bluuebunny/crossref_metadata_2025 huggingface dataset:
The Outcomes of Conservative Versus Surgical Treatment of Pelvic and Hip Avulsion Fractures: A Systematic Review and Meta-Analysis
Authors: Block Andrew M. , Oladeji Afolayan K. , Carsen Sasha , Crepeau Allison , Ellis Henry B. , Nepple Jeffrey J.
Published: May 2022

Background:

Avulsion fractures of the pelvis and hip are common injuries in adolescent patients. Avulsion sites include the rectus femoris at the anterior inferior iliac spine (AIIS), the sartorius at the anterior superior iliac spine (ASIS), the hamstrings at the ischial tuberosity, abdominal muscles on the iliac crest (IC), iliopsoas at the lesser trochanter (LT). Although these fractures are commonly treated conservatively, there is no consensus on the preferred treatment modality (conservative vs. surgical fixation) or thresholds for surgical treatment. The published literature is generally limited to small retrospective series, with in some cases conflicting results.

Purpose:

To summarize the available evidence on outcomes of pelvic and hip avulsion fractures in the pediatric and adolescent population using a systematic review of the literature.

Study design:

Systematic review.

Methods:

A systematic review of the literature was performed per PRISMA guidelines. Inclusion criteria included mean patient age of ≤18.0 years, ≥5 patients, avulsions treated with 3 months of injury, and publication in the English language. Patient characteristics, type of activity performed when injured, treatment modality, complications, and outcomes (rates of persistent symptoms, return to sport, subsequent surgery), were recorded by specific fracture type.

Results:

A total of 1034 patients with acute avulsion fractures from 23 studies were included. Of these, the outcomes were reported in 799 patients, including 693 (86.7%) who underwent conservative treatment and 106 (13.3%) who underwent surgical intervention. All types of acute avulsion fractures had good results with conservative treatment. Ischial tuberosity avulsions had the highest rate of persistent symptoms (25.4%) but only 10.2% underwent subsequent surgery. AIIS avulsions also had a high rate of persistent symptoms (19.3%) but very few underwent subsequent surgery (1.3%). Faster return to sport was noted in conservatively treated patients in ASIS and AIIS avulsions (both p<0.05). While good results have been reported with surgical treatment, conservative treatment of ASIS, AIIS, ischial tuberosity, IC, and LT avulsions appears to be nearly uniformly successful with low rates of persistent symptoms or subsequent surgery.

Conclusions:

Both conservative treatment and surgical treatment of pelvic avulsion injuries appear to be effective for the majority of patients. Ischial tuberosity and AIIS avulsions have the highest rates of persistent symptoms at 25% and 19%, respectively. Further prospective research into all fracture types is needed to better define indications for surgery in a subgroup of patients. [Figure: see text]
Sports and Physical Activity Attenuate the Emotional Toll of the Covid-19 Pandemic
Authors: Walker Gregory A. , Seehusen Corrine N. , Armento Aubrey , Provance Aaron J. , Howell David R.
Published: May 2022

Background:

The COVID-19 pandemic resulted in the alterations or restrictions of youth sports and physical activity. These changes may have had negative ramifications on anxiety and both physical and psychological readiness to return to sport in youth athletes.

Hypothesis/Purpose:

Our purpose was to investigate the relationships between the physical and mental health ramifications on youth athletes during restricted sport activities that resulted from COVID-19 stay-at-home orders. Our hypothesis was that youth athletes who participated in a similar or greater volume of organized sports would have less anxiety during the COVID-19 stay-at-home orders compared with those who reported a decrease in organized sport volume.

Methods:

Our cross-sectional study evaluated male and female athletes who competed in club sports (e.g., non-school sponsored) at the time of questionnaire completion. All participants completed an online questionnaire between July 15, 2020 and August 10, 2020. We asked participants to report the average hours/week they spent in organized sports or physical activity unrelated to their sport prior to COVID-19 and currently. We grouped participants on whether they had a decrease or increase/no change in their reported activity level. Participants also completed the Generalized Anxiety Disorder-7 questionnaire.

Results:

A total of 192 participants (13.0±2.2 years of age; range= 6-18 years, 56% female) completed the study. On average, participants reported 2.3 (SD+5.2) fewer hours of sport training per week during the COVID-19 stay-at-home orders compared to prior. Over half (56%) of participants reported a decreased training volume during stay-at-home orders, and 44% reported a similar or increased training volume (Table 1). The respondents reporting decreased training volumes had significantly greater anxiety scores than those who reported similar training volumes (Figure 1). After adjusting for the potential confounders of age, sex, and body size, decreased training volumes during stay-at-home orders were significantly associated with higher anxiety levels (β coefficient = 2.02; 95% confidence interval = 0.64, 3.41; p = 0.005). Those with decreased training volumes were more likely to report feeling undertrained (72% vs 30%, p<0.001) and less physically ready to return to sport (56% vs 88%, p<0.001) compared to those with similar/increased training volumes (Table 1).

