bluuebunny/crossref_metadata_2025 huggingface dataset:
Title: CHANGES IN SUBJECTIVE AND OBJECTIVE SLEEP MEASURES DURING RECOVERY IN PEDIATRIC CONCUSSION
Authors: Wilson Julie C. , Seehusen Corrine N. , Simon Stacey L. , Howell David R.
Published: July 2021

Background:

Sleep problems after concussion have been associated with longer recovery times and more severe symptoms. Early research has primarily evaluated sleep via subjective measures; however, actigraphy data may help objectively understand sleep patterns after pediatric concussion.

Purposes:

Our study examined changes in subjective and objective sleep measures during pediatric concussion recovery. We also evaluated whether sleep measures at initial assessment predict concussion symptom resolution time.

Methods:

Pediatric patients evaluated within 14 days of concussion were given a commercial activity tracker to be worn full-time, including during sleep, through return-to-play (RTP) clearance. During the initial and RTP assessments, patients completed the Pittsburgh Sleep Quality Index (PSQI), self-reporting sleep duration, time spent in bed, and sleep quality. PSQI score >5 indicates poor sleep quality. Activity tracker-recorded sleep duration and time spent in bed from the first 3 nights after initial assessment and 3 nights prior to the RTP clearance assessment were also used for analysis.

Results:

Patients (n=32, 15.1±1.7 years, 41% female) completed initial and RTP clearance assessments (Table 1). On the PSQI, patients reported significantly worse overall sleep quality despite longer sleep duration and more time in bed at initial assessment relative to RTP assessment (Table 2). A majority of patients reported PSQI score >5 at both initial and RTP assessments (Table 2). There were no significant differences across time for sleep duration or time in bed as measured by actigraphy (Table 2). Patients perceived that they spent longer in bed compared to objective measures with initial assessment, and perceived longer sleep duration compared to objective measures for both initial and RTP assessments (Table 3). In each regression model, higher symptom severity was significantly associated with longer symptom resolution time (Table 4). In addition, longer time in bed after the initial assessment measured by actigraphy was significantly associated with longer symptom resolution time (Table 4).

Conclusion:

Patients reported obtaining more sleep and spending longer time in bed at the initial assessment compared to actigraphy measures, and a majority of patients reported poor sleep quality throughout recovery. Concussion symptom duration increased by 1 day for every 13 additional minutes spent in bed, as measured by actigraphy. Increased time in bed may indicate poor sleep habits during recovery. Both subjective and objective assessment of sleep following concussion offer valuable, yet differing, information. Future research assessing the impact of sleep intervention after concussion on symptom resolution should be considered. [Table: see text][Table: see text][Table: see text][Table: see text]
SOFT TISSUE CAM IMPINGEMENT IN ADOLESCENTS: MRI REVEALS IMPINGEMENT LESIONS UNDERAPPRECIATED ON X-RAY
Authors: Johnson Benjamin L. , Alizai Hamza , Ben Montanez , Wagner K. John , Youngman Tyler , Ellis Henry B.
Published: July 2021

Background:

The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described.

Hypthesis/Purpose:

The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI.

Methods:

A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test.

Results:

Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<0.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome.

Conclusion:

In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.
SINGLE LEG SQUAT COMPENSATIONS ASSOCIATE WITH SOFTBALL PITCHING PATHOMECHANICS IN ADOLESCENT SOFTBALL PITCHERS
Authors: Oliver Gretchen D. , Friesen Kenzie B. , Shaw Regan E. , Shannon David , Dugas Jeffrey , Andrews James
Published: July 2021

Background:

Softball pitchers have an eminent propensity for injury due to the high repetition and ballistic nature of the pitch. As such, trunk pathomechanics during pitching have been associated with upper extremity pain. The single leg squat (SLS) is a simple diagnostic tool used to examine LPHC and trunk stability. Research shows a lack of LPHC stability is often associated with altered pitching mechanics consequently increasing pain and injury susceptibility.

Hypothesis/Purpose:

The purpose of this study was to examine the relationship between trunk compensatory kinematics during the SLS and kinematics during foot contact of the windmill pitch. The authors hypothesized there would be a relationship between SLS compensations and pitch kinematics previously associated with injury. In using a simple clinical assessment such as the SLS, athletes, coaches, parents, and clinicians can identify potential risk factors that may predispose the athlete to injurious movement patterns.

Methods:

Fifty-five youth and high school softball pitchers (12.6±2.2 years, 160.0±11.0 cm, 60.8±15.5 kg) were recruited to participate. Kinematic data were collected at 100Hz using an electromagnetic tracking device. Participants were asked to complete a SLS on their stride leg (contralateral to their throwing arm), then throw 3 fastballs at maximal effort. Values of trunk flexion, trunk lateral flexion, and trunk rotation at peak depth of the SLS were used as the dependent variables in three separate backward elimination regression analyses. Independent variables examined at foot contact of the pitch included: trunk flexion, trunk lateral flexion, trunk rotation, center of mass, stride length, and stride knee valgus.

