). At most recent follow-up, patellofemoral pain was present in 15 (28%) HS and 5 (10%) BTB patients (p= 0.027) and a contralateral ACL tear had occurred in 4 patients (3.7%). No differences were seen between graft groups for knee range of motion, Lachman testing, leg raise, ligament stability and subjective scores - Tegner-Lysholm, pediIKDC, KOOSChild (p>0.05 for each comparison at 6-months, 1-year and most recent follow-up).

Conclusion:

In patients <21 years undergoing ACLR, BTB autograft lead to fewer graft ruptures, however, was associated with a higher rate of arthrofibrosis. Older age at surgery, a delay to surgery and chondral injuries increased the likelihood of re-tear. However, failure rates were low, and we observed no differences between graft types in terms of laxity and patient self-reported outcomes.

Tables/Figures: [Table: see text][Table: see text]
COMPARISON OF CONTINUOUS ADDUCTOR CANAL AND FEMORAL NERVE BLOCKS FOR ANALGESIA AND SPORTS READINESS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN ADOLESCENT PATIENTS
Authors: Holland Erica L. , Robbins Robin , Low Daniel K-W. , Bosenberg Adrian , Bompadre Viviana , Schmale Gregory A.
Published: April 2020

Background:

Continuous femoral nerve blocks (cFNB) have become a popular method for post-operative analgesia for patients undergoing anterior cruciate ligament reconstruction (ACLR). However, early weight-bearing and the return of quadriceps function favor a motor sparing block, such as a continuous adductor canal nerve block (cACB).

Hypothesis/Purpose:

We retrospectively compared cACB to cFNB in adolescent patients undergoing ACLR, assessing early post-operative pain scores, narcotic usage, and patient satisfaction; and return of quadriceps function and sports readiness at six months post-surgery. We hypothesized that cACB compared to cFNB would result in in a greater likelihood of sports readiness at six months without having compromised analgesia in the early post-operative period.

Methods:

We retrospectively reviewed a consecutive series of adolescent patients who underwent ACLR between January 2016 and September 2018 and received either a cACB or cFNB for post-operative pain management. Patient demographic and surgical data, post-operative pain scores, opioid consumption, satisfaction and complications, dates and results of the Return to Sports (RTS) evaluations were collected from the medical record. Comparisons of categorical and continuous variables between groups were made using the χ 2 test, Spearman correlation test, and one-way ANOVA with Bonferroni adjustment.

Results:

Ninety-one patients (53 with cFNB, 38 with cACB) were reviewed for post-operative analgesia outcomes and quadriceps function at six months and beyond. Analysis of demographic and surgical data revealed no difference in the make-up of the two groups. There were no significant differences between groups in the total oxycodone use PODs 1-3 ( p = 0.213), daily post-operative pain scores ( p > 0.25), or satisfaction with the blocks ( p = 0.93). There was no difference in time to RTS nor in the percentage of patients who achieved a 90% limb symmetry index for quadriceps strength when comparing the two groups at the six-month mark and beyond ( p = 0.384).

Conclusions:

We found no difference in post-operative analgesic requirements and high satisfaction in both groups when comparing patients who underwent ACLR with hamstring autograft with a cACB to those who underwent a similar procedure with a cFNB. Readiness for return to sports and return of quadriceps function at six months and beyond does not appear to vary with regional technique, either cACB or cFNB, employed at surgery.
PITCH COUNTS IN YOUTH BASEBALL PLAYERS: A COMPARISON TO PITCH SMART GUIDELINES
Authors: Greiner Justin J. , Baer Geoffrey S. , McGuine Timothy A.
Published: April 2020

Background:

Overthrowing injuries in youth baseball players have been linked with pitching behaviors such as as high pitch counts, inadequate rest, and participating in throwing activities throughout the year. Pitch Smart guidelines were developed as an initiative between Major League Baseball and USA Baseball to provide recommendations for youth baseball athletes to help decrease the risk of injuries from overthrowing.

Purpose:

The purpose of this study was to perform a quantitative analysis of pitch counts in youth baseball players and evaluate compliance with Pitch Smart guidelines.