Conclusion:

The COVID-19 pandemic resulted in decreased training volumes and higher anxiety scores (mean difference= 1.9 GAD-7 points, 95% confidence interval= 0.6, 3.2) compared with athletes who reported similar/increased training volumes. Lastly, those in the decreased training cohort felt both under-trained and less physically ready to return to sports. [Table: see text][Figure: see text]
Technique Variation for MPFL Reconstruction in Skeletally Immature Patients: Data from the Jupiter Cohort
Authors: Heyworth Benton E. , Perea Sofia Hidalgo , Veerkamp Matthew , Parikh Shital N. , Wall Eric J. , Wilson Philip L. , Stein Beth E. Shubin ,   JUPITER Study Group, Green Daniel W.
Published: May 2022

Background:

Management approaches and surgical techniques, when applied for pediatric and adolescent patellofemoral instability (PFI), continue to lack clear clinical guidelines and indications. Medial patellofemoral ligament reconstruction (MFPLR) is among the most popular surgical options. However, variation in technique remains significant, particularly in skeletally immature sub-populations.

Purpose:

The purpose of this study was to examine the variation in MPFLR technique in skeletally immature patients within a cohort of 20 orthopedic surgeons with different experience levels and specialty training backgrounds. Methods: All operative records of skeletally immature patients from 2016 to 2021 were retrieved from the JUPITER cohort, a multi-center prospective study involving 13 different tertiary care academic centers. Patients who underwent a primary single-stage MPFLR were evaluated in this study. Demographic information and operative details were collected for each knee.

Results:

Of the 306 knees, 205 (53% female, 47% male) met inclusion criteria and comprised the final cohort (Table 1). The average age was 13.6 ± 1.8 yrs (5.1-19.0). The initial injury mechanism was of a non-contact nature in 73% and a result of contact in 17%. 47% of surgeons utilized autograft while 53% utilized allograft. Suture anchors (including small tenodesis screws) were the most popular patellar fixation technique (61%), followed by the use of tunnel under a bone bridge (37%). The majority of surgeons utilized 2 suture anchors (59%). Interference screws were the most popular femoral fixation technique (84%), followed by suture anchors (12%). The majority of surgeons used either 1 interference screw 97(%) or 1 suture anchor at the femur (96%). In addition to MPFLR, 15% of patients underwent osteochondral fracture treatment: 36% underwent loose body removal, while 61% underwent fixation. Lateral Retinacular Release was performed in 13% of cases, and lateral retinacular lengthening was performed in 2%. 10% of patients underwent concomitant hemi-epiphysiodesis for genu valgum, 3% underwent medial quadriceps tendon-femoral ligament reconstructions, and 3% underwent a Grammont realignment (patellar tendon medialization) procedure.

Conclusion:

Variation in different aspects of MPFLR technique is substantial among this cohort of orthopedic surgeons. Given the well-established importance of decreasing variation for healthcare cost containment and optimization of outcomes, comparative studies and sub-stratified analyses are needed to better elucidate the most favorable techniques and their components. [Table: see text]
The Effects of Early Range of Motion Versus Immobilization Following Acute First-Time Lateral Patellar Instability Episode: Randomized Control Trial
Authors: Purcell Nicholas , McKay Scott , Saloom Adam , Mitchell Katy
Published: May 2022

Background:

The acute management of lateral patellar dislocations (LPD) typically consists of placing the patient in a knee immobilizer for 2 to 6 weeks, but it is not clear on how long these patients should be immobilized, if at all.

Hypothesis/Purpose:

The purpose of this study is to compare outcomes for patients following a rehabilitation protocol that is initiated with or without a short period of immobilization after sustaining a LPD.

Methods:

An IRB-approved prospective study was performed at a children’s hospital which included patients <18 years of age (mean = 14.22) diagnosed with LPD (<10 days). A total of 18 (14 females, 4 males) patients diagnosed with LPD were consented and enrolled in the study (Early ROM group = 11, Immobilization group = 7). Inclusion criteria for the study was history of knee instability, effusion or history of effusion, and (+) apprehension. Subjects were followed for 4 weeks and the following outcomes were assessed: knee ROM, isokinetic strength, Kujala, Pedi-IKDC, and Y balance scores. Split-plot (2x2) ANOVAs were conducted for each of the dependent variables with an alpha level set at .05 for the global tests and independent t-tests were run at baseline and 4 weeks.

Results:

There were no significant differences between groups at baseline. Knee flexion ROM showed a significant main effect of time (p≤.0005) and group (p=.012). Pedi-IKDC showed a significant main effect of time (p≤.0005) and group (p=.026). When comparing groups at 4 weeks, the early ROM group had significantly better scores in both the Kujala (means for both groups: 76.78 and 52.67), p=.049)), and the Pedi-IKDC (means for both groups: 68.85 and 40.88), p=.025)). There were no significant differences in isokinetic strength measures between the groups except for affected side knee flexion at 60 degrees/sec (p=.039) with the early ROM demonstrating higher strength. In addition, the affected side composite Y-balance scores were significantly better for the early ROM group (as compared to the immobilization group) at p=.031.

