bluuebunny/crossref_metadata_2025 huggingface dataset:
A branching algorithm to reduce computational time of batch models: Application for blast analyses
Authors: Dennis Adam A , Smyl Danny J , Stirling Chris G , Rigby Samuel E
Published: May 2022

Numerical analysis is increasingly used for batch modelling runs, with each individual model possessing a unique combination of input parameters sampled from a range of potential values. Whilst such an approach can help to develop a comprehensive understanding of the inherent unpredictability and variability of explosive events, or populate training/validation data sets for machine learning approaches, the associated computational expense is relatively high. Furthermore, any given model may share a number of common solution steps with other models in the batch, and simulating all models from birth to termination may result in large amounts of repetition. This paper presents a new branching algorithm that ensures calculation steps are only computed once by identifying when the parameter fields of each model in the batch becomes unique. This enables informed data mapping to take place, leading to a reduction in the required computation time. The branching algorithm is explained using a conceptual walk-through for a batch of 9 models, featuring a blast load acting on a structural panel in 2D. By eliminating repeat steps, approximately 50% of the run time can be saved. This is followed by the development and use of the algorithm in 3D for a practical application involving 20 complex containment structure models. In this instance, a ∼20% reduction in computational costs is achieved.
Modeling the blood-brain barrier for treatment of central nervous system (CNS) diseases
Authors: Rice Olivia , Surian Allison , Chen Yupeng
Published: May 2022

The blood-brain barrier (BBB) is the most specialized biological barrier in the body. This configuration of specialized cells protects the brain from invasion of molecules and particles through formation of tight junctions. To learn more about transport to the brain, in vitro modeling of the BBB is continuously advanced. The types of models and cells selected vary with the goal of each individual study, but the same validation methods, quantification of tight junctions, and permeability assays are often used. With Transwells and microfluidic devices, more information regarding formation of the BBB has been observed. Disease models have been developed to examine the effects on BBB integrity. The goal of modeling is not only to understand normal BBB physiology, but also to create treatments for diseases. This review will highlight several recent studies to show the diversity in model selection and the many applications of BBB models in in vitro research.
Improving management and antimicrobial stewardship for bacterial and fungal infections in hospitalized patients with COVID-19
Authors: Peghin Maddalena , Vena Antonio , Graziano Elena , Giacobbe Daniele Roberto , Tascini Carlo , Bassetti Matteo
Published: May 2022

SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection is being one of the most significant challenges of health care systems worldwide. Bacterial and fungal infections in hospitalized patients with coronavirus disease 2019 (COVID-19) are uncommon but consumption of antibiotics and antifungals has increased dramatically during the ongoing pandemic resulting in increased selective pressure for global antimicrobial resistance. Nosocomial bacterial superinfections appear to be more frequent than community-acquired coinfections, particularly among patients admitted to the intensive care unit (ICU) and those receiving immunosuppressive treatment. Fungal infections associated with COVID-19 might be missed or misdiagnosed. Existing and new antimicrobial stewardship (AMS) programmes can be utilized directly in COVID-19 pandemic and are urgently needed to contain the high rates of misdiagnosis and antimicrobial prescription. The aim of this review is to describe the role of bacterial and fungal infections and possible strategies of AMS to use in daily practice for optimal management of COVID-19.
Series of isolated sphenoid disease: Often neglected but perilous
Authors: Yap Hui Jean , Ramli Ramiza Ramza , Yeoh Zhi Xiang , Sachlin Ida Sadja’ah
Published: May 2022

Isolated sphenoid sinus disease (ISSD) is an uncommon entity and may present with non-specific symptoms. As sphenoid sinus is located adjacent to vital structures, a diseased sphenoid sinus can potentially lead to devastating complications such as cranial neuropathies, cavernous sinus thrombosis and intracranial abscess. Herein, we report a case series of three patients who presented with different localization of headache as their main symptom. Endoscopic nasal assessment showed abnormal nasal cavity findings with mucosal thickening and soft tissue mass occupying the sphenoid sinus revealed by computed tomography (CT) scan. All the sphenoid sinuses were drained via endoscopic approach. Post operatively, antibiotics or anti-fungal were given, however, these three cases displayed the possible variation in severity of this disease. Case 1 had an uncomplicated inflammatory disease of the sphenoid sinus, which is of bacterial origin, while the other two cases had fungal infection. Case 2 achieved disease stability with anti-fungal treatment, but Case 3 had a serious complication after treatment with permanent vision loss. A patient who presents with atypical headache, not responsive to analgesia should be investigated promptly with nasal endoscopic examination and radiological imaging for isolated sphenoid sinus disease to avoid devastating complications.
Integrating ecumenism and interreligious dialogue in peace education in the Philippines from a Catholic perspective
Authors: Gozum Ivan Efreaim A , Galang Joseph Renus F , Sarmiento Philip Joseph D
Published: May 2022