Results:

The SLS trunk rotation regression, F(1,56) = 4.980, p = .030, revealed trunk flexion significantly predicted SLS trunk rotation (SE = .068, t = 2.232, p = .030) and explained approximately 7% of variance (Adj. R2 = .066). The SLS trunk flexion regression, F(1,56) = 5.755, p = .020, revealed stride knee valgus significantly predicted SLS trunk flexion (SE = .256, t = 2.399, p = .020) and explained approximately 8% of variance (Adj. R2 = .078).

Conclusion/Significance:

Additional trunk rotation and trunk flexion at peak depth of the SLS indicate increased knee valgus and trunk flexion at foot contact of the pitch, both of which suggest poor LPHC stability, may increase the potential for injury. Athletes, coaches and clinicians should acknowledge the risk of poor LPHC in softball pitching and implement exercises to improve LPHC stability in effort to decrease pitching pathomechanics and associated pain.
COACH EDUCATION IMPROVES ADHERENCE TO ACL INJURY PREVENTION PROGRAMS: A CLUSTER-RANDOMIZED CONTROLLED TRIAL
Authors: Janosky Joseph
Published: July 2021

Background:

ACL injury prevention programs have demonstrated limited impact on population health, due in part to poor adherence to expert recommendations by sports coaches. Neuromuscular training (NMT) serves as a protective factor against ACL injury and serves as a key component of many ACL injury prevention programs. The objective of this study was to determine the effect of an educational workshop for sports coaches on adherence to neuromuscular training (NMT) implementation recommendations.

Methods:

In a cluster-randomized controlled trial, 22 teams in 8 high schools were randomized to either the intervention or control group. The intervention schools included 12 teams (5 female), and the control schools included 10 teams (4 female). The sports included basketball, volleyball, track and field, baseball, softball, and lacrosse. Coaches in the intervention group participated in a 60-minute educational workshop designed to teach coaches how to effectively implement a NMT program as a warm-up prior to team practice sessions and games. The schools in the control arm received print materials on recommended NMT exercises. Adherence to NMT implementation recommendation by sports coaches was the primary outcome. Eight data collectors, who were blinded to the teams’ assignment, were trained to observe each team’s practice or game 2-3 times a week. At each session, they completed a study questionnaire to identify the exercises completed by athletes during the team’s warm-up. They then recorded whether the coach 1) delivered exercise instructions, and 2) provided corrective cues. Generalized estimating equations (GEE) were used to account for potential correlations among teams at the same school.

Results:

A total of 399 practices or games were observed over 2 seasons. A greater proportion of coaches in the intervention group provided cues to correct improper technique compared to coaches in the control group [difference=0.04 (95% CI: 0.01, 0.07, p=0.006]. In addition, more coaches in the intervention group completed a full NMT program [OR=4.62 (1.22, 17.50), p=0.02]. There was a similar proportion of coaches in the intervention and control groups who provided exercise instructions [difference=0.01 (95% CI: -0.02, 0.04), p<0.44].

Conclusions:

Coach education can improve adherence to NMT implementation recommendations and the delivery of corrective cues during NMT sessions, which are both critical to reducing the risk of ACL injury. All coaches should receive in-person training that highlights the salience of NMT and provides the knowledge and skills required to effectively implement NMT sessions with young athletes.
THE IMPACT OF SOCIAL MEDIA USE ON SLEEP QUALITY AND PERFORMANCE AMONG COLLEGIATE ATHLETES
Authors: Watkins Rhonda A. , Sugimoto Dai , Hunt Danielle L. , Oldham Jessie R. , Stracciolini Andrea
Published: July 2021

Background:

Social media (SM) use among young adults has increased significantly in recent years and has been linked to poor sleep quality. College athletes pose a unique risk for poor sleep given their many demands. Currently, limited research is available on the impact of SM use on sleep quality, or the competition performance of college athletes.

Hypothesis:

College athletes who use more SM will have worse sleep quality and worse competition performance.

Methods:

A cross-sectional study design was employed among local NCAA Division III athletes. Data was collected via a SM use form, lifestyle survey, and PROMIS sleep disturbance questionnaire. SM volume (hours of SM use per day over 7 days) was recorded using the iPhone screen time function. The main outcome measures were sleep quality, using the PROMIS T-score, and performance, collected through publicly available competition results. Participants were divided into 3 groups based on their SM volume; 1) moderate SM users (SM time ≤ 2hours/day), 2) active SM users (SM time < 2 - ≤5hours/day), and 3) super active SM users (SM time > 5hours/day). For sleep quality, an ANCOVA was used to identify differences in the 3 groups while controlling for covariates (i.e. injury status, caffeine use, number of roommates, academic load, catastrophic life event, life balance and sleep medication use) that might impact sleep and performance. For performance, a binary logistic regression model was used to determine the independent association between each variable and competition performance after adjusting for confounders.