Conclusion:

Patients that underwent early ROM following LPD scored significantly better across patient derived outcome measures and functional outcomes at 4 weeks following the initial physical therapy evaluation when compared to a group that underwent a 2 week period of immobilization. Future studies should analyze longer term comparisons between groups to determine if this short term difference leads to long term differences or improved re-injury rates.
Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Patterns?
Authors: Chesler Kyle C. , Howell David R. , Pierpoint Lauren A. , Comstock R. Dawn , Khodeae Morteza , Provance Aaron J.
Published: May 2022

Background:

Skiing and snowboarding have grown significantly in the past decades with millions of participants worldwide. With popularity increasing, specifically amongst youth athletes, so has the number of injuries and fatalities associated with these sports. In this study, we investigate age as a potential determinant for injury patterns for the growing population of youth skiers and snowboarders.

Hypothesis/Purpose:

The purpose of our study was to investigate the factors associated with different anatomical injury locations among youth skiers and snowboarders. We hypothesized that youth skiers would exhibit predominately lower body injuries, while snowboarders would predominately exhibit upper body injuries. We also expected higher rates of head injuries for the younger snowsports participants given their larger head to body ratios and decreased cervical muscular strength.

Methods:

This retrospective study was conducted from data acquired from the Winter Park Resort during the 2012/13–2016/17 ski seasons. The population includes youth (3-17 years old) participants injured at Winter Park Resort while skiing or snowboarding. Patients were sorted by sport and then into age bins 0-6, 7-14, and 15-17 years of age. The study population was described for gender breakdown, run difficulties, equipment usage, skill level, injury location, mechanism, anatomical location, and diagnosis. Logistic regression analysis was used to examine the association between age, sport, and other predictors of injury with different anatomical locations.

Results:

The study population is described in Table 1. Skiers were more likely than snowboarders to sustain a head injury (odds ratio=1.6, 95% CI=1.2, 2.2), while snowboarders were more likely to sustain upper extremity injuries (odds ratio=5.9, 95% CI=4.6, 7.6). Skiers age 0-6 suffered more head/neck/face injuries (24.2% compared to 14.46 and 14.86% respectively in age bins 7-14 and 15-17). Skiers age 0-6 suffered more fractures (48.2% compared to 28.4% and 23.8% for ages 7-14 and 15-17, where strains/sprains were leading diagnoses).

Conclusion:

Age was associated with injury patterns in youth skiers, as we observed more fractures, head/neck/face injuries and collision-related trauma in skiers age 0-6. Like previous studies, skiing was associated with lower extremity injuries and snowboarding was associated with upper extremity injuries. Taken together, these data support age as a determinant of injury patterns among youth skiers and snowboarders. [Table: see text][Figure: see text]
Quantifying the Impact of the Covid-19 Pandemic on Youth Sports-Related Injuries
Authors: Oganezova Karina , Houlihan Nathan , Maguire Kathleen J. , Lawrence J. Todd , Ganley Theodore J. , Williams Brendan A.
Published: May 2022

Background:

The COVID-19 pandemic has had a tremendous impact on youth sports participation for children and adolescents in the United States. Prior work demonstrated that pandemic-related closures led to a significant reduction in pediatric sports-related injury in the first half of 2020. However, these trends have yet to be evaluated on a national level and during the latter half of the year when organized youth sports began to re-emerge.

Purpose:

To estimate monthly and annual trends in youth sports-related injury over the last 5 years using a national injury database in order to measure the impact of the COVID-19 pandemic on overall and sport-specific rates of injury.

Methods:

We retrospectively reviewed data from the National Electronic Injury Surveillance System (NEISS) database identifying children and adolescents (0-18yo) presenting to US emergency departments with sport participation product codes (Table 1). Cases associated with >1 product code were excluded. The monthly and annual frequency of sports-related injuries was estimated. Quasi-experimental interrupted time series analysis was performed using the period of March-December 2020 as a binary variable. Differences in total and sport-specific injury estimates were calculated with pre-and post-trend analysis of the interrupted time series.

Results:

Our study criteria identified 152,560 youth sports-related injury cases corresponding to a national estimate of 4,582,892 injuries from 2016-2020 (95% CI=4,420,534-4,745,250). The mean yearly estimate from 2016-2019 was 1,041,944 injuries [890,047-1,193,841]. An estimated 415,115 injuries [357,779-480,594] occurred in 2020. Seasonal peaks in September and May were identified. There was a statistically significant decrease in national youth sports-related injuries that coincided with the nationwide COVID-19 shutdown in March 2020 (56,945 [33,143-80,747] fewer monthly injuries (P < 0.0001)). From March-December 2020, an estimated 457,221 [388,450-525,992] fewer sports-related injuries occurred than would have been expected based on prior trends. Sport-specific analyses (Table 1) demonstrated the greatest reduction of estimated injuries from March-December 2020 occurred in basketball (137,772 fewer injuries [130,192-145,246]), football (123,345 fewer injuries [86,883-159,807]), and soccer (70,383 fewer injuries [65,849-74,919]). Estimates of injuries associated with wrestling, ice hockey, and cheerleading had the greatest proportional reduction during the March-December time period (99%, 93%, and 79% respectively.)