This study presents the importance of promoting interreligious dialogue and ecumenism in teaching peace education. It also discusses the applicability of selected papal documents for implementation in current interreligious education in Catholic and government schools in the Philippines. We explain the importance of interreligious dialogue and ecumenism from the Catholic Church documents Ut Unum Sint and Nostra Aetate. Then, we show the need for interreligious dialogue and ecumenism in achieving peace in this time when religion is misconstrued. Conclusions are given to lay out the need for interreligious dialogue and ecumenism to be integrated in peace education.
A (Geo-)Narrative Analysis of Children’s Perceptions of Wellbeing in Relation to Nature as the Basis for Educational Intervention Planning
Authors: González-Tapia Grimanessa , Lazzaro-Salazar Mariana , Mundaca Enrique A.
Published: May 2022

Scholarly endeavors in psychology, environmental, and geographies of health research have shown that the exposure to natural spaces influences children’s wellbeing. However, little is known regarding the experiences that influence children’s feelings of wellbeing for those who live in natural environments. This study investigates the perceptions of nature and wellbeing of 10 children living next to the Altos de Lircay Reserve (Chile). A geo-narrative analysis of the interviews shows that participants living closest to the reserve relate nature to their physical wellbeing, while those living further away often relate it to their psychological wellbeing. Recommendations to plan interventions that improve the children-nature connection are provided.
Morphologic Risk Factor for ACL Rupture in Children Younger than Age 12: An Mri-Based Comparison
Authors: Fogleman Sarah A. , Carroll Alyssa N. , Edmonds Eric W.
Published: May 2022

Background:

There are findings in the adult and adolescent literature regarding anatomic variation that may lead to traumatic disruption of the anterior cruciate ligament (ACL). Previous studies have found an interaction between age and various morphologic risk factors but have been underpowered in assessing younger pediatric patients.

Hypothesis/Purpose:

The purpose of this study was to evaluate morphologic features of the knee in younger children to determine if any of these factors may contribute to risk of ACL injury in this age group.

Methods:

A retrospective review of knee MRIs was performed on pediatric patients evaluated at our facility for confirmed ACL rupture. Seven measures were performed and three ratios were calculated, which were compared to an age-matched control cohort previously used to establish and publish normative data of childhood knee MRIs. They were then grouped for statistical purposes by age: “child” aged 5 – 11 years, and “adolescents” aged 12 – 19 years. A generalized linear model was used to assess interaction between age and ACL status.

Results:

A total of 49 children age <12 years with ACL rupture were identified during the data collection period that met criteria for review. While intercondylar width and notch height index (NHI) were significant in the ACL-torn cohort at large (p=0.015 and p=0.001 respectively), this difference was not present in children. Conversely, tibial plateau to anterior tibial spine (ATS) height was different in ACL-torn children but not in adolescents (p=0.003). Notch Width Index (NWI) was significantly smaller in ACL torn children and adolescents (p<0.0001). When comparing age groups, NWI was the only variable that had minimal to no difference in the normal group, but a significant difference between children and adolescents in the ACL-torn group. No difference was found in Critical Notch Stenosis.

Conclusion:

Children and adolescents demonstrate the effect of multiple morphologic parameters on ACL tear risk. While there is overlap, there are risk factors specific to each age group. Uniquely, increased TP to ATS height was a risk factor for ACL tear in children. Despite the effect of age and ACL tear on NWI, there was no difference for Critical Notch Stenosis, suggesting that the current definition of critical notch stenosis should be adjusted. Given the difference between NWI in children and adolescents with ACL tear, it may be more appropriate to have age-based cutoffs for critical notch stenosis.
Factors Associated with Stiffness Following Pediatric and Adolescent ACL Reconstruction: Early Results from Score: A Multi-Center Quality Improvement Registry
Authors: Cooper Savannah , Adsit Lizzie R. , Schmitz Matthew , Ganley Theodore , Ellington Matthew , Rhodes Jason , Frank Jeremy , Mansour Alfred , Saper Michael , Parikh Shital , Mayer Stephanie , Wilson Philip , Shea Kevin , Ellis Henry B. ,   the SCORE group
Published: May 2022

Background:

Anterior Cruciate Ligament reconstruction (ACLr) is commonly performed in pediatric and adolescent patients. The most common early complication associated with ACLr is stiffness, including motion loss and arthrofibrosis. There is minimal literature regarding risk factors for stiffness following ACLr in this age group.

Hypothesis/Purpose:

To evaluate the incidence and risk factors associated with stiffness following ACLr using a multi-center quality improvement registry.

Methods:

A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of ACLr was reviewed. Audit processes using CPT codes were designed to insure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Stiffness was defined as motion loss that prompted any deviation from the normal post-operative course (Clavien Dindo grade II or greater), including additional clinical or physical therapy (PT) visits, serial/dynamic splinting, or secondary surgery for stiffness (Clavien Dindo grade III). Each case of stiffness and associated complication form was secondarily reviewed to insure consistency of identification and grading. Demographic and peri-operative data were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons.

Results:

2,839 ACLr cases (mean age 15.1, 6-19; female 46.9%) were identified, with stiffness reported in 4.2% of patients (including isolated flexion or extension and combined stiffness) and secondary surgery for stiffness (manipulation under anesthesia and/or lysis of adhesions) performed in 1.1% of patients. Loss of extension occurred in 3.8% of patients (59.3% females), while loss of flexion occurred in 3.1% of patients (49.4% females). Overall stiffness occurred with longer tourniquet times (93.0 min vs. 78.8 min, p<0.001) when used. Anterior displacement of medial or lateral meniscus tear were associated with nearly twice the incidence of extension loss (7.1%) and three times the incidence of surgery for stiffness (3.7%).

