bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Resonance Image (Mri) Measurements of Lateral Discoid Meniscus (Ldm) in Pediatric Patients Match Adult Lateral Discoid Meniscus Definitions
Authors: Beck Jennifer , Wood Anna , Bennet Abbie , Jackson Nicholas
Published: May 2022

Background:

Commonly cited lateral discoid meniscus (LDM) imaging definitions are based upon adult MRI measurements: >70% tibial plateau coverage on the sagittal, >20% tibial plateau coverage on the coronal and >3 bowtie signs. This pathology more commonly presents in pediatric populations and it is unknown if these measurements apply to a pediatric population. Therefore, it is important to understand the Magnetic Resonance Image (MRI) measurements of LDM in a pediatric population.

Hypothesis/Purpose:

The purpose of this study is to define LDM measurements on MRI in a pediatric population. Authors hypothesize there is a wide variation in LDM characteristics on MRI.

Methods:

100 MRIs on LDM patients who are skeletally immature were evaluated and 91 included in this study. Demographics were recorded. Two study authors independently reviewed MRIs measuring meniscal height and width on sagittal and coronal images, tear presence, number of “bowties” on sagittal images, as well as tibial sagittal and coronal width. One study author repeated measurements a minimum of 4 weeks after initial review. Figure 1 describes each measurement. Statistical analysis was performed using fisher’s exact test for differences, as well as multinomial, linear and logistic regression models with clustered robust standard errors.

Results:

Average age at MRI was 12.3 ± 3.4 years, 51% male, 56% left knees. Table 1 reports gender comparison of MRI measurements. Table 2 reports gender comparison of bowtie sign and ratios of meniscal width to tibial width on coronal and sagittal images. Tears were reported in 72 MRIs (80%). Genders of patients with tears were not statistically different (Female: N=33; 73%, Male: N=39; 87%, p=0.16). Sagittal anterior (p=0.005) meniscal width, anterior to posterior meniscal width (p<0.001), and # of bowtie signs (p=0.043) were significantly associated with tear presence.

Conclusion:

MRI characteristics can aide in accuracy of LDM diagnosis. Pediatric patients with diagnosed discoid meniscus had >3 bowtie signs, >70% tibial plateau coverage on the sagittal, and >20% tibial plateau coverage on the coronal consistent with adult reported definitions of discoid meniscus. [Figure: see text][Table: see text][Table: see text][Table: see text]
Differences in Lower Extremity Kinematics Based On Drop Vertical Jump Task Variations
Authors: Loewen Alex M. , Erdman Ashley , Tulchin-Francis Kirsten , Ulman Sophia ,   PRiSM Motion Analysis Research Interest Group
Published: May 2022

Background:

More advanced measures of movement quality may be necessary to better estimate return-to-play readiness. This emphasizes the need for a standardized motion analysis protocol to capture patients’ biomechanics during dynamic tasks, such as the drop vertical jump (DVJ). Given that the DVJ elicits a dynamic, game-like movement, it is commonly used in return-to-play functional testing and injury-risk research. However, the task procedure is not consistent across treatment and/or research centers.

Hypothesis/Purpose:

The purpose of this study was to determine whether variations in jump distance, verbal instructions, or target use would influence mechanics during a DVJ task.

Methods:

Fourteen healthy subjects (7 female, aged 22.7±3.7 years) were asked to perform six DVJ tasks from a 31cm plyo-box. Lower extremity kinematics were collected during the first landing/takeoff phase. Three tasks varied by jump distance (distance from box to center of force plates): zero distance (DROP), one-third (THIRD) and one-half (HALF) subject height. Additional verbal instructions were provided for the DROP task. Specifically, subjects were asked to first “drop off the box onto the force plates” (DROP), and then to “slightly bend their knees to ‘pop-off’ the box with both feet at the same time” (POP). Lastly, a target was positioned above the force plates for the HALF (H-TAR). Wilcoxon signed-rank tests were performed to assess differences between tasks ( α=0.05).

Results:

At initial contact (IC), knee flexion increased in the DROP (24.0˚±18.4˚, p=0.011) and THIRD (16.3˚±7.9, p=0.005) compared to the HALF (12.0˚±6.8˚). During the landing phase, maximum hip flexion increased in the HALF (106.0˚±27.5˚) compared to the DROP (100.6˚±25.0˚, p=0.011). Average pelvic tilt decreased in the DROP (32.1˚±4.8) compared to both the POP (37.8˚±5.7˚, p=0.009) and THIRD (34.5˚±6.2˚, p=0.008). When using a target, knee flexion increased at IC during the H-TAR (H-TAR:18.8˚±8.8˚, HALF:12.0˚±6.8˚, p=0.004).

