bluuebunny/crossref_metadata_2025 huggingface dataset:
DIFFERENCES IN ACUTE POSTOPERATIVE PAIN AFTER ACL RECONSTRUCTION IN ADOLESCENT PATIENTS: ALL SOFT-TISSUE QUADRICEPS VERSUS HAMSTRING AUTOGRAFT
Authors: Levy Brandon , Holland Erica , Bompadre Viviana , Schmale Gregory A. , Saper Michael
Published: April 2020

Background:

Postoperative pain after anterior cruciate ligament (ACL) reconstruction is a subjective experience that contributes significantly to patient satisfaction and subjective outcomes. As such, it is important for surgeons to counsel their patients and set appropriate expectations following surgery. ACL reconstruction with hamstring (HS) tendon autograft remains the most popular graft choice in adolescent patients with open physes, yet recently, reconstruction using all soft-tissue quadriceps tendon autograft has gained in popularity. However, studies are lacking that evaluate acute postoperative pain after quadriceps autograft.

Hypothesis/Purpose:

To investigate differences in acute postoperative pain between adolescent patients undergoing ACL reconstruction with all soft-tissue quadriceps versus HS autograft.

Methods:

A retrospective review was performed of 65 patients that underwent primary ACL reconstruction using either quadriceps (n = 33) or HS (n = 32) autografts between October 2017 and April 2019. All patients received ultrasound-guided adductor canal catheters and single-shot sciatic nerve blocks preoperatively and followed a standard postoperative multi-modal pain management plan. Intraoperative and postoperative intravenous (IV) morphine equivalents (MEQ), post-anesthesia care unit (PACU) length of stay (LOS), and PACU pain scores (numeric rating scale, 0-10) were recorded. Pain scores and supplemental oxycodone use were recorded on postoperative days (POD) 1-3. Differences were compared between the two groups.

Results:

The mean age at the time of surgery was 15.2 ± 1.5 years. There were no statistically significant differences in age ( p = 0.62), sex ( p = 0.72), BMI ( p = 0.18), concomitant meniscus repairs ( p = 0.71), or surgical time ( p = 0.52) between the two groups. There were no statistically significant differences in intraoperative IV MEQs ( p = 0.44), PACU IV MEQ ( p = 0.43), or PACU LOS ( p = 0.47) between the two groups. Patients treated with quadriceps autograft has lower max PACU pain scores (3.2 ± 3.2 vs 4.1 ± 3.1; p = 0.27) and required less supplemental oxycodone doses on POD 1 (1.1 ± 1.2 vs 1.8 ± 1.6; p = 0.07) but the differences were not statistically significant. Max pain scores (at rest and with movement) on POD 1-3 and oxycodone use on both POD 2 and POD 3 were similar between groups.

Conclusion:

In the setting of a multi-modal pain management plan including regional anesthesia, adolescent patients undergoing ACL reconstruction with quadriceps tendon autograft and hamstring autograft have similar pain levels and opioid use in the acute postoperative period.
TRENDS IN CONCOMITANT MENISCAL SURGERY AMONG PEDIATRIC PATIENTS UNDERGOING ACL RECONSTRUCTION: AN ANALYSIS OF ABOS PART II CANDIDATES FROM 2000-2016
Authors: Cruz Aristides I. , Gao Burke , Ganley Theodore J. , Shea Kevin , Beck Jennifer , Ellis Henry
Published: April 2020

Background:

Rates of ACL reconstruction among pediatric/adolescent patients are increasing. Limited knowledge exists about population level rates of concomitant meniscal surgery in this population.

Hypothesis/Purpose:

To examine trends in concomitant meniscus procedures and describe short-term complications in pediatric/adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing, and that the likelihood of performing meniscal repair or meniscectomy is associated with patient and surgeon specific factors.

Methods:

ACL procedures in patients <19 years reported by ABOS Part II examination candidates from 2000-2016 were queried. Regression models examined associations between patient & surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications.

Results:

9,766 cases were identified. Females represented 46% (n=4,468). Average patient age was 16.1 years (SD: 1.62, range 0-18). The rate of concomitant ACL-meniscal procedures increased from 2000-2016 (49%-60%; p=0.005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedics fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscus procedure (p=0.003; p=0.006, respectively). Sports medicine (+3.0%) trained surgeons were more likely to perform meniscus repair vs. meniscectomy (p=0.016). Younger patient age was associated with increased likelihood of undergoing meniscus repair vs. meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included: infection (1.61%), arthrofibrosis (1.14%), and DVT/PE (0.11%). Sports medicine and pediatric orthopaedic fellowship training were associated with higher rates of reporting post-operative stiffness/arthrofibrosis.

Conclusions:

Among ABOS Part II candidates, concomitant ACL-meniscus surgery has become more common than isolated ACL procedures. Surgeries involving sports medicine fellowship trained surgeons and younger patients were associated with increased rates of meniscus repair vs. meniscectomy. Pediatric orthopaedics and sports medicine training were associated with a higher likelihood of being involved in a concomitant ACL-meniscus procedure and also reported a higher incidence of post-operative stiffness/arthrofibrosis.