Conclusion:

Post-operative stiffness following ACLr is rare but may be associated with certain demographic and perioperative factors, such as female sex, prolonged tourniquet time, and certain concomitant injuries such as anteriorly displaced meniscus tears. The degree to which altered practices and/or additional monitoring/vigilance in the setting of such factors warrants additional study.
Biomechanical Analysis of Tibial Motion and ACL Graft Forces After ACLR with and without let at Varying Tibial Slopes
Authors: Pearce Stephanie S. , Bryniarski Anna R. , Gruskay Jordan A. , Brady Alex , Brown Justin R. , Vidal Armando F. , Godin Jonathan A.
Published: May 2022

Background:

Lateral extra-articular tenodesis (LET) is being performed with increasing frequency in the setting of anterior cruciate ligament reconstruction (ACLR) as a way to decrease rotational instability and graft failure rates, especially in young, active patients. The degree of posterior tibial slope has been shown to affect ACL graft failure rates.1 The effect of LET plus ACLRs on tibial motion and graft forces in the setting of varying tibial slopes has not been elucidated.

Hypothesis/Purpose:

LET will decrease tibial translation, tibial rotation, and ACL graft forces compared to ACLR alone with increasing tibial slope throughout knee range of motion.

Methods:

Twelve cadaveric knees (40.5 mean age, all female) were tested in 4 conditions (1: intact; 2: ACLR; 3: ACLR + LET; and 4: ACL cut) with varying posterior tibial slopes (5°, 10°, 15°, and 20°) at three flexion angles (0°, 30, ° and 60°). Specimens were mounted to a load frame which applied a 500-N axial load with 1 N-M of internal rotation torque (Figure 1). The amount of tibial translation was measured using a laser sensor and rotation was measured along the axis of the load frame. ACL graft forces were measured via a force transducer.

Results:

No clinically relevant difference was found in graft force (all differences <6.8 N, except the 5° posterior tibial slope at 30° of flexion showing a 12.1 N reduction with LET), anterior tibial translation (all differences <2.4 mm), or internal rotation (all differences < 1.59°). Compared to the intact state, the cut ACL state had higher anterior tibial translation (maximum increase +9.1 mm at slope 20°, Flexion 60°) and internal rotation (maximum increase +4.3° at slope 5°, flexion 30°). Higher ACL graft forces were observed with increasing posterior tibial slope (ACLR graft force at 0° of flexion was 81.6 N at 5°, 97.8 N at 10°, 107.0 N at 15°, 113.9 N at 20° of slope). Figure 2 shows ACL graft forces in N, Figure 3 shows anterior tibial translation in mm and Figure 4 shows internal rotation in degrees. All figures present data at 30°of flexion.

Conclusion:

No clinically relevant difference was shown with the addition of LET in the setting of ACLR for patients with posterior tibial slopes from 5° to 20° at flexion angles of 0°, 30°, and 60° in regards to graft force, anterior tibial translation, and internal tibial rotation under a 500 N compressive load. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

Reference:

1. Bernhardson AS, Aman ZS, Dornan GJ, et al. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019;47(2):296-302. doi:10.1177/0363546518820302
Sagittal Plane Mobility in Adolsents with Femoroacetabular Impingment
Authors: Johnson Benjamin L. , Cooper Savannah , Wilson Philip L. , Morris William , Ellis Henry B.
Published: May 2022

Background:

Femoroacetabular impingement (FAI) is a dynamic degradative condition of the hip joint characterized by classic physical exam findings in combination with abnormal radiographs and/or MRI. Although this abnormal morphologic relationship contributes to FAI, the role of physical therapy to mitigate symptoms by improving strength and mobility of the hip remains the first line treatment. Despite this common treatment algorithm, limited knowledge exists on the effects of sagittal balance, lumbopelvic mobility, and its role in the development of treatment for symptomatic FAI.

Hypothesis/Purpose:

To review lumbopelvic mobility from standing to sitting position in adolescent athletes who present with clinical signs of FAI.

Methods:

Pelvic radiographic measurements in the sagittal plane were performed on a retrospective series of consecutive patients who presented with clinical diagnosis of FAI at a pediatric sports medicine institution from April 2019-March 2021. Standardized EOS dynamic lateral pelvic images were performed in standing and sitting positions to evaluate the differences in sacral slope, pelvic tilt, and pelvic incidence. Data from bi-positional radiographs were combined with standard measurements for FAI obtained on AP pelvis (lateral center edge angle, acetabular inclination) and 45 degree Dunn views (alpha angle), and patient reported outcomes (PROs) (mHHS, HOOS, UCLA). Differences in sacral slope from pre-treatment radiographs were used to determine comparison groups: those with a change vs. those with limited change between a sitting and standing position.

