bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician Preferences on Surgical Technique and Graft Type for Anterior Cruciate Ligament (ACL) Reconstructions for Pediatric Patients with ACL Injuries
Authors: Nice Emily , Uquillas Carlos , Heidel Eric ,   Shriners Sports Medicine Consortium, Corinna C Franklin, MD
Published: May 2022

Introduction:

The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Most surgeons elect to reconstruct the ACL in young, active patients to facilitate the resumption of sports and restore stability to the knee. Surgical technique and graft type preferences depend on the surgeon and skeletal maturity of the patient, but there is no clear standard based on age.

Hypothesis/Purpose:

This study aims to evaluate physicians’ preferences for choosing a surgical plan for pediatric and adolescent patients with an ACL injury.

Methods:

A voluntary survey link was sent to members of Pediatric Research in Sports Medicine (PRiSM). Consent was obtained by the participants taking part in the survey.

Results:

Forty-five (n=45) physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty completed pediatric orthopaedic fellowships, six completed sports medicine fellowships, and nineteen completed both pediatric orthopaedic and sports medicine fellowships. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. The majority prefer the over the top technique for 8 to 10-year-old males over the all epiphyseal, partial transphyseal, and transphyseal techniques. The technique preference is split for 11, 12, and 13-year-old males. Twenty-five respondents prefer the partial transphyseal technique for 14-year-old male patients. A majority (n=42, n=43) prefer the transphyseal technique for 16 year old males and skeletally mature males. The technique preferences for female patients 9 years or less is the over the top technique. The technique preference is split for 10, 11, 12, and 13-year-old females. The majority (n=37, n=44, n=44) prefer the transphyseal technique for 14-year-old, 16-year-old, and skeletally mature female patients. The graft preference for males 11 years old or younger is the iliotibial band (ITB). The graft preference for males 12-year-old and older was split among the hamstring, ITB, bone-tendon-bone (BTB) and quadriceps grafts. When looking at the preferred graft for female patients, a majority prefer ITB for patients 10-years-old and younger. The participants’ graft preferences for female patients 11-years-old and older is split.

Conclusion:

Results of this survey suggest that graft type and surgical technique preferences for pediatric and adolescent patients with ACL tears change based on the patient’s age, with more agreement among surgeons at the extremes of patient ages. Further research is needed to track the impact of each surgical technique and graft choice on pediatric and adolescent patients. [Table: see text]
Rates of Infection After Pediatric ACL Reconstruction: A Marketscan Database Study of 44,501 Patients
Authors: Block Andrew M. , Eisenberg Matthew , Vopat Matt , Nepple Jeffrey J.
Published: May 2022

Introduction:

Anterior cruciate ligament reconstruction (ACL-R) is increasingly performed in pediatric patients. Infection after ACL-R is among the most serious complications. The use of administrative data has been validated for the assessment of infection after ACL reconstruction. While infection after ACL-R has been well investigated in adults, the literature is limited for ACL reconstruction in pediatric patients.

Purpose:

Describe and analyze the rates of infection after ACL-R among pediatric patients, compared to young adult patients, utilizing the MarketScan database.

Methods:

The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals aged 5-30 years old. ACL-R records performed between 2006 and 2018 were obtained using Current Procedures Terminology (CPT) and International Classification of Diseases Ninth Revision (ICD-9) and Tenth (ICD-10) codes. The presence of postoperative infection requiring reoperation was assessed utilizing previously published algorithms. All patients had at least 180 days of insurance coverage after intervention.

Results:

The ACL-R cohort included 44,501 individuals under 18 years old and 53,915 individuals aged 18-30 years old. The rate of infection after ACL-R in patients under 18 years of age was 0.52%, and was similar to patients 18-30 years old (0.47%, p=0.213). Among patients <18 years old, patients <15 years old had a significantly lower rate of infection at 0.37% compared to adolescents (15.0-17.9 years old) at 0.55% (p=0.039). For those less than 18 years old, males were significantly more likely to have an infection after ACL-R (0.73%) compared to females (0.53%, p=0.008).

Discussion:

Utilizing an insurance database, this study demonstrated that rates of infection after an ACL-R are relatively low (0.52%) and are similar to rates in young adults, despite the differences in graft utilization. Both age less than 15 and female sex were associated slightly lower rates of infections in pediatric patients. [Figure: see text]
Findings from the Prism Concussion Rig: Does the 5P Risk Score Predict Persistent Postconcussive Symptoms in a Multi-Center Sample of Youth Athletes?
Authors: Miller Shane M. , Zaslow Tracy L. , Wilson Julie C. , Master Christina L. , McLeod Tamara C. Valovich , Snedden Traci R. , Halstead Mark E. , Grady Matthew F. , Fazekas Matthew L. , Santana Jonathan A. , Howell David R. ,   the PRiSM Concussion Research Interest Group
Published: May 2022

Background:

Persistent postconcussive symptoms (PPCS) can negatively impact quality of life, school, and return to sport. The Predicting and Preventing Postconcussive Problems in Pediatrics [5P] clinical risk score has been validated in the Emergency Department setting to predict pediatric patients at risk of PPCS using 9 variables.