Results:

87 athletes (age:19.5±1.2 years, 40 males, 47 females) completed the survey. All males participated in track and field, while the females consisted of 37 track athletes and 10 swimmers. Controlling for the effect of lifestyle variables, a difference in sleep quality was identified among the three groups (p=0.025), (Table 1. A pairwise comparison indicated that the sleep quality of super active SM users was worse than moderate SM users (p=0.033) (Figure 1). For competition performance, an independent association was found between increased Facebook time and poor performance after adjusting confounders (aOR: 0.989, 95%CI: 0.978-0.999, p=0.038), (Table 2,3).

Conclusion:

High SM use appears to have a negative impact on sleep quality. Also, greater SM use may hinder competition performance among college athletes. These findings may have implications for developing SM use guidelines for college athletes to improve their sleep quality and performance.

Tables/Figures:

[Table: see text][Table: see text][Table: see text][Figure: see text]
THE UTILITY OF A MULTIDIRECTIONAL SUBMAXIMAL EXERTIONAL STEP AS PART OF AN EXERTIONAL REHABILITATION PROTOCOL AFTER CONCUSSION
Authors: Koschmeder Katelyn , Johnson Kyle , Marx Tyler , Minor Jon , Streeter Leslie , Pita Monica , Braden Gaige , Frino Libby , Peterson Erin , Handmaker Hirsch , Mortazavi Mo
Published: July 2021

Background:

This study aimed to identify whether a 5 Step Exertional Rehabilitation Protocol including a submaximal multi-directional stage (Step 5) has clinical utility for functional activity and sport clearance. Exertional Rehabilitation (EP) is a graded protocol of aerobic exercise ranging from light linear exertion (Step 1) to submaximal linear exertion (Step 4)1,2. In our 5 Step Protocol, Step 4 is followed by standardized multi-directional functional movements at high intensity intervals (Step 5) to rule out ongoing exertional intolerance.

Hypothesis/Purpose:

We aim to investigate if Step 5 testing demonstrates statistical evidence for its use in determining concussion recovery timelines and its diagnostic usefulness.

Methods:

This retrospective-chart review analyzed 60 Step 5 EP test attempts in post-concussion patients, ages 21 or younger, between Jun2019-Jun2020. Tolerance was determined by a concussion specialist who evaluated for the onset of signs/symptoms by surveying the patient throughout exercise and autonomic assessment with cardiac monitoring and pre/post orthostatic testing. Pre/Post exertion King-Devic (K-D) and vestibular testing on Force Plate were completed following Balance Error Scoring System positions. A positive change in K-D was defined as a ≥2 second delay in score on two of three reading cards from the pre-exertion testing. A positive change in vestibular testing was defined as a ≥0.2deg/sec change in the composite balance score from the pre-exertion testing.

Results:

The total number of failed Step 5 attempts was 21.7%. Of the failed attempts, 38.5% demonstrated dysautonomia, 92.35% had symptoms, and 30.8% demonstrated both dysautonomia and symptoms. Force Plate balance scores significantly worsened in failed attempts 15.4% of the time while passed attempts only 2.1% of the time. K-D scores did not show a statistically significant difference although failed attempts did have slightly worsened scores.

Conclusion:

Formal Step 5 testing is a useful diagnostic tool for understanding recovery stage, activity tolerance, and sport clearance. Autonomic, visual, and vestibular testing can be useful as objective markers of test tolerance.

Tables/Figures:

[Figure: see text][Figure: see text]

Citations:

1) Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, Suffoletto HN, Leiter J, Cordingley DM, Willer B. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2019 Apr 1;173(4):319-325. 2) Gagnon etal. Another look at active rehabilitation for slow-to-recover sport-related concussion in children and adolescents: further evidence to support its effectiveness. BJSM, 2013.
GENDER PREFERENCES OF YOUTH ATHLETES FOR THEIR SPORTS MEDICINE PROVIDERS: A SYSTEMATIC REVIEW
Authors: Chung Jane S. , Merkel Donna , Carter Cordelia W. , Kraus Emily , Rizzone Katherine
Published: July 2021

Background:

A multidisciplinary approach is an intrinsic part of the sports medicine management process as providers, therapists and athletic trainers frequently interact to deliver optimal care to athletes both in clinic and on the sideline. Establishing effective communication and engaging athletes in the decision making process as treatment plans are developed may help increase compliance and improve health outcomes. Gender preference of patients for their providers has been found to influence patient satisfaction and health outcomes but has not been studied in depth.

Purpose:

The purpose of this study was to systematically review the literature to identify and characterize young athletes’ gender preferences for their sports medicine providers.

Methods:

This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses Group (PRISMA) guidelines. Pubmed, Embase, CINAHL and PsycInfo databases were searched utilizing MeSH terms, with results limited to English-language publications from the year 1945 to present day. The investigators assessed study eligibility independently and limited to studies that had quantitative outcome measures related to gender preference and participants ≤ 22 years of age. The Appraisal Tool for Cross-Sectional Studies (AXIS) was utilized to assess studies for bias.