[Figure: see text][Figure: see text]
SYMPTOM PROFILES AND BALANCE CONTROL AFTER CONCUSSION AMONG FEMALE YOUTH ARTISTIC ATHLETES
Authors: Sweeney Emily A , Wilson Julie C , Potter Morgan N , Dahab Katherine S , Denay Keri L , Howell David R
Published: April 2020

Background:

Collision and contact sports are often the focus of concussion research; however, concussions also occur in artistic sports, including gymnastics and cheerleading. Few studies have examined how concussion presents in female youth artistic athletes. Specifically, the effects of concussion on symptom profiles and balance performance among these athletes have yet to be investigated.

Hypothesis/Purpose:

The purpose of our investigation was to compare post-concussion symptom profiles and balance measures among female youth artistic athletes relative to ball sport athletes. We hypothesized that artistic athletes would have similar concussion symptom profiles to ball sport athletes, but that artistic athletes would display better balance due to the demands of their sport.

Methods:

Female youth athletes ages 6-18 years who sustained a concussion during gymnastics or cheerleading (i.e. “artistic athletes”) or during volleyball or basketball (i.e. “ball sport athletes”) were seen within 3 weeks of injury. We compared performance between the two groups on measures of self-reported symptom frequency using the Health and Behavior Inventory (HBI), headache severity, and balance control using the Balance Error Scoring System (BESS), tandem gait, and Romberg tests. We compared outcome variables between groups using univariable Mann-Whitney U and Fisher’s exact tests. We constructed multivariable regression models to account for potential confounding variables, defined as those that demonstrated a difference between groups of p < 0.2.

Results:

Twenty-seven artistic athletes and forty-nine ball sport athletes sustained a concussion during the study period of 2015-2017. The artistic athletes were slightly younger, seen later for initial evaluation after injury, had a lower proportion with prior concussion history, and a lower proportion with pre-injury history of migraine compared to ball sport athletes (Table 1). Thus, these four variables were included as covariates in subsequent regression models. After adjusting for the independent effect of these potential confounding variables, we observed that artistic athletes performed the BESS tandem stance foam condition with significantly fewer errors than ball sport athletes (Table 2). Artistic female athletes demonstrated a higher, yet not statistically significant, headache severity than ball sport female athletes.

Conclusion:

Female artistic athletes had similar symptom profiles to ball sport athletes. Although artistic athletes performed better on BESS tandem stance foam condition, their other measures of balance control were not significantly different from ball sport athletes. This suggests that although their sports may require higher levels of balance, artistic athletes’ performance on post-concussion balance tests may be similar to athletes of other disciplines.

Tables: [Table: see text][Table: see text]
MPFL GRAFT TENSIONING TO TREAT PATELLAR INSTABILITY RELATED TO PATELLA ALTA: DYNAMIC SIMULATION
Authors: Jones Travis , Jones Kerwyn C. , Elias John J.
Published: April 2020

Background:

Medial patellofemoral ligament (MPFL) reconstruction is a popular treatment for lateral patellar instability. For knees with patella alta, however, tibial tuberosity distalization is the most common approach due to concerns about graft tensioning. A MPFL graft is tensioned intra-operatively to prevent lateral subluxation without over-constraining the patella by allowing some translation.

Purpose:

To analyze the effects of MPFL reconstruction on lateral tracking and cartilage pressure for knees with patella alta using dynamic simulation of knee function.

Methods:

Knee function was simulated with 8 multibody dynamic simulation models (RecurDyn) constructed from 3.0 T MRI scans of subjects being treated for recurrent patellar instability. The models were validated in previous studies and included ligaments, tendons, and retinacular structures represented by tension-only springs (Fig1). Four models displayed patella alta; the remaining 4 models were made to reflect patella alta by lengthening the springs. Forces were applied to simulate a dual limb squat from 0º to 90º. Motion was simulated in a pre-operative condition and for three MPFL graft tensioning techniques (1.0, 0.5, and 0 patellar quadrants of lateral translation). The maximum bisect offset index during flexion was used as a measure of patellar instability and the maximum pressures applied to patellar cartilage (lateral, medial) as measures of the risk of overloading cartilage. Statistics were used to compare the parameters with significance set at p < 0.05. Post- and pre-operative maximum bisect offset index were also correlated.

Results:

MPFL reconstruction with 0.5 and 0 quadrants of allowed lateral translation significantly decreased the maximum bisect offset index compared to the pre-operative condition, but not for 1.0 quadrants (Table 1). MPFL reconstruction did not significantly influence the maximum pressure applied to medial or lateral cartilage. The maximum post-operative bisect offset index was significantly correlated with the pre-operative bisect offset index for 1.0 and 0.5 quadrants of lateral translation allowed (r2 = 0.80, 0.65, and 0.48 for grafts allowing 1, 0.5 and 0 quadrants of translation, respectively).

Conclusion:

For knees with patella alta, the influence of MPFL reconstruction on patellar tracking varied with the allowed patellar translation during graft tensioning. None of the graft tensioning conditions significantly decreased the maximum lateral pressure or increased the medial cartilage pressure.

Significance:

The graft tensioning process for MPFL reconstruction typically allows some lateral patellar translation to avoid overconstraining the knee. For knees with patella alta, reducing the allowed lateral translation seems to limit maltracking without overconstraining the knee.