Hypothesis/Purpose:

To determine if the 5P risk score, obtained within 14 days of concussion, predicts which athletes seen in an athletic training or pediatric sports medicine clinic setting develop PPCS in a multi-center sample.

Methods:

Data were prospectively collected from participants enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study between September 2018-May 2021 across seven sites. Participants aged 6-18 years diagnosed with a concussion who presented within 14 days of injury were included. Demographics, medical history, and the Postconcussion Symptom Inventory (PCSI) were reviewed to calculate the 5P risk score. 5P risk scores were stratified as low (0-3 points), medium (4-8 points), and high risk (9-12 points). Participants were grouped based on symptom resolution time: PPCS (≥28 days) and no PPCS (<28 days). We compared total symptom resolution time among the 5P risk categories using one-way ANOVA and assessed the odds of developing PPCS based on 5P risk score using a binary logistic regression model.

Results:

We included 117 participants: 23 with PPCS (19.7%). A higher proportion of the PPCS group were female, were seen in a sports medicine clinic setting, and had a longer time to initial presentation (Table 1). Both PCSI symptom severity and 5P risk score were significantly higher in the PPCS group compared to the no PPCS group (p<0.001). Participants with high risk 5P scores had a significantly longer mean symptom resolution time compared to those with low risk scores (Figure 1; 28.4±18.2 vs 7.1±6.8 days, p=0.009). After adjusting for potential confounding variables of initial symptom severity, time to presentation, and assessment setting, each point increase on the 5P risk score was associated with a 1.7x odds of developing PPCS (odds ratio=1.66; 95% CI=1.13, 2.41; p=0.009).

Conclusion:

In a multi-center sample of youth athletes, the 5P risk score accurately predicted which athletes were at risk for developing PPCS. The odds of developing PPCS increases with each point increase on the risk score. The 5P risk score can help clinicians identify which athletes are likely to develop PPCS, which may aid in educating families on expectations of recovery and/or provide opportunities for targeted intervention to facilitate sooner recovery. [Table: see text][Figure: see text]
Direct Costs of Care for Adolescent Patients with and Without Persisting Concussion Symptoms in United States Secondary Schools: A Report from the Athletic Training Practice-Based Research Network
Authors: Weber Rawlins Michelle L. , Marshall Ashley N. , Lam Kenneth C. , Valovich McLeod Tamara C.
Published: May 2022

Background:

Concussions present significant public health concerns and associated medical costs, especially for those with persisting concussion symptoms.

Purpose:

To compare direct costs of care for adolescent patients managed within the secondary school setting with and without persisting concussion symptoms.

Methods:

Our study was a retrospective analysis of medical records using the Athletic Training Practice-Based Research Network which included records from 59 secondary schools in the United States. Participants included 282 adolescent patients following a concussion (male=199, female=83, age=15.5 years, 95% CI:15.3, 15.6). Complete patient cases were identified using International Classification of Diseases and Related Health Problems diagnostic codes for concussion between 2010-2017. We calculated summary statistics for common services and direct costs of care, calculated based on reimbursement rates for Current Procedural Terminology codes. Patients were grouped as with (symptoms experienced 28 days; n=38) and without (symptoms experienced <28 days; n=238) persisting concussion-related symptoms. A Mann-Whitney U test was used to determine if direct cost of care differed between groups (n=276, α=0.05). We used a linear regression to determine cost for each additional day of care.

Results:

The most common service was an athletic trainer re-evaluation (n=1012/1560, 64.9%). The average total direct costs of care was US $286.30 per adolescent patient (95% CI: US $260.14-312.45). Significantly higher direct costs of care were reported for patients with persisting symptoms ( p<0.001; persisting: median=US $471.07, IQR=US $281.21-564.93, 95% CI: US $367.05-528.11; without persisting: median=US $210.95; IQR=US $117.45-337.52, 95% CI: US $234.28-286.82). The concussion base price was US $174.42 (95%CI: US $129.75-219.10) and each additional day cost US $5.99 (95% CI: $3.99-7.99).

Conclusions:

Our findings provide insight to potential costs associated with adolescent patients who are managed within the secondary school setting following a concussion. These results highlight the potential economic value of sports medicine professionals within the school setting. Other health care professionals not in the school setting may advise patients to first be evaluated and managed by the site athletic trainer if able and in accordance with state law, prior to an office visit to also reduce care costs as many athletic trainers do not charge for their services. Future research should examine how to decrease the economic burden for patients.
POST-CONCUSSION DIZZINESS SEVERITY PREDICTS DAILY STEP COUNT DURING RECOVERY AMONG ADOLESCENT ATHLETES
Authors: Smulligan Katherine L. , Seehusen Corrine N. , Wingerson Mathew J. , Wilson Julie C. , Howell David. R
Published: May 2022

Background:

Physical activity after concussion is an important aspect of appropriate management and may help to improve recovery time. However, symptom burden or functional deficits may be self-limiting and reduce activity level in the first weeks following a concussion.