Results:

76 adolescent patients (mean age 15.7 years [12-24]; 71.5% females) with sitting/standing lateral pelvis radiographs and a clinical diagnosis of FAI were identified. Between sitting and standing positions, there was no change in pelvic incidence, while significant differences were noted in sacral slopes and pelvic tilt (Table 1). Variability in sacral slope differences between sitting and standing were identified with 10 (13.9%) patients having minimal (<10o) change, while 8 (11.1%) demonstrated changes > 40o (Figure 1). Adolescent patients with FAI who demonstrated more mobility from sitting to standing position had a higher sacral slope in the standing position. No correlations were noted between pelvic incidence or sacral slope and radiographic measures associated with FAI, PROs or differences in those with variable changes in sacral slope from sitting to standing position.

Conclusion:

Lateral pelvic imaging may be an important tool for understanding dynamic hip impingement. In adolescent patients signs and symptoms with clinical FAI, significant variability exists in lumbopelvic mechanics, regardless of the severity of radiographic values. [Table: see text][Figure: see text]
The Efficacy of a Mental Skills Training Course for Collegiate Athletes
Authors: Griffith Kelsey L. , O’Brien Kimberly H.M. , McGurty Shannon , Miller Patricia E. , Hutchinson Lauren E. , Christino Melissa A.
Published: May 2022

Background:

Psychological skills training has been shown to improve performance in athletes. However, few studies have looked at the efficacy of mental skills training programs in young athletes.

Hypothesis/Purpose:

The purpose of this study was to evaluate satisfaction of collegiate athletes with a 6-session mental skills course, and to assess changes in mental toughness and coping skills before and after the course.

Methods:

We conducted a 6-session mental skills training program with Division I female collegiate athletes during the fall of 2020. Athletes completed pre-course, post-course, and 4-month questionnaires to assess efficacy of the course, as well as their satisfaction. Due to the COVID-19 pandemic, none of the athletes were actively competing at the time of the course or during follow-up surveys. Demographic information was collected and the Athletic Coping Skills Inventory (ACSI, range=0-84) and Mental Toughness Inventory (MTI, range=8-56) were used to assess coping skills and mental toughness at all time points. Satisfaction was assessed on a ten-point scale, with 10 being most satisfied.

Results:

Fifty-four Division I female athletes participated in the program. Mean age was 19.8 years, 61% reported training in their sport for 8 or more months a year, 26% reported history of mental health conditions, and 22% reported being injured or recovering from injury at the time of participation. For participants with paired pre- and post-course data (n=37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI=1.1-4.1; p=0.001) and ASCI scores improved by a mean 4.0 points (95% CI=0.6-7.4; p=0.02) from pre- to post-course. For participants with paired data for pre-course and four-month follow-up (n=25, 46.2%), no change was detected in mean MTI score (p=0.72). There was, however, a mean increase of 3.4 points in mean ASCI from pre-course to four-month follow-up (95% CI=0.4-6.4; p=0.03). Overall satisfaction had a median score of 9/10 at the post-course assessment, and eighteen participants (18/37, 48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported.

Conclusion:

Following a 6-session mental skills course in collegiate female athletes, mental toughness and coping skills scores significantly improved at post-course assessment. Athletes reported being highly satisfied with the content of the course and reported overall positive experiences. [Figure: see text]
Inter & Intra Tester Reliability of Motion Capture of Six Sports Task used for Return-to-Sport Testing
Authors: Chafetz Ross S , Warshauer Spencer , Ulman Sophia , Tulchin-Francis Kirsten , Paula Tatiana N ,   Shriners Sport Consortium, Franklin Corinna
Published: May 2022

Background:

Motion capture has become increasingly recognized as an important evaluation tool for guiding rehabilitation planning and in determining when it is safe to return to sport. To ensure motion capture utility in sports evaluations, it is important to establish training protocols across test centers.

Hypothesis/Purpose:

The purpose of this study was to evaluate the inter and intra tester reliability of return-to-sport testing using motion capture at three different motion analysis centers.

Methods:

A single tester and athlete traveled to three different motion analysis centers. On the first day, the first tester demonstrated marker placement and the execution of the six sports related tasks. The second tester completed the same protocol the same afternoon. On the following day, both testers repeated the process on the same athlete. The six tasks included the drop vertical jump (DVJ), deceleration, heel touch, lateral shuffle, 45° cut, and single leg hop. Kinematic data included trunk flexion/lean, pelvic obliquity, hip flexion/rotation/adduction, and knee valgus/flexion. Additionally, kinetics were analyzed for knee valgus moments. For each testing day, the mean, median, standard deviation, and range were calculated. To compare between days, differences between means and paired t-tests were calculated ( α=0.05).

Results:

Looking at inter tester reliability kinematics and kinetics, of the 48 calculated mean differences only two variables were statistically significant – DVJ moment (mean difference 0.22 Nm/kg, p=0.008) and lateral shuffle trunk flexion (mean difference 4.8 degrees, p=0.004). Looking at only the kinematic data, 95% (41/43) of the variables had mean differences that were four degrees or less. For intra tester reliability, of the 48 calculated mean differences three variables were statistically significant – DVJ knee flexion (mean difference 4.65 degrees, p=.041), DVJ trunk flexion (mean difference -3.7 degrees, p=0.03) and deceleration hip flexion (mean difference -5.71 degrees, p=0.034). Looking at only the kinematic data, all mean differences were less than 6 degrees, and 86% (37/43) were less than four degrees.