Methods:

Local youth baseball teams competing in nine and under (9U) to fourteen and under (14U) age brackets were recruited to track pitches during the summer baseball season. A tablet with a pitch counting application was used to record pitches for each pitcher of the study team and their opponents. Days of rest between games was calculated for the study teams only and not opponents. Pitch counts and days of rest for each pitcher were compared to the recommended Pitch Smart guidelines. Continued prospective collection of data is ongoing through the 2019 summer.

Results:

Interim review of 23 youth baseball teams using a tablet allowed analysis of 181 pitchers of the 23 study teams using tablets and 285 pitchers of 98 opponent teams. Violation of Pitch Smart guidelines occurred in 14 (60.9%) study teams and 29 (16.0%) pitchers. Of these violations, 27 (93%) pitchers had insufficient rest between games while 2 (7%) pitchers exceeded daily maximum pitches. Further, 8 (35%) teams had more than one player violate guidelines. Pitch smart daily maximum pitch counts were violated in 2 of 98 (2.0%) opponent teams and 2 of 285 (0.7%) of opponent pitchers

Conclusion:

A total of 61% of youth baseball teams and 16% of pitchers in this study violated Pitch Smart guidelines at interim analysis. The vast majority of guideline violations were due to inadequate rest between games. The high rate of Pitch Smart violations suggests that further education of coaches, parents, and athletes regarding these guidelines, with emphasis on rest recommendations, is necessary to prevent overthrowing injuries in youth baseball players.

[Table: see text]
FEAR AVOIDANCE BELIEFS RELATED TO PROLONGED RECOVERY FROM PEDIATRIC SPORTS CONCUSSIONS
Authors: Arnold Jennifer , Santana Jonathan
Published: April 2020

Background:

Individuals experiencing persistent pain or discomfort may develop avoidance behaviors and fear. Fear avoidance behaviors have been found to be predictive of chronic disability in adults with neck and low back pain. These behaviors were found to be predictive of symptom severity and disability in adults with mild traumatic brain injury. To our knowledge there has been no research examining this correlation in the pediatric population.

Hypothesis/Purpose:

To evaluate whether pediatric patients who had prolonged recovery from a concussion presented with greater fear avoidance behaviors, as measured by the Fear of Pain Questionnaire (FoPQ).

Methods:

Patients, ages 8 to 17 years old, diagnosed with a concussion and presenting within 2 weeks of the initial injury to sports medicine clinic were included in this study. Individuals were excluded if the mechanism of injury was a motor vehicle accident or assault. Participants who consented were administered a FoPQ at their initial visit. The FoPQ, which has been validated in the pediatric population, contains 24 questions rated on a 5 point Likert scale. Patient’s length of recovery, vestibular ocular motor screen (VOMS) score, and post-concussion symptoms scale score (PCSS) were also recorded.

Results:

From September 2018-May 2019, a total of 82 patients consented for the study. Out of the total number, 44 were female and 38 were male, with an average age of 14 years ( SD = 2.2). Patients who had prolonged recovery (> 28 days) had similar FoPQ scores ( M = 30.06, SD = 16.6) to those with normal recovery ( M = 31.35 SD = 19.1). No significant correlation was found between days to recovery and FoPQ score, r(67) = .05 , p = .668. Patients found to have a positive VOMS (79% of patients) at initial visit took longer to recover by 24.96 days, t(61.65) = -4.26, p < .001 when compared to those with a negative screen. A positive VOMS screen did not correlate with higher fear avoidance score t(21.71) = -.61, p = .550. PCSS severity positively correlated to days to recovery r(67) = .26, p = .037.

Conclusion:

Based on preliminary study results we found no correlation between fear avoidance beliefs and time to recover from sports concussions in a pediatric population. Our data did support previous findings that PCSS severity scores and positive VOMS were predictive of prolonged recovery from a concussion. We will continue to collect data in line with our a priori power analysis (n=200).
ADOLESCENT POSTERIOR-SUPERIOR GLENOID LABRAL PATHOLOGY: DOES INVOLVEMENT OF THE BICEPS ANCHOR MAKE A DIFFERENCE?
Authors: Hansen Cody H. , Asturias Alicia M. , Pennock Andrew T. , Edmonds Eric W.
Published: April 2020

Background:

Adolescent athletes are at risk to sustain an injury to the posterior and superior labrum of the glenoid. Limited information is available regarding the outcomes of surgical intervention in this specific age cohort.