Purpose/Hypothesis:

To examine dizziness and postural stability as potential predictors of physical activity level after concussion. We hypothesized that increased dizziness severity and more postural instability would predict lower step count acutely post-concussion.

Methods:

We initially evaluated athletes ages 12-18 years within 14 days of concussion using questionnaires and clinical tests to assess overall symptom burden, dizziness, and postural stability. Athletes were provided with an activity monitor that tracked daily step count for the subsequent two weeks after their initial care visit. Our primary outcome variable was daily step count (mean steps/day) during this two-week period. Potential predictor variables included participant characteristics (sex, age, time since injury, and history of: concussion, musculoskeletal injury, migraine, ADD, anxiety, depression), Post-Concussion Symptom Inventory (PCSI) total symptom burden, specific PCSI ratings of dizziness and balance impairment, and postural stability assessments [single and dual-task tandem gait (TG) and modified balance error scoring system (mBESS)]. To examine clinical predictors of activity we calculated Pearson correlation coefficients between mean steps/day and each potential predictor, and then included significantly correlated variables in a multiple linear regression model.

Results:

Athletes who participated in the study (n=35, mean 15.2±1.7 years of age, 49% female, mean steps/day=9195±3779) were initially evaluated a mean of 7.3±3.0 days post-concussion. PCSI dizziness rating (Pearson R=-0.49, p=0.003; Figure 1) and sex (mean difference=2449 steps/day, p=0.05) were associated with daily step count upon univariable evaluation and included in the multiple linear regression model. No other participant characteristics, symptom ratings, or objective balance or postural stability measures were significantly associated with steps/day (Table 1). In the multivariable model, PCSI dizziness rating (β=-1035; 95% CI: -191, -1880; p=0.018), but not sex, predicted average steps/day in the two weeks after initial clinical care visits.

Conclusion:

Self-reported dizziness severity assessed within 14 days of concussion predicted daily step count in the subsequent two weeks, while other measures of overall symptom severity and postural stability did not. Given the importance of physical activity for concussion recovery, identifying individuals with acute post-concussion dizziness may facilitate timely treatment of dizziness, potentially reducing a barrier to physical activity to improve recovery trajectories. [Figure: see text][Table: see text]
Managing Concussion Patients Via Telehealth Services Compared to In-Person Clinic Visits
Authors: Price August M. , Knell Gregory , Jones Carrie , Caze Todd J. , Abt John P. , Burkhart Scott O.
Published: May 2022

Background:

Sports medicine is increasingly relying on telehealth to provide patients with better access to care, timelier visits, and reduced cost. Telehealth technology is a growing modality that needs more research to demonstrate its utility in the clinical management of concussion.

Hypothesis/Purpose:

The purpose of this study was to compare the total number of visits, days since injury, and recovery time of pediatric concussion patients evaluated via telehealth versus those in-person. We hypothesized that telehealth patients would have fewer total visits, fewer days since injury, and shorter recovery times compared to in-person patients.

Methods:

Retrospective data from 2019-2021 were abstracted from the medical record for patients aged 4-18 years who were referred to a specialty pediatric concussion clinic. Demographic data included age, sex, and race/ethnicity. Concussion injury and treatment data were examined based on total number of visits, time since injury (days), and recovery time (days). Descriptive statistics were reported as proportions (counts), means (± standard deviations [SD]), and medians (interquartile range [IQR]), as appropriate. The difference between telehealth and in-person treatment data was tested using independent-samples median tests with a significance level set at 0.05.

Results:

A total of 381 patients were included in the study, 21.5% (82) were managed via telehealth services and 78.5% (299) were seen in-person. Of the telehealth patients, 40.2% (33) were males, 54.9% (45) were non-Hispanic white, and the mean age was 13.95 (±2.99) years. For in-person patients, 52.5% (157) were male, 56.2% (168) were non-Hispanic white, and the mean age was 14.75 (±2.05) years. Telehealth patients were seen a median 4.0 (IQR=2.0-6.0) days since injury and in-person patients were seen a median 3.0 (IQR=2.0-5.0) days since injury ( P =0.98). Telehealth patients’ median total visits was 2.0 (IQR=1.0-2.0), while in-person patients was 2.0 (IQR=2.0-3.0) ( P=0.36). Telehealth patients recovered a median 15.0 (IQR=9.0-22.3) days and in-person patients recovered a median of 16.0 (IQR=11-24) days ( P =0.58).

Conclusion:

In this preliminary study, telehealth and in-person patients did not differ based on concussion treatment and recovery. These findings demonstrate the potential equivalence of pediatric concussion telehealth and in-person treatments; however, future research should examine differences in treatment costs and treatment access (e.g., distance to clinic, insurance types, etc.), while also considering the potential influence of concussion severity on the likelihood to utilize telehealth versus in-person treatment.
Novel Mri Classification for Osteochondritis Dissecans of the Knee: A Validation Study
Authors: Feroe Aliya G. , Flaugh Rachel A. , Baxter Tara A. , Majumdar Aditi S. , Miller Patricia E. , Kocher Mininder S.
Published: May 2022

Background:

A simpler three-category magnetic resonance imaging (MRI) classification system for osteochondritis dissecans (OCD) of the knee was recently shown to have comparable reliability to the existing five-category Hefti system. The validity and clinical utility of this simpler system as an alternative to the Hefti system has yet to be established.

