bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-dimensional segmentation and depth-encoded visualization of choroidal vasculature using swept-source optical coherence tomography
Authors: Zhou Hao , Bacci Tommaso , Freund K Bailey , Wang Ruikang K
Published: July 2021

The choroid provides nutritional support for the retinal pigment epithelium and photoreceptors. Choroidal dysfunction plays a major role in several of the most important causes of vision loss including age-related macular degeneration, myopic degeneration, and pachychoroid diseases such as central serous chorioretinopathy and polypoidal choroidal vasculopathy. We describe an imaging technique using depth-resolved swept-source optical coherence tomography (SS-OCT) that provides full-thickness three-dimensional (3D) visualization of choroidal anatomy including topographical features of individual vessels. Enrolled subjects with different clinical manifestations within the pachychoroid disease spectrum underwent 15 mm × 9 mm volume scans centered on the fovea. A fully automated method segmented the choroidal vessels using their hyporeflective lumens. Binarized choroidal vessels were rendered in a 3D viewer as a vascular network within a choroidal slab. The network of choroidal vessels was color depth-encoded with a reference to the Bruch’s membrane segmentation. Topographical features of the choroidal vasculature were characterized and compared with choroidal imaging obtained with indocyanine green angiography (ICGA) from the same subject. The en face SS-OCT projections of the larger choroid vessels closely resembled to that obtained with ICGA, with the automated SS-OCT approach proving additional depth-encoded 3D information. In 16 eyes with pachychoroid disease, the SS-OCT approach added clinically relevant structural details, including choroidal thickness and vessel depth, which the ICGA studies could not provide. Our technique appears to advance the in vivo visualization of the full-thickness choroid, successfully reveals the topographical features of choroidal vasculature, and shows potential for further quantitative analysis when compared with other choroidal imaging techniques. This improved visualization of choroidal vasculature and its 3D structure should provide an insight into choroid-related disease mechanisms as well as their responses to treatment.
The roles of immune cells in atherosclerotic calcification
Authors: Cao Jingsong , Zu Xuyu , Liu Jianghua
Published: July 2021

Atherosclerosis is the leading cause of acute cardiovascular events, and vascular calcification is an important pathological phenomenon in atherosclerosis. Recently, many studies have shown that immune cells are closely associated with the development of atherosclerosis and calcification, but there are many conflicting viewpoints because of immune system complications, such as the pro-atherosclerotic and atheroprotective effects of regulatory B cells (Bregs), T helper type 2 (Th2) cells and T helper type 17 (Th17) cells. In this review, we summarize the studies on the roles of immune cells, especially lymphocytes and macrophages, in atherosclerotic calcification. Furthermore, we prepared graphs showing the relationship between T cells, B cells and macrophages and atherosclerotic calcification. Finally, we highlight some potential issues that are closely associated with the function of immune cells in atherosclerotic calcification. Based on current research results, this review summarizes the relationship between immune cells and atherosclerotic calcification, and it will be beneficial to understand the relationship of immune cells and atherosclerotic calcification.
First report of intravascular ultrasound–guided intravascular lithotripsy to treat an underexpanded stent in the superficial femoral artery
Authors: Donas Konstantinos P , Taneva Gergana T , Bakr Nizar Abu , Psyllas Anastasios , Puchner Stefan B
Published: July 2021

Background/Objective

To evaluate the safety and utility of a new in Europe intravascular ultrasound (IVUS) catheter in a case of peripheral arterial disease caused by in-stent restenosis of the superficial femoral artery.

Method

Pre-therapeutic computed tomographic angiography identified severe stent restenosis related to device underexpansion, which was caused by an underlying eccentric severely calcified stenosis leading to suboptimal device deployment. The OptiCross 18 (30 MHz Peripheral Imaging Catheter, Boston Scientific, USA) is a short rail imaging catheter. It consists of two main assemblies: The imaging core is composed of a hi-torque, flexible, rotating drive cable with a radial looking 30 MHz ultrasonic transducer at the distal tip. An electro-mechanical connector interface at the proximal end of the catheter makes the connection to the Motordrive Unit (MDU5 PLUSTM) Instrument. The MDU5 PLUS-catheter interface consists of an integrated mechanical drive socket and electrical connection.

Results

The use of the IVUS-guided imaging revealed in-stent restenosis, fracture, and protrusion of the calcified plaque in the stent and confirmed the preoperative computed tomography angiography which showed stent compression. Use of intravascular litotripsy catheter (intravascular lithotripsy Shockwave Medical, Santa Clara, California) and drug coated balloon led to improvement in stent expansion, having minimal patent diameter of 5.77 mm. The patient’s subsequent clinical course was uneventful, and clinically had palpable pulses in the foot and ankle-brachial index of 1.

Conclusions

Whether acoustic pulse application might affect device structure in the long term remains to be determined, use of the novel IVUS system demonstrated excellent visibility of the etiology of the in-stent restenosis improving the perioperative diagnostic modalities of suboptimal endovascular outcome.
Outcomes of periarterial sympathectomy in patients with digital ischemia
Authors: Elshabrawy Ahmed A , Elkassaby Mohammed , Abdelgawad Mohamed S , Atif Ehab , Megahed Abdelsalam , Regal Samer
Published: July 2021

Introduction

Digital ischemia with subsequent severe pain and tissue loss is often difficult to treat, with no obvious guidelines or strong evidence in the literature to support a specific treatment modality. Patients who fail medical treatment remain with very limited surgical options due to the difficulty of any intervention in this “no man’s land” area of the hand, as described since 1918. Extended distal periarterial sympathectomy is reported as an effective treatment option since the eighties of last century. The procedure entails large incisions and major technical difficulties. In this study, we describe a less invasive approach with very promising results and equally high success rates.