[Table: see text][Figure: see text]
ACL LENGTH IN PEDIATRIC POPULATIONS: AN MRI RETROSPECTIVE STUDY
Authors: Tran Emily P. , Chen Anthony Y. , Dingel Aleksei B. , Terhune Bailey , Segovia Nicole A. , Ganley Theodore J. , Fabricant Peter D. , Green Daniel W. , Stavinoha Tyler J. , Shea Kevin G.
Published: April 2020

Background:

Young athletes have the highest rates of primary and recurrent anterior cruciate ligament (ACL) tears, and recent research has identified graft diameter as a predictor of graft failure. Newer ACL reconstruction techniques have been developed to increase graft diameter and reduce re-rupture rates. Graft diameter can be modified based upon graft length, number of graft strands/configuration, and native ACL length. While the ACL has been well-studied in adult populations, there is limited research examining the ACL dimensional characteristics in a pediatric population. Appropriate preoperative anatomic dimensions may help surgeons plan for optimal graft length, diameter and bundle arrangement

Purpose:

To develop MRI-based predictors of native ACL graft length in pediatric populations and enhance preoperative planning to optimize graft length, strand configuration and graft diameter to lower the risk of recurrent ACL injury.

Methods:

One hundred and ten subjects were included from the STRIDE database (64 females and 46 males, median age 10 years, range 1-13 years). Our exclusion criteria were if the subjects had musculoskeletal diseases or history of knee injury. Using MRIs, researchers evaluated ACL length, sagittal and coronal inclination of the ACL, inclination and width of the intercondylar notch, depth and width of the femoral condyles, and the medial and lateral tibial slopes. Association between measurements, sex, and age were investigated using linear and multivariate regression models.

Results:

When examining the predictors for ACL length by sex, the best predictor (R⁁2 = 0.65) for female ACL lengths was the depth of the lateral femoral condyle taken in the sagittal view (p<0.001). Other predictors that were statistically significant (p < 0.005) were distal femoral condylar width (R⁁2 = 0.62), age (R⁁2 = 0.52), and coronal notch width (R⁁2 = 0.15). For males, the best predictor (R⁁2 = 0.70) of ACL length was the distal femoral condyle width as viewed coronally (p < 0.001). Other statistically significant predictors (p < 0.005) of male ACL lengths were lateral femoral condyle depth (R⁁2 = 0.62), age (R⁁2 = 0.48), and coronal notch width (R⁁2 = 0.20).

Conclusion:

When predicting the ACL length in pediatric populations, femoral condylar depth and width, and patient age may be valuable predictors for those undergoing ACL reconstructions. Surgical planning to maximizing graft diameter is contingent upon native ACL graft length, and the use of this information to optimize graft utilization may lower the rates of ACL graft failure in the highest risk pediatric populations.

Tables/Figures: [Table: see text][Figure: see text][Figure: see text]
ACLR GRAFT STRAND NUMBER: LONG-TERM FOLLOW-UP ON 400 PATIENTS
Authors: Aoyama Julien T , Bram Joshua T , Lawrence John Todd R. , Ganley Theodore J
Published: April 2020

Background:

Studies on pediatric anterior cruciate ligament reconstructions (ACLRs) often focus on graft choice, as rates of these injuries have risen in recent years. Large multicenter studies have found younger age and smaller graft size to be risk factors for graft failure and contralateral tears, but despite large sample sizes these studies have not looked specifically at graft strand number. Therefore the purpose of this study was to use a large sample size to ask whether ACLR graft strand number affects long-term outcomes.

Hypothesis/Purpose:

Examine long-term effects of ACLR graft strand number using a large cohort.

Methods:

This was a retrospective comparison study of all patients presenting between 1/1/2008 and 12/31/16 for a first-time ACLR at a single pediatric hospital. After querying medical records for all ACLRs using CPT codes, graft strand number, graft diameter, and other variables were abstracted. Long-term outcomes on graft rupture, contralateral ACL tear, and subsequent meniscus injury were collected via phone calls and REDCap emails. Patient groups were compared for differences in graft strand number and diameter using bivariate analyses, and differences in long-term outcomes were analyzed using multivariate regression.

Results:

436 patients met the inclusion criteria also completed the long-term follow-up on outcomes. Long-term follow-up ranged from 18 months post surgery to 10 years post surgery. Patients with larger graft diameter were significantly less likely to suffer a complication (graft rupture, contralateral ACL tear, or subsequent meniscus injury) in multivariate regression (p=0.03), while strand number, sex, weight, and age showed no significant difference. Transphyseal reconstructions had larger graft diameters (8.8mm) than partial hybrid (8.6mm) and all-epiphyseal reconstructions (8.3mm) (p<0.001), but had no differences in graft strand number. Males had larger graft diameters (8.9mm) than females (8.6mm) (p=0.03), but also had no differences in graft strand number. Obese patients had larger graft diameters (9.1mm) than overweight (8.9mm) and normal weight patients (8.6mm) (p=0.002). Obese patients also had more graft strands (6.9) than overweight (6.2) or normal weight patients (6.1), but this difference was not significant (p=0.051).

Conclusion:

This data supports the existing literature that pediatric ACLR patients with larger graft diameters are less likely to suffer long-term complications. Using both a large patient cohort and long-term follow-up, this data also showed that graft strand number was not significantly correlated with outcomes. This suggests that strand number is not important when constructing ACLR grafts, as long as sufficient graft diameter can be achieved.
6- VS 9-MONTH RETURN TO SPORT TESTING RESULTS AFTER ACL RECONSTRUCTION WITH QUADRICEPS AUTOGRAFT IN ADOLESCENT PATIENTS
Authors: Saper Michael
Published: April 2020

Background:

Recently, anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon autograft has gained in popularity, particularly in adolescent patients. Studies are lacking that evaluate return to sport (RTS) testing after ACLR with quadriceps tendon autograft (QT).