Purpose:

To compare those patients with pure posterior pathology and those with involvement of the biceps anchor (superior labrum anterior-posterior tears - SLAP) to determine risks for failure in the surgical management.

Methods:

A retrospective review was performed on all patients under the age of 19 years over an eight year period to identify those treated for superior and posterior labral pathology, followed by chart review, radiographic review and arthroscopic findings. Demographics and other variables were recorded, including: etiology (traumatic versus atraumatic), activity/sports (overhead versus non-overhead), involvement of the biceps anchor – crossing the 12 o’clock position (Posterior vs SLAP), associated pathologies, outcome scores (SANE – Self Assessment Numerical Evaluation versus PASS – Pediatric Adolescent Shoulder Score), and complications.

Results:

48 patients (30 males, 18 females) with a mean age at surgery of 16.5 years (range 13.5 to 19) were identified that met criteria with a mean follow-up of 4.1 years (range 1.3 to 6.9). Nineteen subjects had SLAP tears, and 29 subjects had posterior tears. All but 2 regularly participated in sports at the time of their injury; of the athletes, 26 (56.5%) played an overhead sport and 20 (43.5%) played a non-overhead sport. The etiology of the injury was traumatic in 25 cases (52.1%), and atraumatic in 23 cases (47.9%). Outcome scores were not significantly different between etiology or type of sports played; but, the mean PASS score in the SLAP group was 88.7, compared to 76.2 in the posterior group (p=0.005) at final assessment. Only 1 SLAP patient failed management (5.3%) compared to 5 patients in the posterior only cohort (17.2%).

Conclusion:

SLAP tears have better outcomes and lower failure rates than posterior only tears in the adolescent population. Posterior-superior labral tears can occur in all sport types with multiple etiologies, but the only factor that appears to play a role in ultimate outcome is whether or not the tear crosses under the biceps anchor to the anterior side.
PREVALENCE OF OVER THE COUNTER PAIN MEDICATION USE AMONG HIGH SCHOOL VOLLEYBALL PLAYERS
Authors: Lang Pamela , McGuine Timothy , Mack Lianna , Biese Kevin , Bell David , Watson Andrew , Brooks M. Alison , Post Eric , Kliethermes Stephanie
Published: April 2020

Background:

Volleyball’s popularity among middle and high school girls continues to rise with many athletes playing the sport year-round. While up to 40% of high school basketball players consume analgesics frequently to manage sport related pain, there is limited evidence regarding the prevalence of over the counter (OTC) pain medicine use among high school volleyball players.

Hypothesis/Purpose:

Identify the prevalence of OTC pain medicine use in high school volleyball players and assess its association with prior injury and sports specialization level.

Methods:

Female volleyball players from 78 high schools were recruited to enroll in this prospective cohort study during the fall 2018 volleyball season. Baseline data were collected on demographic and volleyball characteristics including volume and type of volleyball participation, sport-related injuries over the previous twelve months, and level of sport specialization. The frequency of OTC pain medication use for pain management not related to menstrual cramps over the previous seven days was also collected. Participants were asked to describe their OTC pain medicine use during practice, matches, or conditioning and the location of pain they were treating.