Materials and Methods

This was a prospective study. All patients with severe digital ischemia manifesting with bluish discoloration, ulceration, and/or dry gangrene who failed medical treatment underwent distal periarterial sympathectomy for the radial and ulnar arteries, with added digital sympathectomy in very severe cases. Primary endpoints were ulcer healing and improvement in pain scores assessed by Visual Analog Scale pain scoring system. Secondary endpoints included complications and amputation rates.

Results

This study recruited 17 patients between January 2019 and January 2020. The mean follow-up was 14.6 months. The mean age was 33.71 (±SD 13.14) years. 41% were males. 59% suffered from vasculitis, 35% of patients had dry gangrene, and 71% had ulcers. Periarterial radial and ulnar sympathectomy was performed for all cases, with digital sympathectomy for 12 fingers. We had 50% complete ulcer healing within 1 month ( p = 0.031), and 100% were completely healed at 6 months ( p < 0.001). Pain scores showed significant reductions at 1 ( p = 0.001) and 6 months ( p < 0.001) of follow-up.

Conclusion

Distal periarterial sympathectomy demonstrates high success rates in terms of pain relief and ulcer healing in severe digital ischemia.
Haemotropic Mycoplasma species in pet cats in Latvia: a study, phylogenetic analysis and clinical case report
Authors: Berzina Inese , Capligina Valentina , Namina Agne , Visocka Alina , Ranka Renate
Published: July 2021

Objectives

The aim of this study was to evaluate whether haemotropic Mycoplasma species are detected in pet cats in Latvia, to perform a phylogenetic analysis of the detected pathogens and to report a clinical case of feline infectious anaemia.

Methods

Peripheral blood samples (n = 125) from pet cats were submitted; 99 samples were adequate to test for the presence of Mycoplasma species DNA by nested PCR. A clinical case was added in the later stages of the study. Positive isolates were subjected to phylogenetic analysis.

Results

The prevalence of ‘ Candidatus Mycoplasma haemominutum’ was 15% (n = 15/99), that of Mycoplasma haemofelis was 5% (5/99) and that of ‘ Candidatus Mycoplasma turicensis’ was 2% (n = 2/99). Cases of coinfection included ‘ Candidatus M haemominutum’ + M haemofelis (4%; n = 4/99) and ‘ Candidatus M haemominutum’ + ‘ Candidatus M turicensis’ (1%; n = 1/99). This is the first published report of M haemofelis infection in the Baltic states. Two different ‘ Candidatus M turicensis’ isolates were discovered after phylogenetic analysis.

Conclusions and relevance

This report is the first of an autochthonous feline infectious anaemia case in the Baltic region. The prevalence of Mycoplasma species was similar to that in other northern European countries. Phylogenetic analysis revealed variability of the isolates; one of the ‘ Candidatus M turicensis’ genotypes was detected for the first time in Europe.
Young Generation’s Perceptions of Same-Sex Sexuality and Attitudes Toward Same-Sex Marriage in South Korea
Authors: Yang Sungeun
Published: July 2021

It is important to pay attention to the rights of lesbians and gay men within the global context of antidiscrimination. This study focused on the young generation’s perceptions of same-sex sexuality and their attitudes toward same-sex marriage with revisiting Korean Confucianism as a conceptual framework. A total of 110 college students residing in the Seoul metropolitan areas of South Korea participated in this study. The study used participant-generated imagery and face-to-face interviews for data collection. Data were examined using a hybrid approach of thematic analysis that relied on deductive and inductive coding. The results highlighted young Koreans’ conflicting perceptions of same-sex sexuality and ambivalent attitudes toward same-sex marriage. Young Koreans perceived lesbians and gay men as marginalized in spite of democratic transition and social movements in South Korea. They showed tolerance to same-sex sexuality under a human rights–based approach. At the same time, the results revealed that they still held on to traditional Korean Confucianism. There are young Koreans opposing same-sex marriage because of their rationale of Confucian heteronormativity, value of social order within collectivism, and belief of familism. The results suggest a reinterpretation of the young generation’s ambivalence regarding same-sex sexuality in the light of Confucian-family-oriented collectivism in South Korea.
Analyzing the State of Digital Information Warfare Between India and Pakistan on Twittersphere
Authors: Hussain Shabir , Shahzad Farrukh , Saud Adam
Published: July 2021

In this study, we analyze the state of information warfare on Twittersphere between India and Pakistan in the wake of Pulwama attack in Kashmir region and the subsequent surgical strikes by Indian forces inside Pakistan. We selected two leading Twitter hashtags on the conflict from the two countries each. A total of 20,000 tweets were manually analyzed. Contrary to the existing scholarship on digital information warfare, we found citizens from both countries produced most of the content. Among the citizens, those Twitter handles that showed affiliations with the heads of governments that we consider as trolls were the leading contributors. Moreover, the study found that contributors from the two countries mainly posted on their own hashtags and did not engage in counter-arguments with the contributors from other country. This resulted in overwhelming support for the two countries in their own assorted hashtags and outright criticism in the hashtags originating from the other country.
The Impacts of College Students’ Civic Responsibility on Civic Engagement via Online Technology: The Mediations of Civic Learning and Civic Expression
Authors: Hsu Pi-Chun , Chang I-Hsiung , Chen Ru-Si
Published: July 2021