Results:

Six cross-sectional studies met the eligibility criteria. Across studies, there were a total of 2,159 participants with mean ages ranging from 14.7 to 21.0 years. Of the five studies that reported the gender of participants, 50.6% were female. Participants were more likely to have a preference for a gender-concordant sports medicine provider when their chief complaint was related to their genital region and/or their sexual health. Participants of both genders favored a female provider when the health issue pertained to behavioral and/or psychosocial health, such as depression. Female athletes preferred a female provider when the issue was related to body image and/or disordered eating. For strength and conditioning coaches, male athletes reported a strong preference for male providers, but female athletes did not express a gender preference. Two of the studies’ quality was categorized as “good” by the AXIS criteria and four were “fair”.

Conclusions:

Young athletes’ gender preference for their sports medicine providers is situation-dependent. However, there is a paucity of studies examining gender provider preferences in pediatric athletes. Further studies are necessary to address this void in the literature as this may impact health outcomes.
SPORT SPECIALIZATION, ATHLETIC IDENTITY, AND COPING STRATEGIES IN YOUNG ATHLETES
Authors: Christino Melissa A. , Coene Ryan P. , O’Neil Madeline , Daley Mary , Williams Kathryn A. , Ackerman Kathryn E. , Kramer Dennis E. , Stracciolini Andrea
Published: July 2021

Background:

Child and adolescent sports participation continues to rise, often with specialization in a single sport at an early age. Psychological associations with sport specialization have been reported, although targeted research is lacking.

Hypothesis/Purpose:

The purpose of this study was to examine associations between sport specialization, levels of athletic identity, and coping skills among adolescent athletes.

Methods:

A cross-sectional survey study of sports medicine patients, 12-18 years, was performed. Athletes completed a one-time, voluntary, anonymous survey. Surveys included demographics, sport participation information, Athletic Identity Measurement Scale (AIMS,10-item, range 7-70), Jayanthi Sport Specialization Scale (range 0-6), and Athletic Coping Skills Inventory (ACSI, 7 subscales, range 0-84). Statistical analysis included Fisher’s exact tests, t-tests, Pearson correlations, and linear regression.

Results:

334 out of 430 eligible patients completed surveys, with a response rate of 78%. Mean age was 15.0±1.8 years and participants were 64.6% female. 97.7% of participants designated participation in a primary sport, where they spent most of their time. Athletes reported starting this primary sport at a mean age of 7.2±3.7 years. Using the Jayanthi scale, 52.1% of respondents were classified as low specialization (score 0-3) and 47.9% as highly specialized (score 4-6). Sport specialization patterns did not significantly differ by age, sex, or sport. AIMS and Jayanthi scores positively correlated (r=0.39, p<0.0001), and athletes with the highest athletic identities (top 25%) were significantly more specialized than those with the weakest (bottom 25%) athletic identities (4.1 vs 2.5, p<0.001). Regression analysis demonstrated that every 1 point increase in the Jayanthi specialization scale was associated with an AIMS score increase of 2.7 points (p<0.001). The AIMS score also increased 0.83 points for every one month increase in playing their primary sport (p<0.001), and decreased 0.42 points with each year delay in starting their primary sport (p=0.02). Highly specialized athletes had significantly higher overall coping skills scores compared to low specialization athletes (51.6 vs 48.4, p<0.02), particularly on ACSI subscales of Coachability, Concentration, Confidence & Achievement Motivation, and Goal Setting & Mental Preparation (Table 1), however highly specialized athletes reported less Freedom From Worry compared to those with less specialization (5.8 vs 6.7, p=0.02).

Conclusion:

Athletic identity was higher in athletes who were more specialized and started their primary sport earlier in life. Greater sport specialization may confer some advantages in developing coping strategies in young athletes, however these athletes may be at risk for more worry compared to less specialized athletes.

[Table: see text]
BIOPSYCHOSOCIAL RISK FACTORS ASSOCIATED WITH SUBOPTIMAL OUTCOMES FOLLOWING ACLR IN THE PEDIATRIC ATHLETE
Authors: Stapleton Emily J. , Cerza Shelby , Wagner K. John , Ellis Henry B. , Wilson Philip L. , Gale Emily
Published: July 2021

Background:

Anterior cruciate ligament reconstruction (ACLR) is associated with acute postoperative pain, decreased function, and psychological distress. Studies examining risk factors in pediatric populations following ACLR are limited; however, pediatric studies have found low socioeconomic status and fear of re-injury associated with poor outcomes.

Hypothesis/Purpose:

This study aims to expand the understanding of biopsychosocial risk factors for postoperative outcomes in pediatric ACLR populations.

Methods:

A retrospective review of patients that underwent ACLR at a pediatric sports medicine clinic from 5/12/17-5/15/19 was performed. Patients were included in the retrospective chart review if they were between the ages of 12 to 18 years, completed the ACSI-28, PROMIS Global Health 7+2 (PGH-7+2), Pedi-IKDC, and HSS Pedi-FABS, and underwent arthroscopic ACLR for a primary ACL lesion. Medical records were reviewed for demographic, sport involvement, injury, and treatment data collected at initial, pre-operative, first post-operative, one-year post-operative, and final post-operative visits.