Results:

In total, 2,073 female athletes (Age: 15.6 ± 1.1, BMI: 22.4 ± 3.5, Grade: 9-12) enrolled in the study. Sixty-nine percent (n=1425) reported no OTC pain medication use over the past seven days, 16.0% (n=332) reported seldom (one day/week) OTC medication use, 12.6% (n=261) reported sometimes (2-3 days/week) using OTC medications, and 2.7% (n=55) reported frequent (4-5 days/week) OTC medication use. In the same time period, 24.8% (n=513) used OTC medications during practice, 16.0% (n=331) during matches, and 21.4% (n=443) during conditioning. Across practice, matches, and conditioning OTC medications were most frequently used to control headaches (7-13%) and knee pain (4-6%). Highly specialized volleyball players were more likely to frequently use OTC medications (4.5%) compared to low (1.97%) and moderately specialized (2.5%) athletes (p=0.001). Of those reporting no OTC medications use, 16.7% (n=238) had an injury in the last year compared 36.4% (n=20) of athletes who frequently used OTC medications also reporting an injury in the last year (p<0.001).

Conclusion:

Almost one third of female high school volleyball athletes reported using OTC pain medications in the past week. Those with a history of injury and highly specialized athletes were more likely to use OTC medications. Coaches, athletic trainers, and healthcare providers should be aware of trends in the use of OTC medications among volleyball athletes as its popularity continues to rise.
FEMORAL TUNNEL FIXATION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN THE GROWING PATIENT IS SAFE FOR FUTURE GROWTH
Authors: Gross Bruno , Sabatino Meagan J. , Brenner Madison , Wyatt Charles W. , Wilson Philip , Ellis Henry
Published: April 2020

Background:

Medial patellofemoral ligament (MPFL) reconstruction has been shown to be a successful treatment for patients with recurrent patellar instability and is increasingly used to treat skeletally immature patients.

Purpose:

The purpose of this study is to compare radiographic parameters prior to and following an MPFL reconstruction with femoral tunnel fixation in the skeletally immature patient to investigate potential effects on the physis and future growth.

Methods:

Skeletally immature patients undergoing isolated MPFL reconstruction were retrospectively reviewed. Fixation of proximal MPFL was performed as a femoral socket using Schottle’s point with the entry approximately 5 mm distal to the physis (Figure 1). Patients with open growth plates and 1-year post-operative standing alignments were included. Radiographic measures of patellar tilt, patellar height, patellar subluxation, and trochlear dysplasia were compared pre-operatively and post-operatively on the operative limb. Pre- and post-operative coronal alignment and limb length measurements were compared between the operative and non-operative limbs.

Results:

Nineteen skeletally immature patients with an average age of 11.6 years (range 5-15) underwent isolated MPFL reconstruction. The average follow-up time was 24 months. No significant differences were found between the change in femur (0.49 mm, p=0.526) or total limb length (1.08 mm, p=0.241) when comparing the operative to the non-operative limb, with an average of 47 mm of growth in the operative limb seen during the time period. There was no significant difference in the change in LDFA between operative and non-operative limb as well as symmetric changes noted in the mechanical axis. The change in patellar tilt on the operative limb was found to be significant (12.78°, p=0.030), and the change in patellar height by Caton-Deschamps approached significance (0.08mm, p= 0.077). No significant difference was found with trochlear dysplasia measures.

Conclusion:

The present study suggests MPFL reconstruction with femoral tunnel fixation is safe and does not result in growth disturbance in skeletally immature patients.

[Figure: see text]
RETURN TO PLAY ASSESSMENTS: RATES OF NEUROMUSCULAR ASYMMETRIES IN HEALTHY ADOLESCENT ATHLETES
Authors: Jenkins Paul , Minaie Arya , Bauerlein Jaime , Piskulic David , Kirn Tim , Merklein Meghan , Nepple Jeffrey J.
Published: April 2020

Background:

Return to play (RTP) assessments after ACL reconstruction attempt to identify patients with residual deficits that haven’t regained their preinjury function, in hopes of decreasing the high rate of reinjury in this population. However, the utility of common RTP assessments, including hop testing and Biodex isokinetic strength, remains to be better understood. In the adolescent population, RTP assessments commonly rely upon those used in adults with limited evidence. The purpose of the current study was to establish the performance of young healthy athletes on common RTP assessments.