This study focused on college students’ attitudes toward the relationship between online civic responsibility and online civic engagement and its impacts. It also investigated the mediating roles of online civic learning and online civic expression in this relationship. A survey was conducted in Taiwan, testing for indirect effects with mediated variables using a structural equation model. The study tested hypotheses about the mediations of online civic learning and online civic expression on this relationship between online civic responsibility and online civic engagement for college students. The results indicate that the mediators of online civic learning and online civic expression fully mediate the relationship between online civic responsibility and online civic engagement.
Title: IDENTIFYING THE AXILLARY NERVE DURING SHOULDER SURGERY: AN ANATOMIC STUDY USING ADVANCED IMAGING
Authors: Hachadorian Michael E. , Mitchell Brendon C. , Siow Matthew Y. , Wang Wilbur , Bastrom Tracey , Sullivan T. Barrett , Huang Brady K. , Edmonds Eric W. , Kent William T.
Published: July 2021

Background:

The axillary nerve (AXN) is one of the more commonly injured nerves during shoulder surgery. Prior anatomic studies of the AXN in adults were performed using cadaveric specimens with small sample sizes. Our research observes a larger cohort of magnetic resonance imaging (MRI) studies in order to gain a more representative sample of the course of the axillary nerve and aid surgeons intraoperatively.

Methods:

High-resolution 3T MRI studies performed at our institution from January 2010 to June 2019 were reviewed. Four blinded reviewers with musculoskeletal radiology or orthopaedic surgery training measured the distance of the AXN to the surgical neck of the humerus (SNH), the lateral tip of the acromion (LTA), and the inferior glenoid rim (IGR). Intra-class Correlation Coefficient (ICC) was calculated to assess reliability between reviewers. The nerve location was assessed relative to rotator cuff tear status.

Results:

A total of 257 shoulder MRIs were included. ICC was excellent at 0.80 for SNH, 0.90 for LTA and 0.94 for IGR. All intra-observer reliabilities were above 0.80. Mean distance from AXN to SNH was 1.7 cm (0.7-3.1 cm, IQR 1.38-2.00) and AXN to IGR was 1.6 cm (0.6-2.6 cm, IQR 1.33-1.88). The mean AXN to LTA distance was 7.1 cm, with a range of 5.2 to 9.0 cm across patient heights; there was a large effect size related to LTA to AXN distance and patient height with a correlation of r=0.603, (p<0.001). Rotator cuff pathology appears to affect nerve location by increasing the distance between AXN and SNH (p = 0.027).

Discussion/Conclusion:

The AXN is vulnerable to injury during both open and arthroscopic shoulder procedures. This injury can be either a result of direct trauma to the nerve or secondary to traction placed on the nerve with reconstructive procedures that distalize the humerus. Our study demonstrates that the axillary nerve can be found as little as 5.6 mm from IGR and 6.9 mm from the SNH. Additionally, we illustrate the relationship between patient height and LTA to AXN distance and complete rotator cuff tears and SNH to AXN distance. Our study is the first to demonstrate the nerve’s proximity to important surgical landmarks of the shoulder using a large sample size of high-resolution images in living human shoulders.

Tables/Figures:

[Figure: see text][Table: see text]
CHANGE IN KNEE SEPARATION DISTANCE IN ADOLESCENT ATHLETES AFTER A 6-WEEK NEUROMUSCULAR TRAINING PROGRAM
Authors: Gómez Jorge E. , Wilson P. Burke , Johnson Timothy
Published: July 2021

Background:

Existing neuromuscular injury prevention programs have relied principally on lower extremity strengthening, agility, cutting and landing technique to improve jump landing mechanics in order to prevent non-contact knee ligament injuries.

Purpose:

To determine whether a 6-week neuromuscular training program emphasizing core (back & hip) strengthening and dynamic balance exercises can significantly improve normalized knee separation distance (nKSD) during a standard counter-movement jump landing maneuver.

Methods:

Fourteen adolescent athletes (11 boys, 3 girls, ages 12-15) volunteered to undergo a 2 day/week, 6-week off-season training program. On the first day of training, the athletes underwent assessments that included 2 trials of a counter-movement jump from a 40cm platform. The tests were recorded using a video camera in the frontal plane. Using Dartfish motion analysis software, knee separation distance (KSD) was measured as the distance (cm) between the femoral condyles at the lowest point of the jump landing, and intertrochanteric distance (ITD) as the distance (cm) between the femoral trochanters. Normalized knee separation distance was computed as nKSD = KSD/ITD. The training program focused on three progressions; increasing difficulty of core strengthening exercises, balance exercises, and agility drills. One-hour training sessions were subdivided as follows; 5 min dynamic warm-up, 10 min stretching, 10 min body weight core exercises, 15 min balancing exercises, 10 min dumbbell core exercises, 15 minute agility drills, 5 min of rest/hydration breaks. The athletes repeated the counter-movement jump test at the end of the 6 weeks.