Hypothesis/Purpose:

To investigate differences between the 6-month and 9-month RTS assessment in adolescent patients undergoing ACLR with QT.

Methods:

A retrospective review of adolescent patients who underwent primary ACLR with all soft-tissue QT identified 18 patients with formal RTS testing data at 6 and 9 months. Surgeries were performed between June 2017 and October 2018 by single surgeon using an all-inside technique. Concomitant meniscus repairs were performed in 38.9% of patients. All patients followed the same standardized rehabilitation protocol and completed a structured RTS test 6 and 9 months after surgery. The RTS test consisted of isometric and isokinetic strength testing, the Lower Quarter Y-Balance Test (YBT-LQ), and single-legged hop testing. The recovery of muscle strength, assessed via isometric/isokinetic and hop testing, was defined by a limb symmetry index (LSI) ≥ 90%. Differences were compared between the two RTS time points.

Results:

The mean age at the time of surgery was 15.2 years (range, 13-17 years). There were statistically significant improvements in the Pedi-IKDC (92.1 ± 8.4 vs. 82.9 ± 8.7; P = 0.001) and Tegner activity scale (7.1 ± 2 vs. 5.1 ± 2; P = 0.001). There were statistically significant improvements in isometric quadriceps strength (LSI, 82.6 ± 16.8 vs. 93.1 ± 11; P = 0.03) and hamstring strength (LSI, 86.4 ± 11.3 vs. 98.2 ± 9.6; P = 0.001). There were improvements in isokinetic knee extension at both 60 deg/sec (LSI, 75 ± 16.9 vs. 82.8 ± 13.9) and 180 deg/sec (LSI, 79.1 ± 14.8 vs. 84.6 ± 10.9), but the differences were not statistically significant ( P = 0.08 and P = 0.11, respectively). There were no significant differences in isokinetic testing of knee flexion at either 60 deg/sec or 180 deg/sec. There were no statistically significant differences in the anterior reach component of the YBT-LQ at 6 and 9 months. Patients demonstrated statistically significant improvements on single-legged hop testing with mean LSIs > 95% for each of the four tests at 9 months postop.

Conclusion:

Adolescent patients undergoing ACLR with QT demonstrated significant improvements in subjective function and quadriceps strength between 6 and 9 months postop. This data supports delaying RTS beyond 9 months in this at-risk population.

[Table: see text]
MRI KNEE BONE AGE: A NOVEL SHORTHAND APPROACH TO REDUCE BONE AGE RADIOGRAPHS IN CHILDREN
Authors: Meza Blake C. , LaValva Scott M. , DeFrancesco Christopher J. , Striano Brendan M. , Aoyama Julien T. , Carey James L. , Shea Kevin G. , Nguyen Jie C. , Ganley Theodore J.
Published: April 2020

Background:

Determining bone age in skeletally immature patients is critical for proper management and surgical planning. Pennock et al. recently created and validated a bone age atlas using the ossification pattern of the knee on MRI in pediatric patients, obfuscating the need for a hand radiograph and its associated cost, radiation exposure, and clinical inefficiency.

Hypothesis/Purpose:

We sought to validate and demonstrate reliability of a novel shorthand method of bone age determination using knee MRI across multiple levels of medical training.

Methods:

We identified patients who underwent knee MRI and hand bone age radiograph within a ninety-day period. In collaboration with a pediatric musculoskeletal radiologist, stepwise algorithms for predicting bone age on knee MRI were developed- one for males and one for females. Six raters at varying levels of training used the algorithm to assign a bone age for each patient. Intraclass correlation coefficient (ICC) was used to compare each rater’s predicted knee bone age to the Greulich and Pyle (G&P) hand bone age and validate the shorthand algorithm. Inter-rater reliability was also calculated using ICC.

Results:

Thirty-eight patients (44.7% female) underwent a knee MRI at a mean age of 12.8 years (range 9.3-15.7). The mean time between hand bone age x-ray and knee MRI was 20.2 days (range 0-88). The inter-rater reliability for the application of our shorthand algorithm was 0.81 (95% CI: 0.72 – 0.88), indicating good inter-observer agreement. The shorthand methos was shown to be a good predictor of G&P hand bone age, both for each individual rater (ICC range: 0.73 – 0.80) and the mean knee MRI bone age across all raters (ICC 0.81; 95% CI 0.65 – 0.90). It was also shown to be a consistent predictor of hand bone age across level of training, as medical students (ICC 0.77, 95% CI 0.60-0.88), residents (ICC 0.80, 95% CI 0.65-0.89), and attending physicians (ICC 0.80, 95% CI 0.63-0.89) all achieved strong correlation between predicted knee MRI bone age and G&P hand bone age.

Conclusions:

This novel shorthand algorithm is a reliable and valid way to determine skeletal maturity using knee MRI. It can be utilized clinically across different levels of radiographic and orthopaedic expertise and reduces the need for hand bone age radiographs and consequential radiation exposure in children.