Conclusion:

This study demonstrates that after one training session, motion capture sports testing was remarkably consistent within and between testers at three different motion analysis centers. This strengthens the case that sports evaluations using motion capture is reproducible and can be replicated at novel centers with trained motion analysis personnel. To confirm inter and intra tester reliability, future studies should expand to more centers, additional testers, and athletes. [Table: see text]
Changing Trends in Treatment of Meniscal Tears in the Setting of Concomitant ACL Tear in Pediatric and Adolescent Patients: A Marketscan Insurance Database Study
Authors: Block Andrew M. , Eisenberg Matthew , Vopat Matt , Nepple Jeffrey
Published: May 2022

Introduction:

Meniscal tears are commonly present in patients undergoing anterior cruciate ligament (ACL) reconstruction. Decision-making between meniscus repair and partial meniscectomy involves a number of factors from tear pattern to surgeon expertise and available technology. While meniscal and ACL tears in pediatric and adolescent patients are rising in incidence, changes in treatment of meniscus tears in the setting of ACL reconstruction have not been previously demonstrated.

Purpose:

To describe the trends of meniscal repair or meniscectomy in the setting of an ACL reconstruction among pediatric and adolescent patients utilizing the MarketScan Database from 2006 to 2018.

Methods:

The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals younger than 18 years old. ACL reconstruction records performed between 2006 and 2018 were obtained using Current Procedures Terminology (CPT), and International Classification of Diseases Ninth Revision (ICD-9) and Tenth (ICD-10) codes. Inclusion criteria included at least 180 days of insurance coverage after intervention. Relative rates of MY and MR were compared by year in the mid-2000s (2006-2007) were compared to the late 2010s (2017-18) and were sub-stratified by age and estimated skeletal maturity.

Results:

A total of 44,501 patient under 18 years of age undergoing ACL reconstruction were identified. Meniscal tears were present in 57.0% of patients and treated with partial meniscectomy in 30.3% (n=13,482) and meniscal repair in 26.7% (n=11,884). Prevalence of meniscal injury in setting of ACL-R increased significantly with age, with a 19% increase from <12 years old (40.4%) to 17 years old (59.4%, p <0.001). Over the 12-year time period, rates of meniscal tears treated at time of ACL-R was relatively constant (ranging from 56.5-60.4%) (Figure 1). However, the rates of meniscal repair increased significantly (Δ=21.2%, from 37.1% to 58.3%) as the rates of partial meniscectomy decreased (62.9% to 41.7%, p < 0.001) (Figure 2). Even with this increase in the number of repairs, there was no increase in overall rates of reoperation (4.2% v. 2.5%), including lysis of adhesions or subsequent meniscal procedures (meniscectomy, meniscal repair) over the time period analyzed.

Conclusion:

The current study demonstrates that at the time of ACL-R, meniscal pathology is common in pediatric patients. From 2006 to 2018, the rates of meniscal repair in the setting of ACL tears are steadily rising (32.8% to 51.8%) while partial meniscectomies are declining (67.2% to 48.2%), without an increase in early reoperation. [Figure: see text][Figure: see text]
Outcomes of Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients:2-Year Follow-Up
Authors: Perea Sofia Hidalgo , Cordasco Frank A. , Green Daniel W.
Published: May 2022

Background:

The quadriceps tendon (QUAD) autograft has recently become an alternative to the hamstring tendon autograft that demonstrates superior preliminary outcomes in pediatric anterior cruciate ligament reconstruction (ACLR).

Purpose:

To evaluate 2-year clinical and patient-reported functional outcomes of primary ACLR with soft tissue QUAD autograft in skeletally immature patients.

Methods:

Consecutive skeletally immature patients who underwent ACLR with QUAD autograft were included. All cases utilized full thickness soft tissue QUAD autograft without a bone plug and were performed on patients with open growth plates. Preoperative demographic and surgical data were collected ( Table 1 ). The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal (AE) and complete transphyseal (CT). Patients were followed for a minimum of 24 months with successive clinical visits or contacted via telephone. Information regarding the return to sports and concomitant or subsequent surgical procedures was collected. KT-1000 was performed post-operatively, and Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject at their 2-year follow-up appointment.

Results:

The final cohort included of 60 consecutive adolescent patients aged 11.1 to 17.1 (13.9 ±1.2) with a minimum follow-up of 2 years. One patient was lost to follow-up. Prior to surgery, 86% of patients reported playing team sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. 21 (35%) patients underwent AE and 39 (65%) underwent CT ACLR. Additionally, 35 (58%) underwent an a lateral extra-articular tenodesis procedure using the iliotibial band (ITB) with a modified Lemaire technique, and 5 (8%) patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum, both procedures were performed for non-modifiable risk factors as previously published for hamstring autograft ACLR. The rate of graft failure was 0%, and 10 patients had additional surgical procedures, of which 4 were concomitant removal of hardware for hemi-epiphysiodesis, 3 were contralateral ACLR, 3 were meniscal injuries that required surgical intervention and 2 were lysis of adhesions. The mean KT-1000 at 2-year follow-up was -0.36 ±0.75. The median Pedi-IKDC score was 87, and the median HSS-Pedi FABS score was 25. At 2 years after surgery, 90% patients reported returning to sports.