Results:

There was a significant improvement (t = 2.740, p = 0.017) in nKSD between post-test (0.789 + 0.372) and pre-test (0.683 + 0.323)

Conclusion:

A 6-week neuromuscular training program focused on core strengthening and balance significantly improved jump landing mechanics which may reduce the risk of knee ligament injury.
DIZZINESS, PSYCHOSOCIAL FUNCTION, AND GAIT ASSESSMENT FOLLOWING SPORT-RELATED CONCUSSION
Authors: Hunt *Danielle L. , Oldham Jessie , Aaron Stacey E. , Tan Can Ozan , Meehan William P. , Howell David R.
Published: July 2021

Background:

Dizziness after concussion can be detrimental to both the physical and psychosocial wellbeing of patients. Vestibular symptoms, in particular, can amplify postural instability, which may create a greater sense of mental and physical abnormality post-concussion.

Purpose:

To examine the three-way association between self-reported dizziness with concussion symptoms, depression and anxiety severity, and gait deficits within two weeks post-concussion. We hypothesized that participants who endorsed a moderate/severe level of dizziness would report a more severe concussion symptom burden, more severe depression and anxiety, and worse postural stability.

Methods:

For this cross-sectional study, participants ages 14-21, were recruited from either a regional sports concussion clinic or emergency department, and tested within 14 days of a diagnosed concussion. Participants completed the Dizziness Handicap Inventory (DHI), Post-Concussion Symptom Inventory (PSCI), and Hospital Anxiety and Depression Scale (HADS).They also completed an instrumented single/dual-task gait assessment (three trials per condition). The gait assessment included walking at a self-selected pace towards a target 8m ahead, then returning to the start line. Dual task trials included a cognitive task (months in reverse order, serial 7’s, and spelling a 5-letter word backwards) while walking. Descriptive statistics, independent t-tests, and Mann Whitney U tests were used to compare between those with moderate/severe dizziness (DHI score ≥36) and those with mild/no dizziness (DHI score <36), p<0.05.

Results:

40 participants completed the study. 19 self-reported moderate/severe dizziness (63% female, 17.1±2.4 years of age, average DHI score 48.4±12.6) and 21 mild/no dizziness (38% females, 16.5±1.9 years of age, average DHI score 18.7±9.3). Those with moderate/severe dizziness reported significantly more severe symptoms (PSCI: 43.0±20.6 vs. 22.8±15.7, p=0.001), and had higher median HADS anxiety (6 vs. 2, p<0.001) and depression (6 vs. 1, p=0.001) scores than those with no/minimal dizziness. During steady-state gait, the moderate/severe dizziness group walked with significantly lower single-task cadence (Figure 1B) and dual-task cadence (Figure 1E) than the no/mild dizziness group.

Conclusion:

Participants who self-reported a moderate to severe level of dizziness within 14 days of a concussion reported worse symptom severity, anxiety, and depression than those with no/mild dizziness. Further, cadence during gait is negatively affected by the level of dizziness reported. Clinicians should be aware of the psychosocial and physical effects dizziness symptoms may play in a patient’s recovery. Gait deficits in the moderate/severe dizziness group further indicate the importance of evaluating how the feeling of postural instability affects gait following concussion. Word Count: 389/400 [Figure: see text]
SURGICAL TREATMENT OF OSGOOD-SCHLATTER DISEASE IN ADOLESCENT ATHLETES
Authors: Mun Frederick , Hennrikus William L.
Published: July 2021

Background:

Osgood-Schlatter disease is an apophysitis of the tibial tubercle causing pain and difficulty kneeling. A majority of cases resolve spontaneously at skeletal maturity when the tibial tubercle apophysis fuses. Treatment is symptomatic when the physis is open. Adolescent athletes with closed physes and continued symptoms can benefit from surgery.

Purpose:

The purpose of this study is to report the outcomes of ossicle excision and tubercleplasty for unresolved Osgood-Schlatter disease that has failed conservative treatment.

Methods:

A retrospective review was performed on 6 athletes who underwent ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease. Data collected include age at onset of symptoms, age at surgery, gender, laterality, radiographic findings, sports played, time to return to sport, length of follow up, and complications. Surgery involved an open ossicle excision, tubercleplasty, and repair of the patella tendon to bone using a suture anchor. A longitudinal incision was made over the antero-lateral aspect of the patella tendon. The patella tendon was reflected medially to gain access to the ossicle and bump. A direct anterior incision was avoided to minimize post-operative pain with kneeling. Post-operatively, patients were allowed to fully weight bear in an extension knee brace for 4 weeks, and then allowed to gradually resume activity.

Results:

4 males and 2 females were studied. The right knee was involved in 3 cases and the left knee in 3. The average age at onset of symptoms was 15.8 (range 12-18). The average age at surgery was 17.3 (range 17-18). Radiographic findings included a large bump in 3 cases, an ossicle in 2 cases, and free fragments at the tendon insertion in 3 cases. Sports played included basketball, football, running, and dancing. All patients returned to sports at an average of 23.9 weeks post-surgery (range 5-56). The average length of follow up was 14.2 weeks (range 5-27). No patients reported post-operative pain with kneeling, limp, need for a cane, locking sensations, giving way sensations, pain, swelling, difficulty climbing stairs or difficulty squatting. No patients needed additional surgery.