[Figure: see text][Figure: see text][Table: see text]
THE RELIABILITY OF A QUALITATIVE SCORING SYSTEM OF TRUNK AND LIMB ALIGNMENT DURING A 45-DEGREE SIDE STEP CUT
Authors: Butler Lauren , Milian Erin , Latz Kevin , Ellis Henry , Martinez Alexa , Hayden Kristin , Gerstenkorn Christian , Carpenito Sara , DeVerna Amie , Wyatt Charles , Sugimoto Dai ,   PRiSM Injury Prevention Research Interest Group
Published: April 2020

Background:

Three dimensional (3D) motion analysis is considered the “gold standard” for evaluating human movements. However, its clinical utility is limited due to cost, operating expertise and lengthy post-processing time. Numerous qualitative scoring systems, using videos, have been introduced to assess trunk and lower extremity (LE) alignment in dynamic maneuvers. However, it is unknown if a qualitative scoring system is a reliable method to evaluate cutting movement.

Hypothesis/Purpose:

To assess the inter-rater and intra-rater reliability of a qualitative scoring system to evaluate trunk and LE alignment during a 45-degree side step cut. The sub-aim was to investigate the effect of interactive peer discussion on inter-rater reliability.

Methods:

A repeated measures study design was used. Six raters (2 MDs, 2 PTs, and 2 ATs) independently viewed 10 videos, consisting of a 45-degree side step cut performed by adolescent male and female athletes. A clinically established checklist (Figure 1) was given to examine quality of movements. After the 1st round, an interactive peer discussion was held to discuss videos, movement quality, and the checklist. Subsequently, after a 1-week wash out period, a 2nd round of evaluation (examining the same 10 videos) was performed. Following the 2nd round, and a 2-week wash out period, a 3rd round was performed to assess intra-rater reliability. In each round, video sequences were altered in random order to avoid memory bias. Intraclass correlation coefficient (ICC) and their 95% confident intervals (95% CIs) were calculated. Values less than 0.50, between 0.50 and 0.75, between 0.75 and 0.90, and greater than 0.90 were defined as poor, moderate, good and excellent reliability, respectively.

Results:

Inter-rater reliability for the 1st round was moderate (ICC: 0.565, 95%CIs: 0.074-0.866). Inter-rater reliability for the 2nd round was better, however, was still moderate (ICC: 0.632, 95%CIs: 0.100-0.895). Intra-rater reliability between the 2nd and 3rd round ranged from moderate to excellent (ICC: 0.589-0.910).

Conclusion:

The results of this study showed moderate inter-rater reliability and moderate to excellent intra-rater reliability of the qualitative checklist. Following the interactive peer discussion, slight improvements in inter-rater reliability were observed. The findings indicate that this checklist may allow clinicians to standardize their assessment of trunk and LE alignment during a cutting task, however, more objective methods to evaluate multiplane movements, such as genu valgum, may be warranted.

[Figure: see text]
A PROSPECTIVE STUDY ON THE INCIDENCE, MECHANISMS AND RISK FACTORS FOR SPORT RELATED CONCUSSIONS IN HIGH SCHOOL SOCCER PLAYERS
Authors: McGuine Timothy , Hetzel Scott , Schwarz Alison , Snedden Traci
Published: April 2020

Background:

There is a growing concern regarding the incidence of Sport Related Concussion (SRC) in high school soccer players. However, there is limited prospective data regarding the incidence, mechanism and risk factors for SRCs for this population.

Hypothesis / Purpose:

To prospectively document the incidence, mechanisms and risk factors for SRCs sustained by high school soccer players.

Methods:

High school soccer players from 32 high schools were invited to participate during academic years 2015/16 and 2016/17. Subjects completed a demographic form including their history of previous SRC and preseason PCSS symptom and severity scores from the SCAT3. Licensed Athletic trainers (ATs) and coaches recorded all (practice or competition) soccer exposures (SE). ATs reported the onset, mechanism, symptom resolution and days lost for each SRC sustained during the study. Descriptive statistics were calculated to describe the study population while Cox Proportional Hazards Ratios (HR: [95%], p-value) were used to compare the incidence of SRC among the baseline characteristics.

Results:

thousand eight hundred eighty-one subjects (Female = 62.8%, Age = 15.7+1.2 yrs.) participated in 96,947 SE (34.3% competition) during the study duration. Two hundred seventy subjects (14.4%) reported one, while 60 (3.2%) reported two previous SRCs. The median (IQR) preseason PCSS symptom score was 0.0 [0,3] while the severity score was 0.0 [0,4]. Eighty (4.3%) subjects sustained a SRC (0.825/1000 SE) during the study time period and reported a median PCSS symptom score of 10.0 [5.0,15.0] and PCSS severity score of 21.0 [14.0,41.0]. Concussion-related symptoms were reported for 6.0 [4.0,10.0] days and 13.0 [9.3, 20.0] soccer days were missed. SRCs occurred most often during competition (78.8%) and as the result of contact with another player (41.3%), the ball (35.0%) or playing surface (20.0%). Females were more likely to sustain a SRC than males (HR: 3.78 [2.00-7.14], p<0.001). Compared to subjects without a previous SRC, the rate was higher for subjects with one (HR: 2.70 (1.65-4.42), p<0.001) and two (HR: 3.71 (1.68-8.19), p=0.001) previous SRCs. Subjects with a preseason PCSS symptom and PCSS severity score > 0 had a higher rate of SRC (HR: 1.71 [1.10-2.65], p=0.017) than players who did not.