Hypothesis/Purpose:

The purpose of this study was to assess whether a novel, simpler three-category MRI classification system for OCD of the knee demonstrates equal or better validity and correlates more strongly with treatment than the five-category Hefti classification.

Methods:

Demographic data and arthroscopic findings were collected from the medical and surgical records of 144 knees of children and adolescents with arthroscopically diagnosed knee OCD. MRI assessment of OCD lesions was conducted by two independent raters. Inter-rater reliability for novel and Hefti classifications was assessed by estimating weighted kappa ( kw). Agreement between MRI classification and arthroscopic findings was assessed by estimating kw coefficients. Classifications were dichotomized into 1,2 versus 3 for the novel system, and the sensitivity and specificity of classification was estimated as compared to arthroscopic findings. Correlation between arthroscopic classification and treatment type was assessed by estimating Spearman’s coefficient.

Results:

There was substantial interrater agreement with the proposed system’s ratings on MRI ( kw=0.66; 955 CI=0.56-0.75) and moderate agreement for Hefti system’s ratings on MRI ( kw=0.57; 955 CI=0.47-0.67) (Table 1). There was no difference detected in the agreement statistics for the proposed versus Hefti classifications (p=0.89). Binary agreement of the novel classification using dichotomous categories was slightly worse than the three-category classification. When 1&2s were combined, the agreement was moderate with k=0.41 (95% CI=0.25-0.58) and when 2&3s were combined, the agreement was fair with k=0.34 (95% CI=0.21-0.48). There was strong correlation between novel classification on arthroscopy with treatment type ( r=0.85; 95% CI = 0.80-0.89) and between Hefti classification and treatment type ( r=0.82; 95% CI = 0.75-0.86) (Table 2).

Conclusion:

The validity and clinical utility of the proposed three-category MRI classification system for knee OCD is comparable to that of the five-category Hefti system. This simpler classification system provides a foundation for the subsequent establishment of an operative treatment algorithm for knee OCD. [Table: see text][Table: see text]
Functional Outcomes of Arthroscopic OS Trigonum Excision in Adolescents
Authors: Chun Liane , Bastrom Tracey P. , Carroll Alyssa N. , Edmonds Eric W.
Published: May 2022

Background:

Outcomes of symptomatic os trigonum excision have been well described as a successful treatment in adults; however, the literature lacks information on standardized longer term functional outcomes in the pediatric population.

Hypothesis/Purpose:

This study intends to report functional outcomes of arthroscopic os trigonum excision in adolescents who failed conservative management, with the hypothesis that these younger patients would have similar, successful outcomes of adult patients.

Methods:

A retrospective study was performed on adolescents who underwent arthroscopic os trigonum excision at a single institution between 2011 and 2017. Patient demographic, clinical history, radiographic, and operative data were documented. Outcome measures included the Foot and Ankle Ability Measure (FAAM) score comprised of the Activities of Daily Living (ADL) and Sports subscales, Single Assessment Numeric Evaluation (SANE) score, ability to return to the same level of sport, and any additional foot/ankle surgery.

Results:

Ten patients (12 ankles) met criteria with a mean age at surgery of 15.4 years (range, 12 to 18 years) and a mean follow-up of 6.5 years (range, 2.8 to 9.1 years). Mean FAAM ADL subscale, Sports subscale, and SANE scores were 91.0 ± 15.5, 76.3 ± 29.1, and 88.6 ± 15.1 respectively. A chronic duration of symptoms prior to surgery was associated with a lower FAAM Sports current level of function score (p=0.032). Four patients (40%) discontinued their sport due to continued ankle issues and reported significantly lower FAAM ADL subscale (p=0.01), Sports subscale (p<0.001), and SANE scores (p = 0.002).

Conclusion:

Os trigonum syndrome in the adolescent population may not have the same rate of success as that seen in adult athletes over the long term. However, if proven to be refractory to conservative measures and surgical intervention is indicated, patients and their families should be counseled about the risk for persistent ankle symptoms and the possibility that they may not be able to return to their previous level of sport.
Can the Disoid Meniscus Remodel After Saucerization?
Authors: Chan Charles M. , Squiers Monte V. A. , Gamble James G.
Published: May 2022

Background/Purpose:

The discoid meniscus is a congenital variant that is reported to be present in 3-5% of the United States population. Treatment involves partial meniscectomy and saucerization to obtain a more anatomic-appearing meniscus. The immediate post-operative cross-sectional morphology is often squared due to the inherent thickness of the discoid meniscus at the resection margin. The purpose of this study is to determine if the discoid meniscus can remodel and regain the triangular cross sectional configuration of a normal meniscus after surgical intervention.