Conclusion:

This study reveals that QUAD autograft ACLR had a low failure rate when compared to previously reported studies of ACLR with hamstring autograft. Based on these results, we recommend this technique for skeletally immature patients undergoing ACLR. [Table: see text]
Variable Practice Patterns and Variation Among Orthopaedic Surgeons Specializing in Pediatric Sports Medicine
Authors: Block Andrew M , Ellis Henry B. , Schmitz Matthew R. , Crepeau Allison ,   PRiSM Hip RIG, Nepple Jeffrey J.
Published: May 2022

Introduction:

Pediatric sports medicine is a growing subspecialty within orthopedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America.

Purpose:

To evaluate and describe the current practice patterns of orthopedic surgeons specializing in pediatric sports medicine via survey of PRiSM (Pediatric Research in Sports Medicine Society) members.

Methods:

An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through PRiSM in April 2021. The survey was designed to (1) characterize respondent demographics (practice focus on pediatric vs. adult, fellowship training, years in practice, location), (2) characterize the breakdown of different joint specialization, and (3) determine the most common procedures across different joints that the respondent specializes in. Specialization was defined as composing ≥ 25% of a respondent’s practice. Commonly operated joints were defined as composing ≥5% of their practice.

Results:

Responses from 55 orthopedic surgeons were collected and analyzed. The majority of respondents considered pediatric sports medicine as the primary focus of their practice (89.1%, n=49/55). The number of fellowships completed was almost evenly split between either a single fellowship (52.7%, 29/55) or two or more (47.3%, 26/55). The most common combination of fellowships was pediatric orthopaedics and adult sports medicine (32.7%, 18/55). The majority of survey respondents have been in practice for <10 years (69.0%, 38/55), were affiliated with an academic center (61.8%, 34/55), and utilized non-operative providers as a part of their practice (66.6%, 36/54). On average, 77.5% of patients treated were skeletally immature. Overall, 54.5% of respondents reported specializing in one joint and 41.8% specialized in two. Surgeons commonly operated on a mean of 3 joints. The knee was the most commonly specialized joint (composing a mean of 52.1% of an overall practice), followed by the shoulder (15.2%), hip (13.9%), ankle (7.5%), elbow (7.1%), and wrist (4.2%) (Table 1). Interestingly, 87.3% (48/55) commonly operate on the shoulder but only 21.8% (12/55) were specialists. Conversely, the hip had a similar amount of specialization (23.6%, 13/55) but 56.3% (31/55) reported that they rarely operated on the hip.

Conclusions:

Pediatric sports medicine practices in orthopaedic surgery are quite variable. The majority of surgeons are <10 years into practice, affiliated with academic centers and have typically completed either 1 or 2 fellowships after residency. The majority of patients are skeletally immature. Most surgeons specialize in one or two joints, most commonly the knee, followed by hip and then shoulder. [Table: see text][Figure: see text]
Wound Dillemmas: Investigating the Effect of Barbed Knotless Suture Versus Smooth Suture for Subcuticular Tissue Closure During Knee Surgery in Youth Athletes
Authors: Tsang Henry , Gornick Bryn , Schlechter John A.
Published: May 2022

Background:

Surgical procedures of the knee are commonly performed on youth athletes for a myriad of conditions. Restoration of motion is paramount following surgery and wound healing issues may arise. Studies have investigated wound closure technique and its’ effect on wound healing in arthroplasty, but there is a paucity of information in youth sports medicine.

Purpose:

To investigate wound healing following knee surgery as affected by smooth running monofilament versus barbed running knotless suture for subcuticular closure.

Methods:

A retrospective investigation was conducted of a single surgeon’s knee procedures between January 2013 to December 2020. Suture type for closure of the operative wound as well as any wound healing dilemmas (i.e., wound dehiscence and formal operative debridement) encountered during the post-operative period were recorded. The surgical procedure, perioperative antibiotics, wound lavage, dressing type and patient demographics were also recorded. Group 1 underwent subcuticular wound closure performed with a running smooth non-barbed monofilament suture and was compared to Group 2 where closure was performed with barbed monofilament suture. Exclusion criteria was a history of ipsilateral knee surgery and congenital syndromes. Statistical analysis was performed.

Results:

486 patients were identified of which 21 were excluded leaving 202 patients in Group 1 and 263 in Group 2. Average age was 15.8 years (range 10 to 25 years). 277 were female. Wound dehiscence occurred in 17 patients in Group 1 (8.42%) and 25 in Group 2 (9.51%) (p=0.684). Formal debridement was performed in 8 patients in Group 1 (3.96%) and 4 (1.52%) in Group 2 (p=0.100). There was a significantly higher tourniquet time (p<0.001), number of meniscus repairs (p<0.001) and trochleoplasties (P=0.011) in Group 2. There was no difference between groups regarding comorbidities, body mass index, and age. A power analysis yielded to reach 80% power (p<0.05) 12,405 patients per group would be needed for investigating the rate of dehiscence and 868 patients per group for formal debridement.