Results:

107 patients (55F) with an average age of 15.69 years (range 12-18), meeting inclusion criteria were included in this review. Patients were cleared to return to sport (RTS) on average 350.23 days post-surgery. Both days between injury and surgery (109.65 days) and days between initial presentation and surgery (92.64 days) were found to be moderately correlated with RTS (r=0.478; p<0.001 and r=0.525; p<0.001, respectively). Between group comparisons were conducted comparing younger (<14yos) and older (≥14yos) patients. When looking at the PGH-7+2; the <14yos cohort reported significantly higher self-evaluation of health than the ≥14yos cohort (54.93 v 50.08; p=0.004). This younger cohort passed their functional test whereas older counterparts did not (n=13; 1 v 1.15; p=0.045). Patients who passed the functional test during their treatment course (i.e., through final follow-up) reported better pre-operative overall and physical health than those who ultimately failed (PGH-7+2Q1; 4.18 v 3.38, p=0.012; Q3; 4.03 v 3.15, p=0.002). Younger patients were more likely to pass the functional test (15.49 v 17.07 years, p=0.002). Lastly, a comparison between patients who did and did not reinjure their knee post-operatively was reviewed. Reinjured patients reported having increased levels of performance related worry pre-operatively (ACSI-28, FFW; 5.22 v 7.36, p=0.034).

Conclusion:

These findings suggest older athletes (≥14yos), those with lower perceived overall and physical health ratings, with performance related worry, and/or longer time between injury or initial presentation and surgery will need more pre-, peri-, and post-operative support and resources for optimal outcomes.
CLINICAL EFFECTIVENESS OF TRANS-ARTICULAR VERSUS RETRO-ARTICULAR DRILLING OF STABLE OSTEOCHONDRITIS DISSECANS OF THE KNEE: A, PROSPECTIVE RANDOMIZED CONTROLLED TRIAL BY THE ROCK STUDY GROUP
Authors: Heyworth Benton E. , Ganley Theodore J. , Wall Eric J. , Myer Gregory D. , Nissen Carl W. , Edmonds Eric , Lyon Roger M. , Chambers Henry , Murnaghan Lucas , Liotta Elizabeth S. , Hergott Katelyn A. , Milewski Matthew D. , Green Daniel W. , Weiss Jennifer M. , Wright Patrick W. , Polousky John D. , Nepple Jeffrey J. , Carey James L. , Kocher Mininder S. , Shea Kevin G.
Published: July 2021

Background:

The most common presentation of knee osteochondritis dissecans (OCD) is a stable lesion on the lateral aspect of the medial femoral condyle (MFC) in an adolescent or pre-adolescent athlete. Standard of care for conservative treatment, include activity modification and weight bearing protection. Failed conservative management often leads arthroscopy and drilling of the lesion. Two different primary drilling techniques have been utilized, but no prospective studies have compared their relative effectiveness.

Hypothesis/Purpose:

The study hypothesis was that trans-articular (TAD) and retro-articular drilling (RAD) would demonstrate similar rates of healing, times to return to sports, and patient-reported outcome scores (PROs).

Methods:

Skeletally immature (n=113) patients presenting with radiograph indicated stable OCD of the MFC who did not demonstrate healing despite a minimum of 3 months of non-operative treatment were prospectively enrolled and randomized to TAD or RAD, for which 17 surgeon-investigators (at 14 centers, representing all major regions in the U.S.). Serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. Twelve patients were due to lesion instability detected at the time of surgery,

Results:

Ninety-one study subjects were included, consisting of 51 TAD and 40 RAD patients, with the two groups being of similar age (12.6 years vs. 11.9 years), sex distribution (45% vs. 27% female, p=0.081), and 2-year PRO response rate (both 90%). No significant difference between TAD and RAD was detected in follow-up Pedi-IKDC, Lysholm, Marx knee activity score, or KOOS QOL scores (Table 1). Revision/additional OCD surgery occurred in 10% of patients in RAD and 4% in TAD. 71% of TAD patients reached a ‘healed’ status at a mean of 1.15 years, compared with 58% RAD patients at a mean of 1.06 years.

Conclusion:

While both primary forms of OCD drilling (TAD and RAD) showed consistent post-operative healing, achieving a completely ‘healed’ status was often a more prolonged process, taking approximately 1 year, despite clinical improvement being achieved much sooner. While PROs were similar between drilling techniques, revision surgery rates were more than twice as common with RAD compared with TAD but the overall risk was low and the Absolute Risk was only 6%.

[Table: see text]
SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS
Authors: Aitchison Alexandra H. , Lin Kenneth M. , Green Daniel W.
Published: July 2021

Background:

Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle.

Hypothesis/Purpose:

The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group.

Methods:

A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05.

Results:

A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI.

Conclusion:

The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism.