Conclusion:

There was a significant reduction in youth sports-related injuries in 2020 coinciding with the nationwide COVID-19 shutdowns in March 2020 and persisting throughout the remainder of the year. Reduced injury burden was most notable for contact sports including basketball, football, and soccer. [Table: see text][Figure: see text]
Surgical Management of Distal Clavicle Fractures in Skeletally Immature Athletes
Authors: Jasty Naveen , Waters Peter M. , Bae Donald S. , Heyworth Benton E.
Published: May 2022

Background:

Distal clavicle fractures account for a significant proportion of clavicle fractures in the pediatric and adolescent age groups, but clinical decision making to date has largely been informed by adult studies. However, surgical treatment in this younger population may have unique technical and clinical considerations, due to distinct fracture patterns, increased healing potential and periosteal thickness.

Hypothesis/Purpose:

The objective of this study was to characterize distal clavicle fractures in a cohort of pediatric and adolescent athletes who underwent operative treatment at a single, tertiary-care pediatric center, including surgical techniques used and resultant clinical outcomes.

Methods:

A retrospective review was performed of all operatively-treated clavicle fractures extending to the coracoclavicular ligaments or lateral, between 2005-2020. Patients >19 years-old or those with pathological fractures were excluded. Radiographic characteristics, surgical fixation construct, time to radiographic healing, return to sports, and complications were analyzed.

Results:

Fifty-two patients were identified, with mean age 13.8 ± 2.2 years. The majority of fractures were classified as Nenopoulus type IIB (transverse, displaced; 42.3%) or type IIIB (oblique, displaced; 26.9%), with type IIA (transverse, minor displacement; 3.8%), IV (comminuted; 11.6%) , and V (AC dislocation; 15.4%) patterns also observed. Primary direction of displacement was posterior in 90% of cases and superior in 10%. Plate fixation was performed in 53.8% of surgeries, with locking plate (26.9%) and hook plate (17.3%) most frequent. Suture-based fixation was performed in 32.7% of cases (Figure 1). Rate of removal of implants was 66% after plate fixation, the majority of which (72.2%) were planned at the time of primary fixation. Patient age was comparable in suture and plate cohorts (12.9 vs. 13.5, p = 0.19). Total complication rate, including unplanned removal of implants, was higher in the plate fixation group (25%) than in the suture-based fixation group (11.2%). Time to radiographic healing was not significantly different between plate and suture-based constructs (2.9 vs. 2.9 months, p = 0.96) though patients with suture-based constructs returned to sport faster (2.5 vs. 3.6 months, p = 0.014).

Conclusion:

The vast majority of distal clavicle fractures treated operatively in pediatric and adolescent athletes are posteriorly displaced fractures. When chosen in the appropriate patient, suture-only constructs can lead to similar healing and faster return to sports compared to plate-based constructs, with greatly reduced need for removal of hardware. These data provide a foundation for future comparative research further elucidating precise surgical indications and optimal treatment approaches. [Table: see text]
Patterns and Predictors of Opioid Use Following Surgery for Sports-Injury in Adolescents
Authors: Groenewald Cornelius B. , Schmale Gregory A. , Saper Michael G. , Palermo Tonya M. , Rabbitts Jennifer
Published: May 2022

Background:

Opioids provide effective pain relief for many adolescents following sports-injury surgery. However, a subgroup experiences poor pain relief with significant risk of developing iatrogenic problematic opioid use behaviors, such as persistent opioid use and opioid misuse (use in a way other than prescribed: e.g. longer duration, higher doses). Currently, our ability to predict this risk-benefit ratio for individual patients is limited by inadequate understanding of associated risk factors. Therefore, we aimed to 1) characterize opioid use over 14 days following surgery, 2) examine relationships between pre-operative risk factors (pain intensity, depressed mood, sleep disturbance, substance use history) and postoperative opioid use, and 3) determine rates of opioid misuse/persistent use at 2 months post-surgery.

Hypothesis:

We hypothesized finding 1) wide variability in opioid use over the first 14 days post-surgery, 2) higher pre-surgery pain intensity, depressed mood, sleep disturbance, and history of substance use associated with increased opioid use, and 3) 5-10% of patients reporting opioid use beyond 14 days from surgery.

Methods:

Prospective observational study of 50 adolescents (50% female) undergoing outpatient sports-injury (knee, shoulder, elbow) arthroscopic and limited-open surgery. Prior to surgery, participants were surveyed about pain symptoms, depressive symptoms, sleep disturbance, and a history of substance use using validated patient-reported questionnaires. All participants received opioids (oxycodone) to manage moderate-severe pain at home. Opioid use was objectively monitored using a novel medication adherence tracking device (electronic pill box). The primary outcome variable was the number of opioid doses used from the initial prescription following surgery. Generalized estimating equation (GEE) regression models examined associations between risk factor/predictor (pain, depression, sleep, substance use) and opioid use variables, controlling for time since surgery.