Conclusions:

This study provides details regarding the incidence, mechanisms and risk factors for SRCs in high school soccer players. Females, players with a previous history of SRC or those reporting a preseason PCSS symptom and severity score >0 were more likely to sustain a SRC playing soccer.
The Incidence of Second Anterior Cruciate Ligament Injury in Young Athletes is Not Influenced by Time to Return to Sport
Authors: Zwolski Christin M. , Schmitt Laura C. , Thomas Staci , Paterno Mark V.
Published: April 2020

Background:

Incidence of second anterior cruciate ligament (ACL) injury among the population of young athletes is reported to be as high as 30%. Time between ACL reconstruction (ACLR) and return to sport (RTS) has been considered as a factor in second injury risk.

Hypothesis/Purpose:

The purpose of this study was to investigate the effect of time between ACLR and RTS on incidence of 2nd ACL injury. The tested hypothesis was that incidence of 2nd ACL injury among young athletes would not be influenced by time to RTS or patient-reported function following primary ACLR.

Methods:

188 participants (mean age=16.8±3.0 years; 124 females) underwent ACLR, completed rehabilitation, and were medically cleared to RTS. Subjects were enrolled in the study within 4 weeks of their medical clearance to RTS. At this time, each subject completed the International Knee Documentation Committee (IKDC) Survey, the Knee injury and Osteoarthritis Outcome Score (KOOS) and was grouped into an early RTS group (<6 months post-operative (PO)) (n=19), an average RTS group (6-9 months PO)(n=106), and a late RTS group (≥9 months PO)(n=63). Subjects were then tracked for 24 months to record the incidence of a second ACL injury to either the involved limb or contralateral limb. One-way ANOVA was used to identify differences in demographics and patient-reported outcomes among the groups. Crude incidence of 2nd ACL injury was identified within each group and chi-squared analyses were used to determine the difference in proportion of 2nd ACL injuries between groups.

Results:

No significant differences in age (p=0.40), height (p=0.65) or weight (p=0.92) existed among the groups. At time of RTS, no differences between the early RTS, average RTS and late RTS groups were seen in patient-reported function on the IKDC (84.9±10.8, 90.5±9.5, 88.7±10.9; p= 0.08) and all KOOS subscales (p=0.05-0.41). With respect to 2nd ACL injury, there were no group differences (p=0.716) in the proportion of patients within each group who suffered a 2nd ACL injury within 24 months of RTS date (26.3% (5/19) of patients in the early RTS group, 18.9% (20/106) in the average RTS group and 22.2% (14/63) in the late RTS group).

Conclusion:

In accordance with our hypothesis, length of time between ACLR and RTS had no influence on incidence of second ACL injury among a population of young athletes after ACLR. Furthermore, patient-reported function at time of RTS was similar among groups, regardless of time between ACLR and RTS.
THE RELATIONSHIP BETWEEN ACUTE MOOD, SLEEP, AND SEX ON NEUROCOGNITIVE PERFORMANCE POST-CONCUSSION IN ADOLESCENTS
Authors: Stremlau Sara , Allred Richard Cameron , Gerkin Richard , Erickson Steven , Pardini Jamie
Published: April 2020

Background:

Both sleep disturbance and mood changes are common symptoms post-concussion (Sell & Rubeor, 2017). Studies have found these symptoms are correlated with poorer performance on neurocognitive testing (Kontos et al., 2012 and Kostyun et al., 2015). In addition, Brown et al., (2015) showed that females report more symptoms at both baseline and post-concussion compared to males on the Post-Concussion Scale and the Sport Concussion Assessment Tool 2.

Hypothesis/Purpose:

The purpose of this study is to investigate how a patient’s sex, as well as self-reported acute mood and sleep symptoms are related to neurocognitive performance in individuals with concussion.

Methods:

Data were acquired through IRB-approved retrospective chart review. Composite scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized evaluation and self-reported symptom scores on the Post-Concussion Symptom Scale were gathered for 1619 adolescents age 12-18 (49.3% female) who presented to a large metropolitan outpatient clinic for treatment of concussion.

Results:

Females endorsed higher overall symptoms (x=19.52, SD 19.37, median 13.0 for females; x=12.88, SD 15.89, median 7.0 for males; Mann-Whitney U Test p<0.001). This same pattern emerged for the mood and sleep symptom clusters (female mood mean=2.92, SD 4.51; male mood mean=1.64, SD 3.34; female sleep mean=1.59, SD 2.0; male sleep mean=1.11, SD 1.84; both Independent Samples Mann-Whitney U Tests ps<0.001). There were significant but modest negative correlations between mood symptoms and performance on verbal memory (r=-0.174), visual memory (r=-0.213), and visual motor speed (r=-0.146) composites (all ps<0.01). There was positive correlation between reaction time composite and mood symptoms (r=0.191). There were significant but modest negative correlations between sleep symptoms and performance on verbal memory (r=-0.171), visual memory (r=-0.184), and visual motor speed (r=-0.161) composites (all ps<0.01). There was a positive correlation between reaction time composite and sleep symptoms (r=0.196, p<0.01).