Tables/ Figures

[Table: see text][Table: see text]
PEDI-CHAMP© AGILITY TEST VARIES BY AGE, GENDER AND SPORT SPECIALIZATION IN YOUTH ATHLETES
Authors: Tulchin-Francis Kirsten , Ulman Sophia
Published: July 2021

Background:

The Pediatric Comprehensive High-Level Activity Mobility Predictor (Pedi-CHAMP©) is a 4-part agility test aimed to assess functional performance in children with and without sports medicine injuries or orthopedic conditions. The Pedi-CHAMP© assesses bilateral single limb balance, lateral agility, directional changes, and acceleration/deceleration.

Hypothesis/Purpose:

To determine if the Pedi-CHAMP component (Single-Limb-Stance [SLS], modified Edgren Side Step [mESS], L-Test, Illinois Agility Test [IAT]) and composite scores are stratified based on age, sex, and sport-type/specialization in youth athletes.

Methods:

Youth athletes were recruited to complete the Pedi-CHAMP© either as an independent test or as part of larger battery of tests (Specialized Athlete Functional Evaluation [SAFE] Program). Completion times for each test component were converted to points using age-sex matched scoring algorithms. Each participant also answered questions to determine specialization in organized sports (defined as competition with a referee, umpire, etc.). Kruskal-Wallis was used to assess differences based on age groups (elementary [E, 5-9yrs], preteen [PT, 10-12yrs], early teen [ET, 13-15yrs], late teen/young adult [LT, 16-22yrs]), with Mann-Whitney U pairwise post-hoc comparisons (α<0.05). Independent Mann-Whitney U tests were used to assess differences based on sex, sport type (low vs high impact) and specialization (single vs multi-sport) within each age group.

Results:

A total of 251 youth athletes (134 females, age 13.7±3.3yrs; BMI 20.9±5.9) completed Pedi-CHAMP© testing. Significant differences were seen with the Pedi-CHAMP© component and composite scores between all ages ( p<0.001, Table 1), however, there were no differences between ET and LT groups for the SLS or mESS. When assessing age and sex, elementary-aged girls demonstrated improved SLS balance ( p=0.017), and mESS scores were higher in preteen boys compared to girls ( p=0.022). However, all 3 agility components (mESS, L-Test, IAT) and the Pedi-CHAMP© composite scores were significantly higher in boys compared to girls for the ET and LT groups. When accounting for age, there were no differences in single-sport vs. multi-sport athletes. ET and LT low-impact athletes scored lower on the L-test compared to high-impact athletes.

Conclusion:

The Pedi-CHAMP© was able to detect differences based on age, sex and sport impact-type (low- vs. high-impact). Performance improves with age for the L-Test and IAT, however, no differences in SLS and mESS were seen between younger and older teens which may indicate a ceiling effect for these two components. Further research should focus on correlating the Pedi-CHAMP© to other performance measures in youth athletes.

Tables/Figures:

[Table: see text][Table: see text]
LOWER QUARTER Y-BALANCE TEST SCORES ARE ASSOCIATED WITH ISOKINETIC KNEE STRENGTH
Authors: Erdman Ashley L. , Wyatt Charles W. , Tulchin-Francis Kirsten , Ulman Sophia M.
Published: July 2021

Background:

Lower extremity asymmetry has been shown to be associated with increased risk of anterior cruciate ligament injury. Return-to-sport screens commonly involve assessing the restoration of symmetrical strength and balance. Therefore, it is important to understand how these measures are related.

Hypothesis/Purpose:

To determine if relationships exist between the Lower Quarter Y-Balance Test (LQ-YBT) component scores, composite scores, and isokinetic knee strength in healthy, female athletes.

Methods:

Female adolescent athletes completed the LQ-YBT and isokinetic knee strength as a part of a comprehensive evaluation in competitive level athletes (Tegner activity scale≥7). LQ-YBT anterior, posteromedial, and posterolateral component scores for the each leg were normalized to leg length, and composite scores for each leg were calculated for each participant. Knee flexion/extension strength was collected at 120°/second using a Biodex System 4. Peak torque was normalized by body weight, and paired t-tests were used to compare legs ( α<0.05). Spearman correlation coefficients were calculated to test whether any LQ-YBT measures were associated to knee strength.

Results:

A total of 106 participants (age 13.8±2.4 years; BMI 20.2±3.0) were tested, and all were right leg dominant. No differences were found between LQ-YBT right and left component (Table 1), or composite scores (right 97.9 vs left 98.2, p=0.29). Flexion and extension strength were significantly increased on the right side ( p=0.02, <0.01 respectively). There were significant, weak to moderate correlations between all LQ-YBT scores (components and composite) versus knee flexion strength (r=0.26 to 0.40) (Table 2). Left knee extension strength was weakly correlated to left anterior and posteromedial component scores (r=0.24, 0.34 respectively), as well as the left composite score (r=0.29). Right knee extension strength was only correlated to the right posteromedial component score (r=0.21) and the right composite score (r=0.22).

Conclusion:

Weak to moderate relationships exist between both component and composite LQ-YBT scores and knee strength. The strongest correlations were found between the LQ-YBT composite scores and knee flexion strength. LQ-YBT composite scores were relatively high, indicating a low chance of injury while differences were seen in knee strength between legs. Future injury prevention programs would benefit from utilizing both tools as the Y-Balance test evaluates motor control and isokinetic strength identifies muscular imbalance, both of which are important in reducing future injury risk.