Results:

Mean age was 13 years (range 10-18 years). Mean opioid use was highly variable, ranging from 1-25 doses over the first 14 days following surgery (mean 8.5±5.8 doses). Pre-surgery pain (Beta(β)=0.39, p<0.0001), sleep disturbance (β =0.35, p=0.026), and history of substance use (β =0.22, p=0.04) predicted increased opioid use over 14 days. Surgery type and depressive symptoms were not associated with opioid use. At 2-month follow-up, 6/50 (12%) patients reported use of opioids beyond 14 days after surgery.

Conclusion:

Opioid use following sports-injury surgery varies widely and may be related to modifiable preoperative risk factors, suggesting an important role for screening and brief preoperative interventions. Up to 12% of patients used opioids up to 2 months following surgery, however, whether this phenomenon suggests opioid misuse versus persistent opioid use for pain remains unknown.
Grit After Acl Reconstruction: Sex Differences and Association with Knee Outcomes Among Adolescent Athletes
Authors: Armento Aubrey , Logterman Stephanie , Gagliardi Alexia , Hovater Whitney , Howell David , Albright Jay
Published: May 2022

Background:

Grit reflects perseverance for pursuing long-term goals. Recovery from ACL reconstruction requires a long and challenging rehabilitation process. While grit has previously been used to predict success in education and military settings, little is known about the association between grit and the rehabilitation process among adolescent athletes after ACL reconstruction.

Purpose:

The primary aim of the study was to determine differences in GRIT-S scores between male and female athletes pre-operatively to 6 months post-ACL reconstruction. The second aim of the study was to assess the relationship between pre-operative GRIT-S scores and knee outcome measures 6 months post-operatively.

Methods:

All participants completed the GRIT-S questionnaire, the Pediatric International Knee Documentation Committee (Pedi-IKDC) subjective knee form, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) at a pre-operative appointment and then again approximately 6 months after ACL reconstruction. We conducted a linear mixed model analysis to assess the effects of sex and time on GRIT-S scores. We then conducted a linear regression analysis to determine if pre-operative GRIT-S scores predicted IKDC and HSS Pedi-FABS scores at 6 months post-operatively. We defined statistical significance as p < 0.05.

Results:

We included 83 participants (mean age 16.0 +/- 2.3 years, 70% female) from a prospective registry of pediatric athletes undergoing ACL reconstruction by one surgeon at a single institution. For the entire study population, there was no statistically significant change in GRIT-S scores from the pre-operative assessment to 6 months post-operatively. However, there was a statistically significant effect of sex (p=0.03) on GRIT-S scores from pre-operative assessment to 6 months post-operatively, with female athletes demonstrating more grit than male athletes across both assessments (Figure 1). Additionally, there was no significant association between pre-operative GRIT-S scores and Pedi-IKDC and HSS Pedi-FABS scores 6 months post-operatively for the entire group (Figure 2).

Conclusion:

In our study population, female athletes reported higher GRIT-S scores than male athletes across the first 6 months of rehabilitation after ACL reconstruction. Pre-operative GRIT-S scores do not appear to be significantly associated with knee outcome measures 6 months post-operatively, which could suggest that grit may not necessarily predict success in the rehabilitation process after ACL reconstruction. However, future studies will examine how grit is associated with return-to-sport outcomes to determine if grit is a useful marker in predicting successful return-to-sport after ACL reconstruction in adolescent athletes. [Figure: see text][Figure: see text]
Influence of Gender, Race/Ethnicity & Socioeconomic Factors on Meniscus Treatment with Pediatric and Adolescent Acl Reconstruction
Authors: Mercurio Angela M. , Coene Ryan P. , Cook Danielle , Feldman Lanna , Milewski Matthew D.
Published: May 2022

Background:

The rate of anterior cruciate ligament reconstruction (ACLR) in pediatric/adolescent populations has increased over time. However, there is less evidence to support the relative change in concomitant meniscus procedures over time. Demographics and socioeconomic (SES) factors may be implicated in the rate and usage of meniscectomy vs. meniscal repair as treatment.

Hypothesis/Purpose:

The purpose of this study is to assess if the rate of concomitant meniscus procedure with ACLR is increasing and what factors may be contributing to this rise. We hypothesize that age, sex, race/ethnicity, income, or insurance type may affect the rate of concomitant meniscus procedures.

Methods:

The Pediatric Health Information System (PHIS) Database was queried for all patients 18 years or younger who underwent ACLR with or without concomitant meniscus procedures based on CPT code from 2015-2019. Data from 39 out of 52 centers were included based on completeness of their data. Basic demographic information including age, sex, self-identified race/ethnicity, and insurance status was collected. Urban and rural designation was identified based on rural-urban commuting area (RUCA) codes. Based on the 2015 Department Health & Human Services Federal Poverty Guidelines (FPL), patients were stratified into lower (≤199% of FPL) and higher (≥200% of FPL) income brackets. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations.