Methods:

A prospective cohort study of 47 healthy athletes aged 12 to 16 years was performed. All athletes performed hop testing (4 components - single, triple, crossover and timed) and Biodex isokinetic strength (6 components - quadriceps and hamstring; 60, 180, 300 degrees/second). The results were compared to the contralateral leg with a deficit defined as greater than 10% less relative to the contralateral leg. Patient demographics including age, sex, BMI, and sport played, as well as the dominant and nondominant leg were recorded. Analysis was performed relative to a single extremity (total 94) to simulate the evaluation in the setting of ACL return to play.

Results:

A total of 17 males and 30 females were included, with 27 being 12-13 yo and 20 being 14-16 yo. Overall, at least one deficit was present in 61.7% of extremities. This was significantly more common in non-dominant (76.6%) than dominant (46.8%) extremities (p<0.001). Biodex isokinetic strength deficits were present in 55.3% of extremities, while hop testing deficits were present in 24.5% of extremities. A total of 17 extremities had deficits in both Biodex and hop testing, while 35 had isolated biodex deficits and 6 had isolated hop testing deficits. Biodex deficits were present for quadriceps strength in 18.1%, 7.4%, and 17.0% at 60, 180, and 300 degrees respectively, while deficits in hamstring strength were present in 27.7%, 11.7%, and 17.0% at 60, 180, and 300 degrees respectively. Hop testing deficits were present in 7.4% of single hop, 9.6% of triple hop, 9.6% of crossover hop, and 6.4% of timed hop testing.

Conclusions:

The current study demonstrates that asymmetries in strength and hop testing are common in adolescent healthy athletes. These deficits are more common for Biodex isokinetic strength testing than functional hop testing. Deficits are more likely to occur in the nondominant extremity.
CHALLENGES IN SMALL KNEE ARTHROSCOPY: A QUALITATIVE AND QUANTITATIVE PEDIATRIC CADAVERIC EXPERIENCE
Authors: Ellis Henry , Edmonds Eric , Yen Yi-Meng , Wilson Philip , Tran Emily , Cannamela Peter , Shea Kevin
Published: April 2020

Background:

Arthroscopy may be utilized for treatment of septic arthritis of the pediatric knee, with success reported in ages from 3 months to 12 years. There is limited data on the ability to arthroscopically assess articular structures and ensure adequate evaluation without arthrotomy.

Hypothesis/Purpose:

The purpose of this study is: (1) utilize arthroscopy in small cadaveric knees to improve qualitative and quantitative knowledge of pediatric articular structures and (2) to obtain pilot data for common procedures performed in pediatric patients

Methods:

Five small pediatric cadaveric specimens (1-4 years) underwent arthroscopy (2.7 mm Stryker arthroscope). Medial and lateral compartments were assessed for meniscus size/mobility/height, compartmental joint space, ACL insertion, patellar chondral height and length, and position of the medial patellofemoral ligament were recorded. Utilizing standard anterior medial and lateral portals, the ability to visualize the structures of the posteromedial and posterolateral compartments was recorded. Procedures pertinent to immature ACL reconstruction and meniscal repair (unstable discoid) were critically evaluated to provide source data for future work.

Results:

Prior to arthroscopy, all specimens underwent volume-assessed knee insufflation (average 11.4 cc normal saline). Arthroscopic visualization of the menisco-capsular attachment was possible posteromedially in 4/6, and posterolaterally in 5/6 knees. Qualitative arthroscopic relationships were similar to adult references; including patellar-trochlear articulation and lateral meniscal positional relationship to the ACL insertion (see Figure 1). The ACL center was within 2 mm of the posterior aspect of the anterior horn of the lateral meniscus in all specimens. The average height of the medial compartment space under valgus load was 1.5 mm (1 – 2 mm), and lateral space under varus was 2.2 mm (2-3 mm); further emphasizing the need for small joint instruments. The width of the medial and lateral menisci are noted in Table 1. All-inside meniscal devices designed for skeletally mature specimens should be used with caution (Figure 1). Traditionally described inside-out technique for immature ACL reconstruction with an iliotibial band demonstrated significant proximity of the passing device to the neurovascular bundle (Figure 1).