Tables/Figures:

[Table: see text][Table: see text]
BIOMECHANICAL SIMULATION OF RADIAL HEAD SUBLUXATION IN CADAVERIC PEDIATRIC ELBOWS
Authors: Meadows Molly , Vuong Brian , Storaci Hunter , Tam Kaysie , Shea Kevin
Published: July 2021

Background:

Radial head subluxation, known as pulled elbow or Nursemaid’s elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an elbow that is pronated and extended. Although the stability of the proximal radioulnar joint has been previously examined in cadaveric models, there are no current studies quantifying the biomechanics of nursemaid’s elbow. The purpose of our study was to demonstrate and quantify the axial traction force required to produce a nursemaid’s elbow in a pediatric cadaver specimen.

Methods:

Two fresh-frozen cadaveric elbows from a single 3 year-old male donor were dissected by a fellowship-trained orthopedic surgeon. An Instron 5944 testing machine with a 2 kN load cell was used to perform uniaxial testing. The radius and humerus were mounted to the Instron machine, and loaded in the axial direction with the elbow in full extension. Loading occurred at a rate of 10 mm/sec for 4 seconds, during which the force and actuator displacement were continuously recorded. The local instantaneous load and extension displacement at the time of subluxation were recorded, and data was synced with high-frame-rate video footage used to confirm the annular ligament subluxation.

Results:

The load to failure required to produce the nursemaid’s elbow injury in the first elbow was 31N, with a failure displacement of 4.6mm. The second elbow demonstrated a load to failure of 26N, with a failure displacement of 4.6mm. After subluxation, we reduced the annular ligament from the first specimen. The elbow was then re-tested and demonstrated a load to failure of 20N, with a failure displacement of 2.6mm.

Conclusion:

Axial traction applied to a pediatric cadaver specimen results in subluxation of the annular ligament into the radiocapitellar joint. The mean load to failure is 28.5N, and a lower load to failure was required to produce a recurrent subluxation in a previously injured specimen. Lower load for a recurrent subluxation may be attributed to damage on the annular ligament due to the first subluxation.

[Figure: see text]
TIME LOSS INJURIES AMONG FORMER COLLEGIATE GYMNASTS: THE INFLUENCE OF FEMALE ATHLETE TRIAD SYMPTOMS
Authors: Fryar Caroline , Howell David R , Seehusen Corrine N. , Tilley David , Casey Ellen , Sweeney Emily A
Published: July 2021

Background:

Female college gymnasts have one of the highest injury rates in the NCAA and are at risk for female athlete triad syndrome. While female athlete triad syndrome leads to bone stress injuries, little research has been done on specific injury location and type.

Purpose:

Our objective was to compare injuries sustained during gymnastics between former collegiate gymnasts who did and did not report experiencing symptoms of Female Athlete Triad Syndrome during college, including disordered eating (DE) or menstrual irregularity (MI).

Methods:

465 former collegiate gymnasts completed an online survey distributed via social media. Participants were grouped based on mensural irregularity and whether they had a history of DE/ED of not. We compared injury outcomes (time-loss injuries and injuries resulting in surgery) and injury locations between groups using Chi-square analyses.

Results:

A significantly greater proportion of those who reported MI during college reported a time-loss wrist/hand and injury during gymnastics compared to eumenorrheic gymnasts (Table 1). A significantly greater proportion of those who reported MI during college sustained an injury that required surgery relative to those who reported regular periods during college (52% vs 65%, p=0.009). Specifically, they reported a greater proportion of hip/pelvis (2% vs. 7%, p=0.02) and leg/ankle/foot surgeries (23% vs. 33%, p=0.009). A significantly greater proportion of the group who reported DE during college reported a time-loss gymnastics injury during college that did not require surgery or retirement, relative to those who did not report DE (78% vs 66%, p= 0.005) (Table 2). Specifically, they reported a greater proportion of spine (25% vs. 14%, p=0.002), hip/pelvis (8% vs. 2%, p=0.001), and leg/ankle/foot injuries (53% vs. 41%, p=0.01). There was a significantly greater proportion of gymnasts who reported DE during college who sustained a hip/pelvis (7% vs. 3%, p=0.04) and leg/ankle/foot injury (34% vs. 23%, p=0.02) requiring surgery compared to those who did not report DE during college.

onclusion:

College gymnasts who experienced triad symptoms were more likely to experience a time-loss injury, or have an injury requiring surgery. Clinicians and providers should be aware of the association between injuries and DE and MI in gymnasts. Early intervention for athletes with triad symptoms should be undertaken to decrease the risk of musculoskeletal injury.
RADIOGRAPHIC FOLLOW-UP AFTER MILD SLIPPED CAPITAL FEMORAL EPIPHYSIS: WHAT IS THE INCIDENCE OF SUBSEQUENT SURGERY FOR FEMORACETABULAR IMPINGEMENT?
Authors: Skelton Anne , Martino Rachael , Mayer Stephanie , Selberg Courtney
Published: July 2021

Background:

Slipped capital femoral epiphysis (SCFE) is characterized by translation of the proximal femoral epiphysis posterior and medial relative to the metaphysis. The gold standard treatment of mild SCFE, defined as a slip angle <30°, remains in-situ pinning (ISP) to stabilize the epiphysis in its current position after slippage.