Results:

14,398 patients underwent ACLR during the study period with 8,337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over five years (Figure 1). Of the 8,337 patients with concomitant meniscus treatment, 46% had a meniscectomy and 54% had a meniscus repair. There was a 0.86-fold change in meniscectomy and a 1.70-fold increase in meniscus repair during the study period (Figure 2). Males, older patients, Black race, living in an urban area, and those with non-private insurance had increased odds of undergoing a concomitant meniscus procedure (all p<0.05). Patients of Black or other race and those with non-private insurance had increased odds of having a meniscectomy vs. meniscus repair (all p≤0.01). There were no associations detected between income bracket and our outcomes.

Conclusions:

This study shows that in pediatric and adolescent patients undergoing ACLR, there is a rise in concomitant meniscus procedures from 2015-2019. In addition, patients of non-white race and those with non-private insurance have increased odds of undergoing meniscectomy vs. meniscus repair. This study identifies access and inequality issues in ACLR with concomitant meniscus procedures in pediatric and adolescent populations. [Figure: see text][Figure: see text]
Can a Knee Brace Prevent Acl Re-Injury: A Systematic Review
Authors: Marois Bianca , Tan Xue Wei , Pauyo Thierry , Dodin Philippe , Ballaz Laurent , Nault Marie-Lyne
Published: May 2022

Background:

Recent literature shows a rate of ACL retear after ACLR when returning to sport between 8% and 23%, depending on the population and clinical implications. The risk of a second injury is higher in patients who (1) return to cutting and pivoting sports, (2) do not meet the return to sport criteria before returning to sport, and (3) returning to pivoting sports earlier than 9 months after ACLR. A second ACL injury, either a graft rupture or contralateral ACL injury after ACLR, negatively impacts knee function, quality of life, accelerates degenerative changes in the knee and challenges an athlete’s career.

Purpose:

This systematic review aimed to investigate whether a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR).

Methods:

This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Data were extracted independently by two reviewers. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials.

Results:

A total of 1196 patients in 3 studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patient. (p < 0.05).

Conclusion:

Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction. [Table: see text][Figure: see text][Table: see text][Table: see text][Table: see text][Table: see text]
Trends in Anterolateral Ligament Reconstruction and Lateral Extra-Articular Tenodesis in Children and Adolescents
Authors: Patel Neeraj M. , McKay Scott D. , Pandya Nirav K. , Ganley Theodore J.
Published: May 2022

Background:

Graft failure remains a challenging complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Anterolateral ligament reconstruction (ALLR) and lateral extra-articular tenodesis (LET) show promise in lowering the risk of ACL graft failure, but there is little data on surgeon practices and preferences in the pediatric population. An improved understanding can help determine the feasibility of future research, identify questions of interest, and ultimately design clinical studies.

Hypothesis/Purpose:

The purpose of this study is to quantify surgeon practices regarding ALLR and LET in children and adolescents.

Methods:

An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society. Surgeon and practice demographic information was collected. The survey then asked several questions about indications, preferences, and techniques for ALLR or LET in the context of primary and revision pediatric ACLR. Chi-square and Fisher exact tests were used to evaluate factors that impact surgical preferences.

Results:

A total of 63 surgeons completed the survey, of which 62% performed ≥50 pediatric ACLR annually. In the setting of primary ACLR, 35/63 (56%) sometimes perform ALLR or LET. The frequency increased to 50/63 (79%) with revision ACLR. The most common indications for ALLR/LET in the primary setting were high-grade pivot shift, knee hyperextension, generalized laxity, and type of sports participation. Surgeons whose practice was >75% sports medicine were more likely to perform ALLR/LET with both primary and revision ACLR (p=0.005 and <0.001, respectively). Those that completed a sports medicine fellowship were more likely to perform these procedures than those with only pediatric orthopaedic training in both primary (68% vs. 36%, p=0.01) and revision scenarios (92% vs. 60%, p=0.002). Of the 28 respondents that do not perform ALLR/LET with primary ACLR, 75% cited insufficient evidence as the reason. However, 95% of surgeons that do perform these procedures expressed interest in studying them prospectively and 86% were willing to randomize patients.

Conclusion:

In this study of pediatric sports surgeons, 56% sometimes perform ALLR or LET with primary ACLR and 79% with revision ACLR. Surgeons with sports medicine fellowship training or a mostly sports practice were more likely to perform these procedures. Insufficient evidence was the most common reason given by those that do not perform ALLR or LET. However, there was substantial willingness to prospectively study and even randomize pediatric patients to assess the impact of ALLR/LET in this population.
Anterior Cruciate Ligament Injuries Change Muscle Co-Activation Strategies in Adolescent Females During Landing
Authors: Bel Michael Del , Romanchuk Nicholas J. , Benoit Daniel , Carsen Sasha
Published: May 2022

Background:

Anterior cruciate ligament (ACL) injuries in adolescents continue to rise. Given that muscles are the only modifiable contributors to knee joint control, there has been a focus on their management in rehabilitation research. After an ACL injury, increased co-activation of the thigh muscles is considered a hallmark characteristic in stabilising the knee joint among adults with ACL injuries. However, increasing co-activation to improve joint stiffness should not be the rehabilitation goal after an ACL injury since a prolonged increase in co-activation about the joint alters knee joint loads and is associated with the onset and progression of knee osteoarthritis in adults.