Methods:

A retrospective chart review was performed to identify all patients undergoing partial meniscectomy for symptomatic discoid meniscus within the past 3 years at our institution. Patients were included if they had a subsequent knee magnetic resonance imaging (MRI) study. Each MRI study was evaluated by two orthopaedic surgeons independently. The extent of remodeling was graded on the cross-sectional morphology of the saucerized discoid meniscus on coronal and sagittal T1-weighted images of the corresponding knee mri based on the following scheme: 1) complete for a triangular cross-section, 2) partial for a trapezoidal cross-section , and 3) none for a square cross-section. Descriptive means and statistical analysis for intraclass correlation coefficient (ICC) were performed using Microsoft Excel.

Results:

A total of 11 patients and 14 knees were included in this study. Average age at time of surgery was 10.85. Average time to the follow-up MRI of the same knee was 540.50 +/- 341.84 days. 2 knees required additional surgical intervention following their index surgery. Complete remodeling was identified in 78.5% (11/14) knees. 1 knee had no remodeling and 2 knees had partial remodeling. Our ICC was 0.87 (95% CI: [0.66,0.96]).

Conclusion:

Our results indicate that the discoid meniscus has the potential to remodel into a “normal” triangular cross-sectional morphology after partial meniscectomy and saucerization. In our series, 21.4% (3/14) knees did not experience complete remodeling. This may have been due to over resection of the discoid meniscus at the index surgery owing to the extent of an existing tears. The remodeling all occurred within a two-year time frame though the exact time is unknown. This study indicates no additional intervention is required at the central resection margin to thin out the thick edge that often results from the meniscal biter.
Accelerated Vs Conservative Rehabilitation Following Meniscus Repair In Pediatric Pateints With Or Without Acl Reconstruction
Authors: Ali Sabah , Ciranna-Truong Alexandra , Kiebzak Gary M. , Stinson Zachary
Published: May 2022

Background:

There are variations in postoperative restrictions following pediatric meniscus repairs, whether they are performed in isolation or at the time of an anterior cruciate ligament reconstruction (ACLR).

Hypothesis:

We hypothesized that there would be no difference in failure rates when comparing accelerated versus conservative post-operative management following both isolated meniscus repairs and meniscus repairs performed at the time of an ACLR.

Methods:

A retrospective chart review was performed to investigate pediatric patients who underwent an isolated medial or lateral meniscus repair with or without a combined primary ACLR from January 2010 to January 2019 within a large children’s health system among eight different surgeons who all utilized different rehabilitation protocols. Patient outcomes of a need to return to the operating room secondary to failure of meniscus repair were analyzed with regard to accelerated versus conservative rehabilitation. Accelerated management included early unrestricted weightbearing within 3 weeks, unrestricted range of motion in a brace within 6 weeks, less than 6 weeks of brace use, initiation of outpatient physical therapy within 6 weeks, and returning to play sports earlier than 16 weeks for the isolated meniscus group or earlier than 30 weeks for the combined group.

Results:

138 patients aged 14.1 + 2.9 years had an isolated meniscus repair with 24.6 + 16.8 weeks of follow-up and a 17% failure rate, and 190 patients aged 15.5 + 1.6 years had a meniscus repair at the time of an ACLR with follow-up of 42.9 + 27.4 weeks and a 13% failure rate. A binomial logistic regression showed no differences in failure rates for accelerated versus conservative weightbearing restrictions, brace immobilization, physical therapy timing, or return to play timing (Table 1).

Conclusion:

These findings demonstrate that pediatric meniscus repair failure rates remain similar despite wide variations in postoperative management, whether performed in isolation or at the time of an ACLR. Further investigation should be directed towards determining optimal post-operative management protocols that attempt to strike a balance between protecting the surgical repair and avoiding measures that may be overly burdensome to the patient or add unnecessary treatment costs. [Table: see text]
Higher Rates of Mensical Repair and Rim Preservation in Younger Patients with Discoid Lateral Menisci
Authors: Kemper W. Craig , Adsit Lizzie R. , Cooper Savannah , McKay Scott , Latz Kevin , Shea Kevin , Fabricant Peter , Beck Jennifer , Schmale Gregory , Tenfelde Allison , Gupta Andrew , Green Dan , Albright Jay , Cardelia Marc , Ellis Henry B. ,   the SCORE group
Published: May 2022

Background:

Management of discoid meniscus in pediatric patients requires understanding of the presentation, associated risks, and appropriate techniques. Surgical treatment consists of saucerization, meniscus repair, meniscocapular stabilization, and, periodically, subtotal meniscectomy. The type of meniscal treatment is commonly determined during arthroscopy. Thus, surgeons, patients, and their parents/guardians must be prepared for a variety of surgical options.

Hypothesis/Purpose:

To compare intraoperative arthroscopic findings and treatment of discoid meniscus across pediatric age groups in a large multicenter quality improvement registry.

Methods:

A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of discoid meniscus surgery was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases from 2018-2020 were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Patients were grouped into five groups based on age at time of surgery (<7, 7-10, 11-13, 14-16, >16). Demographic characteristics, discoid type, presence and type of tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons.