Methods:

127 hips from 113 individuals met inclusion criteria: mild SCFE (Southwick angle <30°) that underwent ISP with available pre- and post-procedure radiographs. Medical records were reviewed to collect demographic data, preoperative symptoms, surgical details, radiographic measurements, and post-operative follow-up. Six hips were identified as having undergone additional joint preserving surgery of the hip (JPSH) while seven other hips were identified as having undergone screw removal and/or replacement within two years of initial ISP. Anterior-posterior (AP) and frog-leg lateral alpha angles, femoral epiphyseal-metaphyseal offset angle, and Southwick angle were all measured preoperatively, post-operatively, and at final radiographic follow-up. Chi-squared analyses, binary logistic regression models and Kruskal-Wallis tests were used to evaluate the association between clinical and radiographic parameters and the occurrence of additional surgery or screw failure.

Results:

Demographic variables, including age, body mass index, prodrome pain, sex, laterality, and chronicity were not found to significantly influence the likelihood of additional surgery. Preoperative AP alpha angle, frog-lateral alpha angle, epiphyseal-metaphyseal offset angle, and Southwick angle did not significantly impact the likelihood of additional surgery or screw failure. Radiographic measurements taken after ISP demonstrated that AP alpha angle significantly increased the likelihood of additional surgery. For every one degree increase, the likelihood of additional surgery increased 1.091 times (average 70.264° for no additional surgery and 82.333° for additional surgery, p=0.017).

Conclusion:

Mild SCFE can progress to residual pain and limited hip motion even after initial treatment with ISP. Of our cohort of 127 hips, six (4.72%) went on to have secondary JPSH while an additional seven (5.51%) presented with screw failure within two years of initial ISP. Increased AP alpha angle after ISP was correlated with an increased likelihood of secondary JPSH. This increased AP alpha angle may contribute to intra-articular pathology due to CAM-type morphology which may lead to the necessity of JPSH. These findings suggest that patients with increased AP alpha angle after ISP may need to be followed long-term for the development of further joint symptoms and may need to be counseled after ISP for mild SCFE for the risk of secondary JPSH.

Tables/Figures:

[Table: see text][Table: see text][Table: see text]
HURDLE STEP COMPONENT SCORE FROM THE FUNCTIONAL MOVEMENT SCREEN IS ASSOCIATED WITH STRENGTH, SPEED, AND JUMP PERFORMANCE
Authors: Ulman Sophia M. , Saleem Laura , Tulchin-Francis Kirsten
Published: July 2021

Background:

The Functional Movement Screen (FMS) is a tool designed to establish a baseline for fundamental movement capacity, highlight limitations and limb asymmetries, and identify potential injury risk. Previous research has shown that individual components of the screen are also indicative of injury risk, as well as potential predictors of athletic performance unlike the FMS composite scores. However, this literature is limited and lacks statistical power. Identifying which component scores are predictive of injury risk and athletic performance would provide a quick, powerful tool for coaches and trainers to evaluate athletes.

Purpose:

To determine if individual component scores of the FMS are associated with athletic performance in highly-active youth athletes.

Methods:

Youth athletes participated in the Specialized Athlete Functional Evaluation (SAFE) Program. Data collection was extensive, however, for the purpose of this abstract, only a selection of data was analyzed – age, BMI, years played, total number of past injuries, isokinetic knee strength, 10- and 20-meter sprint, single-leg hop (SLH) distance, and FMS scores. Seated knee flexion/extension strength was collected at 120°/second using a Biodex System 4, and peak torque was normalized by body weight. The maximum distance of three SLHs was recorded for each leg and normalized to leg length. FMS scores used for analysis included the total composite and component scores, including the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, and rotary stability. Wilcoxon Signed Ranks Tests were used to determine side-to-side differences, and Kruskal-Wallis tests were performed to determine differences in athletic performance based on FMS scores ( α<0.05).

Results:

A total of 38 highly-active, youth athletes (26F; 15.4±2.6 years; BMI 21.0±5.3) were tested. Participants reported playing organized sports for 8.7±3.4 years, having 2.0±1.2 past sports-related injuries, and 74% reported specializing in a single sport. No side-to-side differences were found. While the composite FMS score significantly differed by number of past injuries ( p=0.036), it was not associated with athletic performance. Alternatively, left knee strength, sprint speeds, and right hop distance significantly differed by the hurdle step component score (Table 1).

Conclusion:

While the composite FMS score was not an indicator of athletic performance, the hurdle step component score was associated with strength, speed, and jump performance. This individual task could be a beneficial tool for coaches and trainers when evaluating athletic ability and injury risk of athletes.

Tables/Figures:

[Table: see text]