Conclusion:

Surgical treatment of unresolved Osgood-Schlatter disease was successful in 100% of adolescent athletes in this series. For symptomatic patients after closure of the growth plate, we recommend removal of the ossicle and adjacent bursae, smoothing down the bump with a burr, and repairing the reflected patella tendon to bone using suture anchors. The outcomes were excellent in all patients with no complications.
Trends in Adolescent Hip Arthroscopy From the PHIS Database: 2008 to 2018
Authors: Hassan Mahad M. , Hussain Zaamin B. , Rahman Omar F. , Kocher Mininder S.
Published: July 2021

Background:

Previous studies have suggested that hip arthroscopy has been performed with increasing frequency. Few studies have examined this trend in the adolescent population.

Purpose:

The purpose of this study was to evaluate the trend in the frequency of hip arthroscopy in adolescents standardized by total orthopaedic surgeries in adolescents at pediatric hospitals in the United States.

Methods:

The Pediatric Health Information System (PHIS) database was queried for patients aged 10 to 19 years who underwent orthopaedic surgery at any of the PHIS-participating hospitals from 2008 to 2018. The subgroup of patients in this age cohort who underwent hip arthroscopy was identified using Current Procedural Terminology (CPT) procedure codes. The yearly rate was expressed as the number of hip arthroscopies per 1000 orthopaedic surgeries. A linear model was used to fit the data and illustrate the relative trend.

Results:

A total of 432309 orthopaedic surgeries including 9491 hip arthroscopies were performed for patients 10 to 19 years of age. Hip arthroscopies were performed at a yearly rate of 22 per 1000 orthopaedic surgeries. Over the 10-year period, the number of hip arthroscopies increased 6.2-fold, whereas the number of orthopaedic procedures increased 1.6-fold. There was a 3.9-fold increase in hip arthroscopies relative to total orthopaedic surgeries.

Conclusion:

The number of hip arthroscopic procedures in adolescent patients has increased by 3.9-fold times relative to total orthopaedic surgeries in adolescents over a 10-year span. This finding mirrors the trends in the adult population over similar time periods. This may be due to increasing participation in sports in the adolescent population as well as a better understanding of the diagnosis and treatment of femoroacetabular impingement and other sports-related hip pathologies. [Table: see text][Figure: see text]
ANTERIOR CRUCIATE LIGAMENT RECONSRUCTION IN CHILDREN: OUTCOMES OF QUADRICEPS VERSUS HAMSTRING AUTOGRAFTS
Authors: Bram Joshua T. , Gans Itai , Parisien Robert , Greenberg Elliot , Ganley Theodore J.
Published: July 2021

Background:

Emerging evidence has suggested reduced donor site pain and equivalent/improved functional outcomes in adults undergoing ACL reconstruction (ACLR) with quadriceps (QT) autograft versus hamstrings (HT) grafts. No studies in children comparing QT versus HT autografts have assessed postoperative strength or active range of motion (AROM) in addition to more commonly accepted patient-reported outcome measures (PROMs).

Hypothesis/Purpose:

The purpose of this study was to directly compare clinical and patient-reported outcomes of pediatric patients undergoing QT and HT autograft ACL reconstructions. We hypothesized that use of QT autografts would result in similar clinical and PROMs to HT autografts.

Methods:

A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary transphyseal ACLR from 1/2018-12/2019 without concomitant multiligamentous reconstruction was conducted. Outcomes at 3 and 6 months, including isokinetic strength testing, PROMIS and IKDC scores, and AROM were compared between patients receiving either HT or QT autografts. Hamstrings to quadriceps (H/Q) ratios were calculated using the ratio of the respective peak torque values normalized to body weight. Multiple imputation was utilized to minimize bias resulting from missed follow-up appointments.

Results:

84 patients met inclusion criteria (Table 1). The 40 patients receiving QT were more often male (62.5% vs 34.1%, p=0.009). There were no differences in operative time (p=0.053) or proportion of patients requiring meniscus repair (p=0.958). At 3 months postoperative, those with HT had lower H/Q ratios (62.2 ± 15.8 vs 78.6 ± 19.9, p<0.001) and limb symmetry index (LSI) in flexion (86.1 ± 17.1 vs 94.3 ± 17.6, p=0.042), while patients with QT had lower LSI in extension (66.8 ± 13.2 vs 77.3 ± 12.6, p=0.001). The H/Q ratio was also lower at 6 months among patients receiving HT (59.7 ± 11.2 vs 66.3 ± 8.2, p=0.004). IKDC, PROMIS physical function, and PROMIS pain interference scores were not different between cohorts at either 3 or 6 months. There was no difference in AROM in flexion or extension between groups at all postoperative visits. Patients with QT were more likely to have a postoperative wound issue (20.0% vs 2.3%, p=0.012).

Conclusion:

Significant differences in quadriceps and hamstrings strength at 3 months were observed for ACLR patients by graft type. This contributed to higher H/Q ratios at 3 and 6 months postoperatively for patients receiving QT. QT grafts appear to have a higher rate of postoperative infection/wound issues.

Tables/Figures:

[Table: see text]
Reliability of Two-Dimensional Video-Based Analysis in Adolescent Runners
Authors: Matsuzaki Yukiko , Heath Madison R. , Khan Julianne M. , Spitzer Elad , Fabricant Peter D.
Published: July 2021

Background:

Running analysis is an essential component of evaluation of both injured runners and uninjured runners seeking advice on injury prevention. Reliability of two-dimensional (2D) video analysis has been reported in the adult running population. However, these findings may not apply to youth runners given their unique state during growth and development. The reliability of quantitative and qualitative video-based running gait analysis in the adolescent population is unknown.