Results:

274 patients were identified (mean age 12.4 years, range 3-18; 47.3% females). Complete discoid meniscus and peripheral rim instability were found to be more prevalent in younger age groups (Table 1). Peripheral rim instability was noted in 55.5% of cases, most commonly in the posterior horn (24.8%). While a focal region of instability was most common, the youngest age group was more likely to have either multifocal instability or no instability. Repair was conducted more commonly in the younger cohorts, with a significant decrease in repair percentage (p=0.008) per age group. All-inside was the most common repair technique in all age groups. Partial meniscectomy/debridement beyond saucerization occurred more frequently in older age groups than younger age groups (p=.0002), including 38.4% of cases in the oldest age group (Table 2).

Conclusion:

Younger patients experienced a greater incidence of complete discoid menisci and meniscus repair in this age group and was more likely to have more than one area of rim instability. However, when meniscal resection beyond a saucerization was required, this was more likely to occur in older patients. [Table: see text][Table: see text]
Influence of Anxiety Sensitivity and Negative Affect on Concussion Outcomes
Authors: Caze Todd , Williams Kimberly , Boucher Sarah , Price August , Abt John , Burkhart Scott
Published: May 2022

Background:

Approximately two million children sustain a concussion annually, with negative mood being associated with elevated initial symptom reporting and longer recoveries. Despite this finding, minimum research has explored the predictive value of a person’s negative mood and propensity to misinterpret internal sensations (anxiety sensitivity) on concussion outcomes.

Hypothesis/Purpose:

The purpose of this study was to examine how the relationship between anxiety sensitivity, negative affect, and positive affect relate to various concussion outcomes. It was hypothesized that higher anxiety sensitivity, higher negative affect, and lower positive affect would be predictive of higher initial concussion symptom reporting, increased number of total visits, and longer time to medical clearance.

Methods:

Children aged 8-18 years who sustained a concussion were examined in an acute concussion clinic for diagnosis and treatment of injury. Patients were evaluated within 14 days of injury and remained under clinical care until cleared to return to activity/sport. Patients were administered the Anxiety Sensitivity Index-3 (ASI-3), The International Positive and Negative Affect-Short Form (I-PANAS-SF) and Post-Concussion Symptom Scale (PCSS). Independent t-tests were run for all independent variables. Linear regressions were run to determine potential predictive value of ASI-3 (cognitive, physical, social subscale and total score) and I-PANAS-SF (negative and positive affect) on concussion outcomes (initial visit concussion symptom scores calculated by PCSS, total number of clinical visits, and days till medically cleared).

Results:

A total of 43 children (age: 15.6±1.6 years) were enrolled. Independent t-tests for all independent variables resulted in females on average having higher ASI-3 subscale and total scores ( p<0.01). Sex was therefore entered as a control variable in the regression models. Higher negative affect was significantly predictive (β = 0.38, p=0.030) of higher initial visit concussion symptom reporting (R2 =0.46, F(5,36)=4.48, p=0.003). More days to clinic (β = 0.88, p≤0.001) and higher ASI-3 physical subscale scores (β = 0.25, p=0.008) were predictive of more days until medical clearance (R2 =0.88, F(5,35)=5.33, p=0.001).

Conclusion:

Results from this study show that both a person’s negative affect and anxiety sensitivity are not just related to concussion outcomes but also predictive. Negative affect and anxiety sensitivity are easy to measure and amenable to treatment. Targeted interventions on improving negative affect and normalizing symptoms to minimize misinterpretations (anxiety sensitivity), could improve concussion outcomes.
The Impact of sport particiaption on the Health of Adolescents During the CoVID-19 pandemic
Authors: McGuine Timothy , Biese Kevin , Schwarz Alison , Dickman James , Hetzel Scott , Reardon Claudia , Watson Andrew
Published: May 2022

Background:

Since April 2020, some high schools were closed to in-person teaching, and interscholastic and club sports were cancelled in an attempt to slow the spread of COVID-19. While some US adolescents participated in sports since April 2020, other US adolescents did not participate in sports during this time. It is unknown what effect sport participation has had on the health of adolescents.

Hypothesis/Purpose:

To identify how sport participation during the COVID-19 pandemic impacted the health of adolescents.

Methods:

Adolescents across the US were recruited via social media to complete an online survey in the spring of 2021. Participants were asked to report their demographics (age, gender, race), whether they participated in school club or school sports since May 2020, type of school they attended (in-person, online, hybrid), and measures of mental health (MH), physical activity (PA) and quality of life (QoL). Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. Assessment scores were compared for respondents who participated in sports (PAR) with those that did not participate in sports (NoPAR). Univariable comparisons between the groups were made via t-tests or chi-square tests while means for continuous outcome measures were compared between the groups by ANOVA models that controlled for age, gender, race and the type of school attendance.

Results:

4,693 adolescents (52% female, Age = 16.1+1.3 yrs., grades 9–12) from 38 states participated in the study with PAR = 4,286 (91%) and NoPAR = 407 (9%). NoPAR participants reported a higher prevalence of moderate to severe levels of anxiety (29.3% vs 21.3%, p<0.001) and depression (40.7% vs 19.8%, p<0.001). NoPAR participants reported lower (worse) PFABS scores (mean 13.2 [95%CI 12.4, 13.9] vs 21.2 [20.7, 21.6] p<0.001) and lower (worse) PedsQL total scores compared to the PAR group (77.9 [76.5, 79.3] vs. 83.2 [82.3, 84.1], p<0.001).