Conclusion:

Consistent with prior research, adolescent females reported more symptoms post-concussion, including total symptom score, mood symptoms, and sleep symptoms. Adolescents presenting with more mood and sleep symptoms demonstrated poorer performance on neurocognitive testing. However, given the modest nature of the correlation, a significant amount of variation in test performance is not explained by symptom report. Results from this study underscore the importance of a multidimensional concussion assessment that includes both symptom report and cognitive testing when working with pediatric athletes. This study also reinforces the importance of understanding potential effects of sleep, mood, and sex on concussion.
ARTICULAR CARTILAGE THICKNESS IN PEDIATRIC AND ADOLESCENT KNEES DECREASES WITH AGE AND SKELETAL MATURITY: IMPLICATIONS FOR OSTEOCHONDRAL GRAFTING PROCEDURES
Authors: Sidharthan Sreetha , Yau Annie , Almeida Bryan Aristega , Shea Kevin G. , Jones Kristofer J. , Fabricant Peter D.
Published: April 2020

Background:

Quantifying native cartilage thickness in pediatric and adolescent knees can help match donor and recipient sites for articular cartilage restoration procedures such as osteochondral autograft transplantation (OATS) and osteochondral allograft transplantation (OCA).

Hypothesis/Purpose:

The purpose of the current study was to quantify articular cartilage thickness in pediatric and adolescent knees using magnetic resonance imaging (MRI). We hypothesized that cartilage thickness is inversely correlated with skeletal maturity and age.

Methods:

One hundred and twenty MRI scans were evaluated in a cohort of patients 9 to 18 years old without osteochondral lesions, chondral wear or pathology, intraarticular fractures, history of knee surgery, or inflammatory arthropathy. Measurements of articular cartilage thickness at the medial femoral condyle, lateral femoral condyle, lateral trochlea, and patella were made on axial, coronal, and sagittal MRI scans (Figure 1). Skeletal maturity was categorized as ‘open’, ‘closing’, or ‘closed’ based on the status of the proximal tibial and distal femoral growth plates. Descriptive statistics was used to evaluate cartilage thickness by age and sex. Independent samples t-test, analysis of variance (ANOVA), and linear regression were performed to investigate for associations with sex, skeletal maturity, and age.

Results:

On the femur, cartilage was thickest at the lateral trochlea with mean articular thickness of 4.2 ± 1.4 mm in males and 3.6 ± 1.3 mm in females ( p=0.015) (Table 1). Skeletally immature patients with open physes had significantly thicker cartilage at the medial femoral condyle, lateral femoral condyle, and lateral trochlea compared to patients with closing and closed physes (Figure 2). Linear regression analysis also revealed a significant association between femoral cartilage thickness and age (Figure 3). Age explained 63% of the variance at the medial femoral condyle (B=6.1, p<0.001), 64% of the variance at the lateral femoral condyle (B=4.9, p<0.001), and 68% of the variance at the lateral trochlea (B=8.2, p<0.001) (Table 2). In contrast, cartilage thickness at the patella did not significantly vary by age, sex, or skeletal maturity (Figures 2 and 4).

Conclusion:

There is a strong inverse association between increasing age and cartilage thickness of the femoral condyles and lateral trochlea. In particular, pediatric knees demonstrate relatively thick cartilage at the lateral trochlea that decreases with age. This information will help surgeons understand recipient site anatomy and identify appropriate donor site tissue for articular cartilage restoration procedures such as OATS and OCA in children and adolescents.

Tables: [Table: see text][Table: see text] Figures: [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
THE EFFECTS OF INTERNAL JUGULAR VEIN COMPRESSION FOR PRESERVING WHITE MATTER INTEGRITY IN HIGH SCHOOL FOOTBALL PLAYERS COMPARISON OF HIGH VS LOW
Authors: Foss Kim D. Barber , Diekfuss Jed A. , Yuan Weihong , Dudley Jonathan A. , DiCesare Christopher A. , Reddington Danielle L. , Zhong Wen , Nissen Katharine S. , Shafer Jessica , Leach James L. , Logan Kelsey , Myer Gregory D.
Published: April 2020

Background:

Repetitive head impacts experienced during competitive sports contribute to neurologic changes over the course of a season. Internal jugular vein compression, by means of an externally worn neck collar device has shown efficacy in mitigating white matter (WM) alterations following repeated head impact exposure. However, its relative effectiveness in high versus low head impact exposures is unknown.

Hypothesis/Purpose:

The purpose of this study was to investigate the effectiveness of an externally worn neck collar device in limiting WM alterations over a season of high school football in players who receive high and low cumulative head impact exposures over 90 g.

Methods:

213 male high-school football athletes were prospectively assigned to two study groups: a control group (non-collar; n=106) and an experimental group who wore the jugular vein compression collar during all practices and games (collar; n=107). MRI data was collected from all participants pre- and post-season. Fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD) were calculated to assess WM integrity at both time points. Cumulative head impact exposure was monitored by accelerometers attached to each athlete’s left mastoid process during every exposure. Participants were dichotomized into subgroups based on accumulated exposures to hits over 90 g, which divided the entire cohort into four subgroups, using a cut-off of 40 hits : (1) non-collar group (≥40 hits, n=57); (2) collar group (≥40 hits, n=51); (3) non-collar group (<40 hits, n=49); (4) collar group (<40 hits, n=56).

Results:

As seen in Table 1, in athletes with ≥40 hits, both the non-collar and collar group showed significant pre- to post- season reductions in MD, AD, and/or RD. The non-collar group with ≥40 hits also showed a significant increase in FA, MD, and AD. RD, FA, and MD changes were greater in the non-collar group compared to the control group with ≥40 hits, while AD changes were greater in the collar group compared to the non-collar group with ≥ 40 hits. The non-collar group with <40 hits presented significant pre- to post-season reductions in MD, AD, and RD that were greater than the collar group with < 40 hits (whom did not show pre-to post-season changes).