Conclusion:

The entirety of the small knee is assessable via standard diagnostic arthroscopy, when a 2.7mm arthroscope is utilized. These findings suggest that intra-articular pathology can be reliably identified utilizing this surgical technique. However, the ability to work on the infant meniscus and cartilage with standard arthroscopic instruments is likely limited given the constraints of joint height.

[Table: see text][Figure: see text]
CLOSED REDUCTION IN THE TREATMENT OF DISPLACED TIBIAL SPINE FRACTURES: REVISITING A LOST ART
Authors: Ellis Henry , Adkins Morgan , Elliott Marilyn , Huang Sharon G. , Wyatt Charles W. , Wilson Philip
Published: April 2020

Background:

There is renewed interest in optimal treatment, and development of algorithmic care for pediatric tibial spine fractures. While recent publications have most often investigated operative treatment, closed reduction of selected tibial spine fractures may result in good outcomes without invasive surgical procedures.

Purpose:

To evaluate an institutional series of displaced tibial spine factures treated with closed reduction for factors associated with treatment success.

Methods:

An IRB-approved, retrospective review of consecutive pediatric patients treated by a tertiary pediatric orthopedic group for displaced tibial spine fractures with closed reduction (2000 - 2017) was performed (Figure 1). Those with inadequate imaging or follow up were excluded. Demographics, injury data, exam findings, and reduction variables were recorded. Radiographic measures of fracture displacement pre and post-reduction, and at union were noted. Statistical comparison of variables associated with definitive closed reduction vs conversion to operative treatment was performed.

Results:

Of the 35 patients (mean age= 10.9 years [6-16 years]; 24 males) who underwent closed reduction of a tibial spine fracture, 19 (54.2%) had Type II Meyers and McKeever fractures, with the remainder Type III. Mean time to treatment was 6 days (2 hrs-46 days). Hemarthrosis aspiration with anesthetic injection was performed in 20 (57.1%) patients and 9 (25.7%) had general anesthesia or procedural sedation. Short-duration immobilization (typically 3 weeks) of long-leg casting (32, 91.4%) or bracing was utilized. The average reduction (Δ) in superior displacement of the tibial spine fragment was 4.6mm (0-16.4 mm) with 12 fractures improving > 5 mm following reduction maneuver. Eight patients (22.8%) failed closed reduction and were converted to operative fixation to treat residual displacement. Although no differences where noted in demographics, injury mechanism, classification (II vs III), or type of reduction; failures of closed reduction were noted to have more superior displacement (12.93 vs. 8.17 mm; p=0.023).

Conclusion:

Closed reduction of both Type II and Type III tibial spine fractures can result in acceptable reduction in in pediatric patients. Further prospective study of closed reduction of tibial spine fractures in selected patients presenting early, without critical meniscal pathology is warranted.

[Figure: see text]
BRAIN WHITE MATTER ALTERATIONS IN STRUCTURAL INTEGRITY AND CONNECTIVITY FOLLOWING A SPORTS-RELATED CONCUSSION: EVALUATION OF THE POTENTIAL AMELIORATING EFFECT OF A JUGULAR VEIN COMPRESSION COLLAR DEVICE
Authors: Diekfuss Jed A. , Yuan Weihong , Foss Kim D. Barber , Dudley Jonathan A. , DiCesare Christopher A. , Logan Kelsey , Leach James L. , Myer Gregory D.
Published: April 2020

Background:

Sports-related concussion is a significant public health problem which may result in exacerbated or prolonged neurologic deficits. A neck collar device has been developed to apply mild jugular vein compression, increasing intracranial blood volume, with the intent of reducing brain slosh and preventing damage to brain microstructure from head impact exposure.

Hypothesis/Purpose:

We aimed to quantify the alterations in white matter (WM) diffusion properties and network structural connectivity in high school athletes after sports-related concussion and to test the effect of a jugular vein compression collar device worn during the concussive event.