Conclusion:

Subcuticular suture type did not significantly affect the rate of wound healing dilemmas encountered following knee surgery in this young cohort. Formal debridement was required at a diminished rate in the barbed suture group but not significant enough to recommend routine use. Larger cohort studies are needed to further investigate this trend. [Table: see text]
Radiologic Predictors of Failure of Patellofemoral Instability Surgery in Adolescents
Authors: Wilson Benjamin R. , Zheng Evan T. , Cook Danielle L. , Hussain Zaamin B. , Nunally Kianna D. , Heyworth Benton E. , Micheli Lyle J. , Yen Yi-Meng , Kramer Dennis E. , Kocher Mininder S.
Published: May 2022

Background:

Adolescents often benefit from surgical management of recurrent patellofemoral instability (PFI). However, the precise radiologic risk factors for failure of PFI surgery remains incompletely investigated.

Hypothesis/Purpose:

The purpose of this study was to determine the rate of failure, defined as recurrence of instability, in a large cohort of adolescent athletes undergoing primary surgery for PFI, and to identify preoperative radiologic risk factors for recurrence.

Methods:

A retrospective review was performed on patients aged ≤19 years who underwent primary surgery for PFI at a single tertiary care center between 2008 and 2017. Patients underwent procedures including medial retinacular plication/reefing/advancement (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy with or without MRP (TTO), or combined TTO/MPFLR. Exclusion criteria were BMI >30kg/m2, surgery for fixation of chondral fractures >1cm, and diagnosis of a syndromic disorder. Preoperative magnetic resonance imaging (MRI) studies were reviewed, and radiologic parameters were recorded. Demographic and radiologic variables were compared between patients with and without subsequent PFI. Logistic regression was utilized to determine which imaging variables were associated with post-operative PFI.

Results:

303 patients (mean age 15.1 years, 71% female) underwent surgery for PFI with median follow up time of 3.0 years. At final follow-up, 76/303 (25%) of patients experienced post-operative PFI, with 41 of these patients (54%; 14% overall) undergoing revision PFI surgery. Post-operative PFI patients were younger (14.3 vs 15.4 years; p<0.001) and more likely to have undergone isolated MRP surgery (66% vs 35%; p<0.001) (Table 1). Pertinent radiologic findings in recurrent PFI patients vs non-recurrence patients included open physes (62% vs 49%; p<0.001), larger sulcus angle (163.9 vs 159.2; p<0.001), larger patellar tilt angle (26.3 vs 23.6; p=0.04), and larger Caton-Deschamps Index (CDI) (1.3 vs 1.2; p=0.03) (Table 2). Each additional degree of sulcus angle increased the odds of recurrent instability by 5% (OR=1.05; p=0.002), while each additional year of age decreased the odds of failure by 23% (OR=0.77; p<0.001).

Conclusion:

In conclusion, 25% of adolescents experienced post-operative PFI after primary patellofemoral stabilization surgery. However, such patients were more likely to be younger—a known risk factor for recurrence—and were more likely to undergo MRP, a procedure now largely replaced by MPFLR. Radiologic risk factors for failure included open physes, flatter trochlea, greater patellar tilt, and greater patella alta. Such data should guide treatment decisions and inform the risk of failure of surgical stabilization procedures in adolescents with PFI. [Table: see text][Table: see text]
Trochleoplasty in the Pediatric Population - A Systematic Review of Patient Characteristics, Treatment Strategies and Outcomes
Authors: Amato Chad , Williams Brendan A.
Published: May 2022

Background:

Trochleoplasty is a treatment considered for patellofemoral instability patients with high grade dysplasia and those who have failed other surgical intervention. However, the indications for and the safety profile of this procedure remain unclear, particularly in the pediatric population where concerns exist regarding physeal arrest and the development of premature patellofemoral arthritis.

Purpose:

To systematically review the literature to evaluate trochleoplasty use, outcomes and complications observed among pediatric patients.

Methods:

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines reviewing Pubmed and SCOPUS databases. Inclusion criteria were studies including pediatric (<18yo) patients undergoing trochleoplasty with either a mean age <18 or those in which individualized patient characteristics and resultant outcomes were reported. Patient demographics, dysplasia type, procedure type and patient outcomes were abstracted when available and summarized with descriptive statistics.

Results:

Our search strategy identified 4 studies published from 2016-2020 that included 86 patients (mean age=14.5yo) with a mean follow up of 31.6 months (range 12-60 months). All were classified as Level IV evidence. The majority (65%) of patients were Dejour B (56/86). A thin-flap technique was used in three studies while a lateral wedge augmentation procedure was utilized in the fourth. Kujala and Lysholm scores were collected in two studies with demonstrable patient improvement. The most common early complication noted was arthrofibrosis requiring arthroscopic lysis of adhesions (5 total patients). Only a single recurrent instability event was reported. In a single study, 4 of 23 patients had radiographic trochlear osteoarthritic changes at 5 years postoperatively. There were no reports of premature physeal arrest in two studies that monitored for this outcome.