Purpose:

Co-activation information currently does not exist among adolescents, therefore this study set out to address this gap.

Methods:

Twelve female patients with ACL-deficiency (ACLd) and 12 matched controls (CON) performed countermovement jumps while having the following muscle activations recorded for both limbs: rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus (ST), lateral (LG) and medial gastrocnemii (MG), and gluteus medius (GM). During the landing phase of the task, co-activation indices were calculated for the lateral thigh muscles (VL and ST), medial thigh muscles (VM and BF), and the total thigh muscles (VL&VM and BF&ST). Independent-sample t-tests ( p=.05) evaluated mean group differences for each of the three co-activation indices.

Results:

A significant difference was found in medial co-activation ( p=.019), while a trend towards significance ( p=.071) was found in total thigh co-activation, with ACLd females having higher co-activations indices in both compared to matched controls (Figure 1). No differences were observed between groups in their demographics or lateral co-activation indices.

Conclusion:

Failure to appropriately adapt one’s neuromuscular control strategies may explain why some individuals continue to have knee instability and difficulty returning to their pre-ACL injury activity levels after rehabilitation. This is evidenced by our findings among this cohort of females with ACL injuries who displayed higher co-activations, specifically in the medial thigh musculature. Moreover, our findings highlight the need to target individual muscles during rehabilitation and to avoid generalization of segment muscles (i.e. quadriceps and hamstrings) where vital information in knee joint stabilization may be missed. [Figure: see text]
Objective Infrared Eye Tracking Aids in the Identification of Concussion-Related Vision Disorders in Adolescen Ts with Persistent Post-Concussive Symptoms
Authors: Master Christina , Rogers Tyson , Podolak Olivia , Howell David , Grady Matthew F. , Scheiman Mitchell
Published: May 2022

Background:

The visio-vestibular examination (VVE) of smooth pursuit, saccades, vestibulo-oculomotor reflex, near point of convergence (NPC), accommodative amplitude (AA), and complex tandem gait, has enhanced the physical examination of concussed individuals. The EyeBOX is a FDA-approved device for the diagnosis of concussion.

Hypothesis:

The goal of this investigation was to determine the diagnostic accuracy for concussion-related vision disorders of infrared eye-tracking via the EyeBOX.

Methods:

A cross-sectional study of 112 adolescents ages 11-18 years of age experiencing persistent post-concussion symptoms 4-12 weeks after concussion was conducted. All subjects had a clinical visio-vestibular examination (VVE) with a sports medicine physician, and a formal, comprehensive vision examination conducted by a pediatric developmental optometrist. A binocular eye tracking assessment was performed using the EyeBOX. Binocular pupil gaze positions are captured to ensure quality data acquisition and binocular movements in the X and Y axes are recorded at 500 Hz. Dynamic time series eye tracking data is acquired with 89 different metrics from eye movement in different planes recorded for each eye at 500 Hz captured over 220 seconds. From the time series data, a summary score, between 0 and 20, the BOX score, is generated. Logistic regression was used to estimate the association between each clinical VVE parameter and concussion-related vision diagnosis. Univariate and multivariate analyses were performed to determine the predictive ability of all VVE parameters to predict a concussion-related vision diagnosis. The area under the receiver-operator (ROC) curve was estimated by treating the linear predictor from the logistic regression as a continuous diagnostic parameter. A p-value is reported for the Wald test of whether a logistic regression coefficient differs from zero.

Results:

The clinical VVE variables had an AUC = 0.64 for tandem gait errors (p=0.06), 0.64 for monocular AA (p=0.01 for each), and 0.66 for NPC (p<0.01). A multivariable model including all nine VVE variables had predictive ability to identify concussion-related vision disorders in adolescents with persistent post-concussion symptoms with an AUC = 0.73. The BOX score alone had an AUC = 0.67 (p<0.01).

Conclusions:

The addition of the BOX score, a composite measure of objectively acquired eye tracking data, to the multivariable model with all nine dichotomous VVE variables added significant additional diagnostic ability (p<0.01), yielding an AUC = 0.81. The combination of a clinical visio-vestibular examination and objective infrared eye tracking has relevant diagnostic value, facilitating identification and treatment of concussion-related vision disorders.
Effect of Menstrual Dysfunction in Adolescent Concussion Patients on Length of Time to Recovery and Symptom Burden
Authors: Barsky Brandon W , Fischer Anastasia N. , Young Julie A.
Published: May 2022

Background:

Concussions are one of the most common sport-related-injuries seen in the adolescent population. It is well known that female athletes are at higher risk for concussion, but factors that influence this risk, including hormonal influences, are not entirely known. There is no literature to date that explores the relationship between menstrual dysfunction (MD) and outcome measures of concussion.

Hypothesis/Purpose:

Our primary purpose is to determine if MD predicts prolonged recovery from concussion and our secondary purpose is to determine if MD predicts a higher initial symptom burden.