Discussion & Conclusion:

The present results provide support for internal jugular vein compression to protect the brain from both low- and high-level repeated head impact exposure. However, less consistent changes were observed for athletes exposed to repeated, high-level head impacts, warranting further investigation.

[Table: see text]
FEMORAL NERVE CATHETER IS ASSOCIATED WITH PERSISTENT STRENGTH DEFICITS AT 6 MONTHS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC PATIENTS
Authors: Parikh Harin B. , Mandler Tessa N. , Gagliardi Alexia G. , Howell David R. , Albright Jay C.
Published: April 2020

Background:

The long-term outcomes of femoral nerve blockade following ACL reconstruction are not well defined. Femoral nerve blocks are typically administered as either a single-injection nerve block (FNB) or a continuous femoral nerve catheter (FNC). Prior work among pediatric patients found knee extension and flexion strength deficits 6 months postoperatively using FNB. However, this work was limited by the use of multiple graft choices and orthopedic surgeons.

Purpose/Hypothesis:

The purpose of this study was to investigate functional recovery after primary ACL surgery with quadriceps tendon-patellar autograft (QPA) in patients receiving a sciatic nerve block and either FNB or FNC. Our hypothesis was that short-term functional performance would be worse among those who underwent FNC compared to FNB.

Methods:

We conducted a retrospective chart review of pediatric patients 10-19 years of age who underwent ACL reconstruction with QPA by a single orthopedic surgeon. Surgery was performed at two locations: one of which administered FNB and the other FNC. Both were combined with sciatic nerve block. A physical therapist performed functional asymmetry assessments at approximately 6 months postoperative. We compared single-leg squat symmetry between groups using independent samples t-tests. We compared the proportion of patients in each group who achieved 80% symmetry on single-leg squat and Y-Balance tests, had initiated ballistics and running programs, and demonstrated functional symmetry at the 6-month post-operative appointment using Chi-square analyses.

Results:

Demographics were similar between groups (Table 1). Single leg percent symmetry of the operative limb was significantly greater in the FNB group compared to the FNC group (Table 2). In addition, a greater proportion of those in the FNB group demonstrated functional symmetry compared to the FNC group during the 6-month assessment (Table 2). There were no proportional differences between the groups for the number of patients who demonstrated 80% symmetry during single-leg squat or Y-Balance test, or had initiated a ballistics or running program at the time of assessment.

Conclusion:

Pediatric patients in the FNC group demonstrated poorer single-leg squat symmetry and functional symmetry compared to those in the FNB group at 7 months following ACL reconstruction with QPA. These preliminary findings may relate to increased concentration and duration of local anesthetic in the FNC group postoperatively. Providers should be cognizant of the implications of FNC on long-term outcomes of ACL reconstruction. [Table: see text][Table: see text]
SPORTS PERFORMANCE, SLEEP AND ANXIETY IN CHILDREN AND ADOLESCENTS: SECOND YEAR RESULTS OF A LONGITDUINAL STUDY
Authors: Sarkisova Natalya , Herrera-Hamilton Anita , Hartline Kenneth D. , Perez Iris , Wren Tishya A.L. , Skaggs David L. , Edison Bianca
Published: April 2020

Background:

In the preliminary results of a longitudinal study, we gathered baseline insights into students’ sleeping habits, activity levels and anxiety. The results showed that the seventh grade (now eighth grade) students reported mild anxiety, played sports non-competitively and underslept according to the National Sleep Foundation (NSF). In the second year of this study, we continue to look at the trends of sleep, athletic performance and emotional wellness.

Methods:

40 eight grade students were administered an ActiGraph watch to assess sleep patterns. Students completed a background survey to obtain information regarding sports participation and subjective injury reports. Students completed the Beck Youth Anxiety Inventory (BYAI) to assess anxiety. Actigraph data was reviewed with a board certified sleep pulmonologist.

Results:

16 males and 24 females wore the watch for 5 school nights. Average age of patients was 13 years (range: 13 to 14). 200 nights of nocturnal sleep were analyzed with total sleep time (TST) averaging: 6.2 hours (370 minutes) (range: 216 to 448 minutes). Females averaged 6 hours (368 minutes) and males averaged 6.25 hours (375 minutes) (p=0.62). Out of the 40 students that wore the watch, 78% (31/40) completed the background survey regarding sports participation. 78% (24/31) reported playing a sport and on average spend 7 hours a week playing (range: 1 to 30 hours). 78% (24/31) also participate in an organized or recreational sport and on average started competitive sports at the age of 6 years (range: 3 to 12 years). 46% (11/24) of students reported injuries that removed them from their sport during the school year (range: 1 to 4 injuries). On the BYAI (n=32), scores were significantly higher this year with a mean score of 16 (moderate anxiety) compared to last year (mean=12, p=0.01). Females scored significantly higher (p=0.04) on the BYAI (mean=18, n=20) than males (mean=12, n=12). Patients that also reported higher anxiety received significantly less sleep (p=0.01, r=-0.46).

Conclusion:

In the second year of our longitudinal study, our results show that students continue to sleep below the recommendation of the NSF (9 to 11 hours, 546 to 660 minutes) and select students are starting to specialize in sports. However, anxiety compared to last year was significantly higher. As they transition from middle school to high school, we expect to see students undergo personal development, commit to one sport and have a more rigorous school schedule that will continue to affect sleep and emotional wellness.