Purpose:

The purpose of this study was to determine the intra-rater and inter-rater reliability of sagittal and frontal plane kinematics using 2D video analysis in healthy adolescent runners.

Methods:

High-definition videos were recorded of 10 healthy runners between 14-18 years old running on a treadmill at self-selected speed with markers attached to the thoracic spine, pelvis, and lower extremities. Kinematic variables in the sagittal and frontal planes were measured using Dartfish Motion Analysis Software™ (Fribourg, Switzerland) by three raters. Intra- and inter-rater reliability were calculated using Intraclass Correlation Coefficients (ICCs).

Results:

Of the 10 runners, 4 (40%) were male and the mean age was 16 ± 1.5 years. The intra-rater ICC for all kinematic variables ranged from 0.574 to 0.999 for the primary sports physical therapist, and 0.367 to 0.973 for the inexperienced research assistant. The inter-rater ICC for all raters ranged from -0.01 to 0.941. Eleven kinematic variables showed substantial agreement and 4 showed almost perfect agreement. Step width and foot progression showed fair and poor agreement, respectively.

Conclusion:

The results of this study demonstrate that a 2D video-based running analysis can be reliably performed in an adolescent population on all kinematic variables except for step width and foot progression. Inexperienced raters can be properly trained in the video analysis of running kinematics using Dartfish Software in order to consistently assess the same runner.

[Table: see text][Table: see text]
ATHLETE IDENTITY AND COMMON BENEFITS AND BARRIERS TO SPORT PARTICIPATION AMONGST ADOLESCENT SLED HOCKEY PLAYERS
Authors: Napolitano Jonathan , Iliescu Daniela , Hoehn Jessica , Berner Theresa , Meyer Carlie , Jackson Kristen , Kemp Erika
Published: July 2021

:

The physical, psychological, and social benefits of sports participation in adolescents have been well reported in the able-bodied population. However, those with physical disabilities encounter many barriers to participating in sports, which limits access to these benefits. Additionally, due to their disabilities, these individuals are often not viewed as athletes by the general population and therefore may not identify as one themselves.

:

Our study seeks to use qualitative research techniques to identify the themes influencing adolescents’ participation in sled hockey and determine their identity as athletes.

:

Cross-sectional qualitative interview. Our IRB approved study recruited athletes at sled hockey practices and tournaments where interviews were moderated and transcribed. Transcriptions were coded according to common themes mapped in Figure 1.

:

We surveyed 19 youth sled hockey players (range 10-24 years old, mean 15.3) with multiple physical disabilities, the most common diagnosis being spina bifida (14) (Table 1). Our qualitative analysis identified the most prevalent themes that influence participation in adaptive sports to be: social factors, intrapersonal factors, motivators to start sport, access, physical and mental health, and athletic identity (Figure 1). Initial motivators to start involvement included encouragement from parents, role models, adapted sports organizations, healthcare providers or personal interest in the sport itself. Despite the perceived medical and financial barriers, support from teammates and funding assistance in purchasing equipment facilitated continued involvement. Our population also reported many perceived benefits to continued participation in adaptive sports, each reporting “having fun” while playing a sport they “love”. Other benefits were connecting with friends of similar disabilities and capabilities, who encourage them, serve as role models, and make them feel included. Furthermore, the mentorship the coaches provide, pushing the athletes to achieve, creates an atmosphere of competitiveness and a feeling of physical and mental wellbeing. Ultimately, this competitive environment allows for formation of an athletic identity, reported by 18 out of the 19 interviewees.

:

Despite encountering barriers to participating in a team sport that requires expensive equipment and travel and negotiating the limitations of physical disabilities requiring frequent medical procedures and time away from sport, the overpowering benefits of participation allow majority of our adolescent population to thrive and to identify as athletes. Among the main facilitators to continued involvement are mentorship and support from coaches and parents, comradery and competition, all which lead to physical and mental wellbeing and feeling of inclusiveness and accomplishment.

[Figure: see text][Table: see text]
A PILOT STUDY EVALUATING THE TIMINGOF VESTIBULAR THERAPY AFTER SPORT-RELATED CONCUSSION: EARLIER IS BETTER
Authors: Ahluwalia Ranbir , Miller Scott , Dawoud Fakhry M. , Malave Jose O. , Tyson Heidi , Bonfield Christopher M. , Yengo-kahn Aaron M.
Published: July 2021

Background:

Vestibular dysfunction, characterized by nausea, dizziness, imbalance and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physiotherapy is important to promote recovery; however, the benefit of earlier therapy is unclear.

Purpose:

To determine if earlier vestibular therapy for young athletes with sport-related concussion is associated with earlier return-to-play (RTP), return-to-learn (RTL), and symptom resolution.

Study Design:

Retrospective Cohort Study

Methods:

Patients ages 5-23 with sport-related concussion who initiated vestibular therapy from 1/2019-12/2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤ 30 days post-injury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots and multivariate Cox proportional hazard modeling were performed.