Methods:

Patients who presented to a pediatric sports medicine concussion clinic for an initial visit, were ≤18 years-old, and were at least 2 years post-menarchal were included in the study. Those who reported taking any hormonal medications, were pregnant, or who suffered symptoms greater than 180 days were excluded. Subjects who were >15 years old at menarche, experienced <10 menstrual periods per year or >35 days between cycles were categorized as having MD. Two linear regressions were analyzed to determine differences in initial symptom score and time to recovery between those with and without MD while controlling for age, history of headaches, and history of prior concussions.

Results:

A total of 801 participants were included in the study (697 controls and 108 MD patients). There was no statistically significant difference in time to recovery between the groups (p=0.12). However, MD patients took 5 days longer to recover than controls (51.23 vs. 46.42 days). There was no statistical difference in initial symptom score between the MD and control groups (p=0.67, 56.04 for controls and 58.47 for MD).

Conclusion:

No statistically significant differences were found in time to recovery after concussion or in initial symptom burden between subjects with MD and controls. Additional study is warranted to further characterize these relationships.
The Association Between the Female Athlete Triad and Mental Health in High School Athletes
Authors: Wolfenden Emily , Olson Emily Miller , Mehta Shayna , Sainani Kristin , Roche Megan , Jochen Karis , Hastings Katherine , Kraus Emily
Published: May 2022

Background:

The Female Athlete Triad (Triad) is the interrelationship of low energy availability, reproductive irregularities, and low bone mineral density. It is theorized that mental health illness can both contribute to and result from low energy availability. Limited data exists that describes the relationship between the Female Athlete Triad and mental health symptoms.

Hypothesis/Purpose:

The purpose of this study was to investigate the relationship between the Triad and mental health illness, specifically depression and anxiety symptoms, in high school athletes.

Methods:

This was a cross-sectional survey study of high school athletes distributed via social media with responses accepted from 12/30/20 – 2/15/21. Data was collected including age, sex, training history, menstrual history, history of bone stress injuries, and eating behaviors. The Female Athlete Triad Coalition Consensus Statement Cumulative Risk Assessment Tool was used to score athletes (range: 0-10 points) and to classify them as low-, moderate-, or high-risk for Female Athlete Triad. Mental health was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress Depression and Anxiety short form questionnaires. Mental health scores were scored as none, mild, moderate, or severe self-reported depressive or anxious symptoms. Ordinal logistic regressions were performed.

Results:

There were 78 self-reported female high school participants (mean age = 16). Depression symptoms were reported in 74% of participants (19% mild, 40% moderate, 15% severe). Anxiety symptoms were reported in 64% of participants (18% mild, 26% moderate, 21% severe). Triad risk assessment responses categorized participants as 45% low risk, 41% moderate risk, and 14% high risk of developing the Triad. Depression symptoms were significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.245 (1.004 – 1.544) ( p = .0462). Anxiety symptoms were also significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.264 (1.020 – 1.567) ( p = .0319).

Conclusion:

Anxiety and depression symptoms were both significantly associated with increasing Triad risk scores in this preliminary cross-sectional study. Notably, this study is limited by sampling bias. Further research is needed to explore the relationship between mental health illness and the Female Athlete Triad.
Treatment of Borderline Acetabular Dysplasia in the Adolescent Patient: Outcomes of Periacetabular Osteotomy
Authors: Parilla Frank , Clohisy John C. , Nepple Jeffrey J.
Published: May 2022

Introduction:

The treatment of borderline acetabular dysplasia [defined as lateral center edge angle (LCEA) 18-25°] is controversial as there is limited evidence regarding the optimal surgical treatment [hip arthroscopy versus periacetabular osteotomy (PAO)]. The decision-making is particularly challenging in the adolescent patient where a durable outcome is particularly important.

Purpose:

To define early clinical outcomes, complications and rates of reoperation in adolescent patients undergoing PAO for the treatment of borderline acetabular dysplasia.

Methods:

A prospective single surgeon hip preservation database was retrospectively reviewed for adolescent patients treated with PAO for symptomatic instability in the setting of borderline acetabular dysplasia. A total of 56 hips were identified from 2010 to 2019 and followed for an average of 3.5 ±1.9 years (range, 1-7). Modified Harris hip scores (mHHS) were analyzed relative to minimal clinically important difference (MCID 8) and patient acceptable symptoms state (PASS>74). Complications and reoperations were recorded.

Results:

The 56 included hips (age 16.3 ±1.4 years; 89% female) had a mean preoperative LCEA of 20.9° ±.2.0° (37%, 18-20°; 63% 20-25°). Concurrent hip arthroscopy for symptomatic labral pathology was performed in 28% of cases. Major improvement in mHHS (27 ±17) from baseline to final follow-up (59 vs. 86, p<0.001) corresponded to a high observed rate of achieving MCID or PASS (91%). Two patients (3.6%) underwent subsequent arthroscopy. There were no other non-hardware removal reoperations. There were no outcome differences between those treated with and without concurrent arthroscopy (p>0.5).

Conclusion:

PAO surgery provides excellent pain relief and improved function in adolescent patients with symptomatic, borderline acetabular dysplasia. The observed reoperation rate (3.6%) is low for this patient population. The PAO remains our preferred treatment for borderline dysplasia with clinical signs and symptoms of hip instability.