Conclusions:

Adolescents who did not play a sport during the COVID-19 pandemic reported significantly higher levels of anxiety and depression, as well as lower physical activity and quality of life scores compared to adolescents who did play a school or club sport. Participation in organized sports may offer an important opportunity to improve physical activity and mental health for adolescents during and after the COVID-19 pandemic.
Assessment of Coping Skills in Pediatric Sports Medicine Patients
Authors: Townsend Tracy K. , Coene Ryan P. , Williams Kathryn A. , Pluhar Emily , Ackerman Kathryn E. , Kramer Dennis E. , Stracciolini Andrea , Christino Melissa A.
Published: May 2022

Background:

Psychological variables play integral roles in an athlete’s response to injury recovery, and poor mental coping skills have been shown to have a negative impact. The Athletic Coping Skills Inventory-28 has been demonstrated to have predictive value in identifying pediatric patients who may be at risk for a prolonged recovery.

Hypothesis/Purpose:

The purpose of this study was to investigate variations in coping skills in pediatric sports medicine patients using the Athletic Coping Skills Inventory-28, and to examine correlations with the following variables: age, gender, individual vs. team sports, and time devoted to sport.

Methods:

This was a cross-sectional, single institution study, that assessed young sports medicine patients, ages 12-18. A one-time, voluntary, anonymous survey was utilized to assess demographics, primary sport, sport participation patterns, and the validated Athletic Coping Skills Inventory-28 (ACSI, range 0-84). Younger adolescents were considered to be ages 11-14 and older adolescents ages 15-18 for data analysis. Statistical analysis included Fischer’s exact tests, t-tests, Pearson correlations, linear regression analysis, and Wilcoxon rank sum tests.

Results:

Of 430 eligible patients, 334 (mean±sd age 15.0±1.8 years, 64.7% female, 35.3% male) completed questionnaires, for a 78% response rate. The mean ACSI score was 50.2±10.9. No significant differences were observed in overall ACSI scores between genders. ACSI scores were higher in younger adolescents compared to older adolescents (52.4±10.5 vs 48.9±10.9, p <0.010). Team sport athletes reported higher coping skill scores than individual sport athletes (51.2±10.9 vs 47.2±10.8, p<0.001). Multivariable linear regression revealed that younger team sport athletes demonstrated higher coping skill scores compared to older team sport athletes (55.9 vs 49.8, p<0.001). Younger team sport athletes also scored higher than the younger individual sport athletes (55.9 vs 47.6 p=0.002). In addition, playing >16 hours per week of sports adds 6.36 (95% CI: 3.14, 9.57) units to the total ACSI score compared to participants who play <11 hour per week.

Conclusion:

Athletic coping skills scores did not significantly differ among genders in adolescent athletes. ACSI scores were higher in younger adolescents and athletes playing team sports. Coping skill scores are also positively correlated with time devoted to playing sports.
No Difference in Patient Reported Outcome Measures for Patients with High Grit Scores
Authors: Mackie Alexandra T. , Pascual-Leone Nicolas , Fabricant Peter D.
Published: May 2022

Background:

The importance of grit on maintaining overall wellness is well described, but less is known about how grit impacts surgical outcomes, specifically among pediatric patients. The pediatric-validated 5-item Grit Scale measures trait-level perseverance and passion for long-term goals.

Purpose/Hypothesis:

The purpose of this study was to identify whether Grit scores were associated with baseline PROMIS Pain Interference and Pain Intensity scores. The investigators hypothesized that higher Grit would be associated with lower PROMIS Pain Interference and Pain Intensity scores.

Methods:

Pediatric and adolescent patients who underwent lower extremity sports or trauma surgery between 2018-2020 at a single orthopaedic hospital preoperatively completed the Grit scale along with PROMIS Pain Interference and Pain Intensity questionnaires. Patients were excluded if they underwent multiple surgeries (with the exception of implant removal). Patients were divided into five groups based on their Grit quintile (<20th, 20-40, 40-60, 60-80, >80th). Statistical analysis was run on IBM SPSS version 22.

Results:

A total of 103 patients were included in analysis with a median preoperative Grit Score of 4.0. Spearman correlation between Grit cohort and PROMIS Pain Interference and Pain Intensity scores demonstrated no associations between higher Grit scores and higher PROMIS baseline Pain Interference and Pain Intensity scores (p = 0.612, 0.981, respectively).