Results:

Overall, 23 patients were included (10 early,13 late) aged 16.14±2.98 years and 43.5% male. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110[61.3,150.8] vs. 31[22.5, 74.5], 95% CI-115.0—8.0, p=0.028), but not to RTL (12[3.5,26.5] vs. 17.5[8,20.75], 95%CI -11.0-12.0, p=0.085. Most notably, the late therapy group required more time to achieve symptom resolution (121.5 days [71,222.8] vs. 54 days [27,91] 95%CI -150.0-9.0, p=0.018). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution (HR 0.988, 95%CI 0.98-0.99, p=0.008).

Conclusion:

This pilot study evaluating vestibular therapy timing suggests that initiating VRT within the first 30 days following SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT to resolve post-concussion syndrome should be pursued.

Tables/Figures:

[Figure: see text]
45° FLEXION ANTEROPOSTERIOR ELBOW RADIOGRAPHS IMPROVE DIAGNOSTIC ACCURACY OF CAPITELLUM OSTEOCHONDRITIS DISSECANS
Authors: Saper Michael , Burton Monique , Menashe Sarah , Nagle Kyle , Schmale Gregory , Bompadre Viviana , Thapa Mahesh
Published: July 2021

Background:

The initial diagnosis of capitellum osteochondritis dissecans (OCD) is typically confirmed using standard anteroposterior (AP) and lateral elbow radiographs, despite low sensitivity, which is approximately 44-47%. An AP image of the elbow in 45° of flexion has been suggested to increase diagnostic accuracy.

Purpose:

To assess the diagnostic performance, inter- and intra-observer reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP) in pediatric and adolescent patients.

Methods:

This was a retrospective study including pediatric and adolescent patients with capitellum OCD and a healthy control group. Independent clinicians were blinded to the official radiologists’ reports and reviewed images on a picture archiving and communication system on two separate occasions 1 week apart. A 5-point Likert scale was used to assess the clinicians’ level of confidence (1-not at all confident; 5-very confident). Inter- and intraobserver reliability was determined using kappa statistics.

Results:

The study included 28 elbows (24 patients) with a mean age of 12.5 ± 2.0 years. 64.3% were female. There were no differences in age ( P = 0.18), sex ( P = 0.62), or laterality ( P = 1.0) between the two groups. There were marked variations in the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each of the following views: AP: Sensitivity 85.1; Specificity 89.3; PPV 88.8; NPV 85.7; accuracy 87.2. Lateral: Sensitivity 73.2; Specificity 91.7; PPV 89.8; NPV 77.4; accuracy 82.4. 45° flexion AP: Sensitivity 91.7; Specificity 91.1; PPV 91.1; NPV 91.6; accuracy 91.4. Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the three combined views was 100%. Confidence levels in the clinicians’ diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (k=0.65 and k=0.60, respectively) but highest for the 45° flexion AP radiographs (k=0.72). Intraobserver reliability for all views was moderate to perfect (k=0.52 to 0.93).

Conclusion:

The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, capitellum OCD can be diagnosed in 100% of cases.
Comparison of Y-Balance Test Performance by maturation status in youth distance runners
Authors: Rauh Mitchell J. , Garcia Micah C. , Bazett-Jones David M. , Long Jason T. , Ford Kevin R. , Paterno Mark V. , Taylor-Haas Jeffery A.
Published: July 2021

Background:

Distance running is a popular interscholastic sport, but also has an associated high risk of running-related injuries. Recent literature suggests that functional tests may help to identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength and balance and to expose asymmetries between tested limbs.

Purpose:

To determine if YBT performance was associated with maturation status in healthy, youth distance runners. We hypothesized that mid-pubertal (MP) runners would demonstrate less functional reach distance than pre-pubertal (PrP) or post-pubertal (PoP) runners.

Methods:

A convenience sample of 142 (Females: n=79, Males: n=63) uninjured youth runners (ages 13.5±2.7 years; weekly running distance: 18.2±20.4 km) were recruited from the local community. All runners met inclusion criteria, indicating that they were between 9 and 19 years old and participated in long-distance running activities such as school/club track and field, cross country, road races, trail running, and/or soccer. The runners completed a modified Pubertal Maturational Observation Scale (PMOS), then were screened for right (R) and left (L) anterior (ANT), posteromedial (PM) and posterolateral (PL) reach distances (cm) normalized by lower limb length (cm). Composite reach distance was calculated by the sum of the three reach distances divided by three times the limb length multiplied by 100 for R and L limbs. ANOVA with Bonferroni post hoc tests were used to compare maximum normalized reach distances for the three directions and composite reach distance by maturation status and sex.

Results:

Overall, 31.7% were classified as PrP status, 26.1% as MP, and 42.3% as PoP, with similar percentages by sex ( p=0.84). The only significant mean difference was found for R ANT maximum normalized reach distance between PrP and PoP ( p=0.02), indicating a greater normalized reach in PrP athletes. No significant mean differences were found for R or L PM and PL maximum normalized reach distances, or for R or L composite reach distances, by maturation status or when stratified by maturation and sex ( p>0.05).