Conclusion:

There remains a limited evidence base regarding trochleoplasty use in pediatric patients. Overall, favorable outcomes have been observed with infrequent recurrent instability. There are no reports of growth disturbance from physeal arrest as a result of this procedure identified, but reporting among patients with confirmed skeletal immaturity is scarce. Patellofemoral arthritic changes were observed radiographically in a small subgroup of patients, but further work is necessary to determine if this is a result of the procedure itself or the underlying pathology being treated. As interest grows in implementing trochleoplasty in the pediatric population and potentially skeletally immature individuals, improved evidence is necessary to determine the incidence of major complications in order to better define the safety profile and indications for use in children and adolescents.
Type VII Tibial Tubercle Fractures are Different from Osgood Schlatter Syndrome and Tibial Tubercle Physeal Fractures
Authors: Gamble James G. , Shirodkar Rati , Gamble Jamison G. , Chan Charles M.
Published: May 2022

Introduction:

Children and adolescents are prone to both overuse and acute injuries at the tibial tubercle. The most common overuse injury is Osgood Schlatter Syndrome (OSS,) and the most common acute severe injury is tibial tubercle avulsion fracture (TTF). Here we present evidence for a Type VII, all-epiphyseal, tibial tubercle fracture (VIITF) that is different from OSS and TTF.

Methods:

This IRB–approved study involved patients that were treated and registered at a tertiary care pediatric hospital from 2014 to 2020. We compared the clinical information, the radiographs, the treatments, and the outcomes of 15 patients with VIITF to 19 patients with OSS and to 14 patients with TTF.

Results:

All VIITF patients had a sudden onset of pain associated with a specific sports-related injury, and all had lateral radiographs showing a chip-like ossific fragment displaced from the secondary center but with no involvement of the physis. All of the OSS patients had an insidious onset of symptoms with no specific injury, and none had radiographs showing a chip-like fragment. All the TTF patients had a sudden onset of pain after an acute injury. Eleven of the 15 VIITF patients (73%) have formed retro-patellar tendon ossicles, and 7 of those patients (46%) have undergone surgery. All but one of the OSS patients have resolved, and all with non-operative management. All the TTF patients have resolved, and all except those with Ogden type IA fractures, had undergone urgent surgery.

Conclusions:

We accepted our hypothesis. VIITF is different from OSS and TTF and can be differentiated on the basis of clinical and radiographic data.

Clinical Relevance:

Most patients with OSS resolve with non-operative management, and TTF patients usually require urgent surgery. Children with VIITF do not need urgent surgery but do need to be followed because some can form painful retro-patellar tendon ossicles, have focal anterior knee pain, and may need surgery to resolve their symptoms. Level of Evidence: Level III: Case Control Study.
Pediatric Research in Sports Medicine Research Interest Group Spine/Spondylolysis Clinical Practice SurveY
Authors: Riederer Mark F. , Achar Suraj , McHorse Kevin , MacDonald James P.
Published: May 2022

Background:

The Pediatric Research in Sports Medicine (PRiSM) society is a multi-disciplinary group of healthcare providers who provide clinical care to young athletes with a variety of conditions, including isthmic spondylolysis. It is thought that significant practice differences exist in the way providers diagnose, image, and treat this condition.

Hypothesis/Purpose:

The purpose of this study is to survey the members of PRiSM on clinical practice patterns in the diagnosis, imaging, and management of isthmic spondylolysis in young athletes.

Methods:

An electronic, thirty-three question REDCaps survey was distributed to the PRISM membership via email during the 2021 virtual annual meeting and one reminder was sent after the meeting. Responses were collected during a 6-week period. The survey collected information based upon the following: demographics, diagnosis, imaging, and management.

Results:

Ninety-eight surveys were completed. Most of the respondents were divided between orthopaedic surgeons, non-operative sports medicine physicians and physical therapists, approximately half of which are fellowship trained. Approximately 42% of respondents make the diagnosis based upon MRI results in addition to history, physical examination, and plain radiographs. Approximately 24% obtain oblique radiographs as part of their assessment. MRI is the most frequently used advanced imaging modality with nearly 90% of respondents using this. The use of rigid bracing varies widely among respondents, with 20.6% bracing regularly, 35.3% sometimes bracing, and 44.1% not using rigid braces at all. The use of non-rigid bracing is similarly varied with 17.6% prescribing this regularly, 44.1% sometimes, and 38.2% not using non-rigid bracing at all. There is variance as well with regards to initiation of physical therapy (PT): prescribing immediately (42.6%) versus prescribing a period to rest prior to PT (57.4%). When young athletes are returned to sport, 52.9% of respondents indicated that they would impose restrictions to activity and 47.1% would not.

Conclusion:

Although there are similarities in how the diagnosis of isthmic spondylolysis in young athletes is made by PRISM members, there is variability in management, especially the use of bracing, the timing of physical therapy, and return to sport restrictions. MRI is the most common advanced imaging modality being used to help with the diagnosis.