Conclusion:

This study did not find associations between baseline Grit and PROMIS Pain Interference and Pain Intensity questionnaires. Therefore, Grit may be an independent construct that is not measured in the existing outcome scales and should be further investigated. Although not associated with baseline pain, its associations with postoperative pain improvement should be further studied. [Figure: see text]
Did the Covid-19 Pandemic Affect Psychological Readiness to Return-To-Sport in Young Athletes Undergoing ACL Reconstruction?
Authors: Christino Melissa A. , Majumdar Aditi S. , Coene Ryan P. , Cook Danielle L. , Kocher Mininder S. , Kramer Dennis E. , Micheli Lyle J. , Yen Yi-Meng , Milewski Matthew D.
Published: May 2022

Background:

Return-to-sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is influenced by multiple physical and psychological variables. Psychological readiness has been associated with improved patient reported outcomes as well as RTS rates in young athletes. The COVID-19 pandemic may have altered the typical recovery process for patients undergoing ACLR.

Hypothesis/Purpose:

To compare 6-month postoperative levels of psychological readiness to RTS in ACLR patients before and during the pandemic.

Methods:

Patients were prospectively enrolled 6 months after primary ACLR at a single academic sports medicine practice, from December 2018 until May 2021. Patients were categorized into pre-COVID (enrollment prior to March 13, 2020) and COVID groups (March 13, 2020 - May 26, 2021). Demographic information, outcomes scores including the ACL-Return to Sport after Injury Scale (RSI) and PROMIS Psychological Stress Experiences (PROMIS-PSE), and physician RTS clearance were obtained and compared for both groups. Comparisons were performed utilizing Chi-square, Student’s t-tests and linear regression. A matched analysis was conducted between groups controlling for age, sex, and graft type.

Results:

231 patients were included in the present study (89 males, 142 females; mean age 16.9 years), with 76% (176/231) in the pre-COVID group and 24% (55/231) in the COVID group. There were no significant differences in age and sex between the two population cohorts. There was a significant difference in time from surgery to enrollment in the COVID group compared to the pre-COVID group (7.1 vs 6.2 months, p<0.001). In the matched cohort (n=126, 37/126 COVID group), the COVID group was cleared earlier by their physician to RTS compared to the pre-COVID group (6.9 months vs 8.5 months, p<0.001). While there was no significant difference between groups in 6 month ACL-RSI scores (63.8 pre-COVID vs 66.6 COVID, p=0.48), both groups yielded globally low scores. There were no significant associations between matched groups in PROMIS-PSE (p=0.71), IKDC (p=0.55), Pedi-IKDC (p=0.15), and Pedi-FABS (p=0.77) scores (Table 1).

Conclusion:

Young athletes demonstrated similar levels of psychological readiness to RTS at 6 months following ACLR prior to and during the COVID-19 pandemic. Patient-reported outcome scores were similar in pre-COVID and COVID ACLR patients, suggesting that the pandemic may not have played a detrimental role in perceptions of recovery. Psychological readiness may not be fully optimized at 6 months post-ACLR and young athletes may benefit from additional time and training for progressive confidence, muscle strength, and performance. [Table: see text]
Changes in Patellofemoral Joint Morphology During Skeletal Growth and Maturation are not Sex-Dependent
Authors: Pruneski James A. , Hosseinzadeh Shayan , Emami Seyed A. , Sanborn Ryan , Barnett Samuel , Kiapour Ata M.
Published: May 2022

Background:

Patellofemoral disorders account for approximately 25% of patients seen in sports medicine clinics. A variety of anatomic risk factors have been identified in the pathogenesis of patellofemoral instability. While studies have analyzed these factors in adults, or compared them between healthy controls and patients with patellar injuries, little is known about how these anatomic markers change during skeletal growth and development.

Hypothesis/Purpose:

(A) The anatomic risk factors associated with patellar instability and dislocation change significantly during skeletal maturation. (B) These age-related changes during maturation will differ between male and female patients.

Methods:

After institutional review board approval, magnetic resonance imaging data from 239 unique knees (patient age 7-18; 55% female), without previous or current injury, were randomly selected and used to measure patellar height, lateral patellar tilt angle, trochlear width, trochlear depth, trochlear sulcus angle, and tibial tubercle trochlear groove distance. Linear regression was used to test the associations between age and anatomic measurement indices. Subsequently, patients were divided into four age groups: pre-pubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old). Additionally, two-way analysis of variance with the Holm-Sidak post hoc test was used to compare anatomic morphologies between male and female patients in each age group.

Results:

Patellar height (Caton-Deschamps index), lateral patellar tilt angle and trochlear sulcus angle all decreased significantly with age (P<0.001). Trochlear width, depth, and tibial tubercule trochlear groove distance all increased significantly with age (P<0.001). Except for trochlear width in late adolescence (P<0.001) where males had wider trochlea (medial and lateral) compared to matched females, the age-related anatomic changes were similar between males and females (P>0.1).

Conclusion:

The findings partially support our hypothesis, as we observed significant age-related changes in all quantified anatomical indices, which was not different (except trochlear width in late adolescence) between males and females. The lack of significant differences in key morphological features of the patellofemoral joint that are linked to patellar dislocation between females and males is consistent with a similar prevalence of this injury between the two. However, the findings suggest that there are significant differences in the trochlear width between females and males at later stages of growth and maturation. The current observations suggest that these anatomic risk factors undergo significant changes during skeletal growth, providing us with a window of opportunity to use prophylactic interventions to prevent or minimize the development of high-risk morphology. [Figure: see text][Figure: see text]