Conclusions:

In this sample of youth runners, the YBT was only a discriminator of anterior reach distance between pre-pubertal and post-pubertal runners. As decreased anterior reach is associated with reduced quadriceps muscle strength and anterior knee pain, reduced anterior reach in post-pubertal runners may potentially signify an increased risk of sustaining a running-related injury. Thus, preventive efforts to ensure good functional quadriceps muscle strength may be merited.
SEX, PATELLAR TENDON GRAFT, AND EARLY MOTION DEFICITS PREDICT ARTHROFIBROSIS AFTER PEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Ouweleen Abraham J. , Hall Tyler B. , Finlayson Craig J. , Patel Neeraj M.
Published: July 2021

Background:

Arthrofibrosis remains a concerning early complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Previous studies suggest that those receiving patellar tendon (PT) autograft may be at higher risk than hamstrings tendon (HT), but there is little data regarding this complication in patients receiving quadriceps tendon (QT) autograft.

Purpose:

The purpose of this study is to identify risk factors for arthrofibrosis following pediatric ACLR with attention to graft type.

Methods:

The medical records of patients that underwent primary ACLR at a single tertiary children’s hospital were reviewed for this retrospective cohort study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, or a modified MacIntosh reconstruction were excluded. Arthrofibrosis was defined as a deficit of 10 degrees of extension and/or 20 degrees of flexion at 3 months after ACLR. Demographic data, intra-operative findings and techniques, and post-operative motion and complications were recorded. Univariate analysis was followed by purposeful entry logistic regression to control for confounding factors.

Results:

A total of 378 patients were included in the analysis, of which there were 180 PT, 103 HT, and 95 QT grafts. The mean age was 15.9±1.7 years and 188 (49.7%) were female. In univariate analysis, the rate of arthrofibrosis was 1.9% for HT, 6.3% for QT, and 10.0% for PT (p=0.04). Females developed arthrofibrosis more frequently than males (10.6% vs. 3.2%, p=0.004). Additionally, those that ultimately experienced this complication had lower median flexion at 6 weeks after ACLR (88 vs. 110 degrees, p<0.001). After controlling for covariates in a multivariate model, PT graft raised the odds of arthrofibrosis 6.2 times compared to HT (95% CI 1.4-27.6, p=0.02), but there were no significant differences between QT and other graft types. Females were at 4.2 times higher odds than males (95% CI 1.6-10.8; p=0.003). Patients that were unable to attain 90 degrees of flexion 6 weeks after ACLR had 14.7 times higher odds of eventually developing arthrofibrosis (95% CI 5.4-39.8; p<0.001). Finally, those with an extension deficit of ≥5 degrees 6 weeks after ACLR had 4.7 times higher odds of experiencing this complication (95% CI 1.8-12.2, p=0.001).

Conclusion:

After adjusting for multiple covariates, PT autograft, female sex, and motion deficits at 6 weeks after ACLR (<90 degrees of flexion or extension deficit ≥5 degrees) were predictive of arthrofibrosis in children and adolescents. Quadriceps tendon autograft did not increase the risk of this complication.
SLIPPED CAPITAL FEMORAL EPIPHYSIS ACETABULAR ORIENTATION AND SHAPE: A THREE-DIMENSIONAL CT STUDY
Authors: Paez Conner , Bomar James D. , Farnsworth Christine , Bandaralage Harsha , Upasani Vidyadhar
Published: July 2021

Background:

Previous studies have analyzed the acetabulum in patients affected by slipped capital femoral epiphysis (SCFE), however controversy remains over how the acetabular shape may be altered in hips experiencing SCFE. In particular, changes in acetabular over-coverage and acetabular version are thought to contribute to SCFE.

Hypothesis/Purpose:

The purpose of this study was to determine the acetabular morphology in hips with SCFE and compare them to normally developing children.

Methods:

Images from patients with the diagnosis of SCFE who had a computed tomography (CT) exam of their pelvis were compared to images from an age- and sex-matched cohort of patients with CT exams of the pelvis/abdomen for a non-orthopedic related evaluation (controls). Three dimensional (3D) reconstructions were created from each CT exam (MIMICs software). Custom MATLAB software was used to uniformly align and calculate acetabular parameters from the 3D reconstructions. The acetabular parameters calculated were articular surface area, acetabular tilt, acetabular version, and acetabular coverage angles measured in a radial fashion in 5 out of 8 octants.

Results:

Two-hundred-ninety-eight hips were evaluated, including 67 hips with SCFE, 39 unaffected contralateral hips in patients with SCFE, and 192 normal controls. The SCFE group consisted of 33 males and 34 females. Acetabular version was similar amongst all SCFE affected hips, unaffected contralateral hips, and normal controls (p=0.575). Control hips had higher acetabular tilt than SCFE affected hips (p=0.001) and unaffected contralateral hips (p=0.012). Acetabular surface area was higher in SCFE affected hips compared to controls (p=0.003)(Table 1). SCFE affected hips had significantly increased acetabular coverage compared to controls in the superior, superior-anterior, and anterior octants (p<0.01). The unaffected contralateral sides had significantly increased acetabular coverage compared to controls in all five regions (p<0.02)(Table 2).

Conclusions:

Contrary to some previous studies, we did not find the acetabulum to be retroverted in hips with SCFE compared to normal hips. Both the affected and unaffected hips of SCFE patients have decreased acetabular tilt. Acetabular surface area is high in both the affected and unaffected sides in SCFE, suggesting it may be involved in the pathogenesis of the condition. There is increased acetabular coverage in the superior regions of SCFE hips. The shared morphological characteristics of both affected and unaffected sides in SCFE patients suggest that their hip anatomy may predispose them to slips.

[Table: see text][Table: see text]