Methods:

379 athletes (male American football and female Soccer) were included in this report. Of the 16693 total athlete exposures, 40 resulted in a diagnosed concussion and were included in these analyses. Prospective longitudinal MRI data were collected at pre-season and post-concussion: 20 athletes were in the non-collar group (12M, age =15.93±1.27yrs) and 20 athletes were in the non-collar group (16M, age=16.37±1.06yrs). DTI parameters, including fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD), were calculated to determine post-concussion alterations in WM diffusion properties. Graph analysis was utilized to quantify post-concussion changes in WM structural connectivity.

Results:

Diffusion property results revealed significant pre-season to post-concussion increases in MD, AD and RD within the non-collar group (p<0.05), but no change was found in the collar group (p>0.05). The pre-season to post-concussion MD, AD, or RD increase was significantly greater (p<0.05, Figure 1) in the non-collar group than the collar group. Graph analysis revealed a pre-season to post-concussion decrease in mean local efficiency in the non-collar group (p=0.036) and a significant increase in mean local efficiency in the collar group (p=0.017). The pre-season to post-concussion change in the mean local efficiency was significantly different in the non-collar group, when compared to the collar group (p=0.0024, Figure 2).

Discussion & Conclusion:

Results indicate that sports related concussion is associated with alterations in WM diffusion properties. The mean local efficiency of the network, a structural connectivity index reflecting network wiring redundancy and tolerance to brain injury, was also found to decrease after the concussion. Results indicate that wearing a neck collar device has the potential to limit these WM changes following a concussive event. Further studies are warranted to investigate the temporal progression of these changes for preventing long-term, neurologic squeala.

[Figure: see text][Figure: see text]
PEDIATRIC REFERENCE ANATOMY FOR ANTEROLATERAL LIGAMENT RECONSTRUCTION– A CADAVERIC STUDY
Authors: Randhawa Sahej D , Trivedi Sunny , Stavinoha Tyler J. , Ganley Theodore J. , Tompkins Marc , Shea Kevin G.
Published: April 2020

Background:

The anatomy of the anterolateral ligament (ALL) has been controversial, with modern studies varying in their description of the precise origin and insertion, as well as relation to surrounding structures on the lateral femur and anterolateral tibia Regardless of such controversy, principles of reconstruction, even non-anatomic, require a clear understanding of the referenced anatomy and surrounding structures. Due to high rates of primary and recurrent ACL tears in pediatric/adolescent patients, the use of ALL reconstruction is increasing in these groups. No pediatric cadaveric study to date has clearly identified the locations of the known surrounding structures of the anterolateral ligamentous complex.

Purpose:

The purpose of this study was to quantitatively assess the anatomy of the pediatric lateral collateral ligament (LCL) origin, the popliteus origin, and in the tibial insertion of the iliotibioband (ITB).

Methods:

Nine pediatric cadaveric knee specimens were dissected to identify the ligamentous femoral origin of the LCL, popliteus, and tibial insertion of the ITB.. Marking pins were used to localize the central footprint of these structures, followed by CT Scans.

Results:

LCL & Popliteus: On the femur, the popliteus was consistently found deep to the LCL and inserted both distally and anteriorly to the LCL a mean distance of 4.6 mm (range 1.9 to 7.6 mm; std dev 2.0). The LCL measured a mean of 12.5 mm to the joint line while the popliteus measured a mean of 8.2 mm from the joint line. Both the LCL and popliteus were consistently distal to the physis. The LCL was a mean distance of 4.4 mm (range 1.0 - 9.5 ) and the popliteus was a mean distance of 8.2 (range 1.7 – 12.5), respectively. ITB insertion: The ITB insertion at Gerdy’s tubercle had an average footprint measuring 28.2 mm2 (range 10.3-58.4), and the ITB center was found proximal to the physis in 6 specimens and distal in 3 specimens. Mean distance from the footprint center to the physis was 1.6 mm proximal (range 7.1 mm proximal to 2.2 mm distal).

Conclusion:

This study provides quantitative anatomy to structures on the lateral femur and anterolateral tibia, commonly referenced in descriptions of the ALL and lateral extraarticular reconstruction techniques. Knowledge of these structures will define the anterolateral complex and guide extra-articular procedures that provide extraarticular anterolateral rotatory stabilization in the pediatric patients.

[Figure: see text][Figure: see text]