Conclusion:

These findings emphasize the importance of understanding movement strategies associated with different variations of the DVJ. Specifically, a shift in landing strategy was seen as box distance increased. Therefore, the DROP may be more appropriate early in rehabilitation given that maximum hip flexion was reduced. In contrast, the HALF may be more appropriate for return-to-sport testing given that patients would exhibit improved neuromuscular motor control. These findings also highlight the need for standardized instructions and task setup. While this pilot data was collected in young adults, future work will need to focus on evaluating these task variations in a youth population. [Table: see text]
Short-term Recovery After Displaced Adolescent Clavicle Fractures: Do Differences an Exist Between Surgical and Non-Surgical Treatments?
Authors: Block Andrew M. , Ganapathy Aravinda , Nepple Jeffrey J.
Published: May 2022

Introduction:

Clavicle fractures are common in the young, active adolescent population. It is increasingly recognized that displaced clavicle fractures treated either conservatively or surgically have good outcomes at 1 year. Currently, it is not well established whether any differences in the short-term recovery (<3 months) exist. Patient-Reported Outcomes Measurements Information System (PROMIS) computer adaptive testing (CAT) has been shown to be a valid and reliable means to assess PROs.

Purpose:

To compare short-term recovery between surgical and non-surgical treatment of displaced clavicle fractures in adolescents utilizing PROMIS.

Methods:

Patients with displaced clavicle fractures were assessed prospectively utilizing PROMIS at each clinic visit. Patients completed the Pediatric PROMIS CAT domains Upper Extremity Function and Pain Interference. Inclusion criteria included patients <18 years old, treatment either surgically or conservatively, and at least two follow up time points within 2 months post-op. Time points were calculated as <10 days, 7-21 days, 6 weeks (22-52 days), and 3 month (70-110 days) post-injury. Time points were compared utilizing a mixed-linear regression model. Ceiling or Floor Effects were present when ≥15% of study cohort had reached the maximum or minimum possible score.

Results:

A total of 52 patients with displaced clavicle fractures were identified (26 surgically treated and 26 conservatively treated). Mean age was similar (15.4 v. 14.1, respectively). No differences in mean PROMIS scores between treatment modalities were present at baseline (p>0.05). For Pain Interference and Upper Extremity Function, significant improvement by 6 weeks was seen in both surgically and conservatively treated patients (Figure 1). For Pain Interference, significant improvement by 6 weeks was seen in both surgically (Δ=-6.8, p=0.03) and conservatively treated patients (Δ=-8.3, p=0.003). More surgically treated patients reached a floor effect for Pain Interference at 6 weeks (24%), compared to conservatively treated patients (4%). For the Upper Extremity function, significant improvement was seen by 6 weeks in both surgically (Δ=7.2, p=0.042) and conservatively (Δ=11.9, p=0.003) treated patients. For UE Function, 21% of surgically treated patients reached a ceiling effect at 6 weeks, compared to 13% for conservative treatment (p>0.05). No differences were present at 3 months post-injury.

Conclusions:

While both surgical and conservative treatment of adolescent displaced clavicle fractures demonstrate similar trends of PROMIS recovery, surgical treatment may allow for rapid recovery at 6 weeks compared to conservative treatment in some patients.
Age-Related Changes on Mri Of Posterior Cruciate Ligament Morphology in A Skeletally Immature Population
Authors: Flaugh Rachel A. , Feroe Aliya G. , Shahein Amir A. , Mathew Stephen T. , Miller Patricia E. , Kocher Mininder S.
Published: May 2022

Background:

Magnetic resonance imaging (MRI) analysis of the developmental morphology of the anterior cruciate ligament (ACL) in pediatric and adult patients has led to the identification of anatomical risk factors for injury and optimization of surgical reconstruction. Similar work regarding pediatric posterior cruciate ligament (PCL) morphology is limited despite increasing incidence of PCL injury and rising favorability of surgical reconstruction.

Purpose:

The aim of this study was to describe age-dependent changes in ligamentous and osseous anatomy of the pediatric PCL by comparison of MRI measurements across pre-adolescent and adolescent age groups.

Methods:

Sixty patients with a knee MRI and wrist radiographs who were seen from 2008 to 2018 at a single tertiary care center were randomly selected from a departmental database and categorized into skeletal age groups (ages 7-9 years, 10-12 years, and 13-15 years) with 20 patients in each group (Table 1). Skeletal age was determined from wrist radiographs and patients with a PCL injury or prior knee surgery were excluded. Twelve dimensions of the PCL substance or its osseous attachment sites were measured on MRI by two independent reviewers. Pairwise comparisons were conducted between the youngest and intermediate, as well as the intermediate and oldest skeletal age groups.

Results:

There was statistically significant growth across skeletal age groups in femoral physis width (p<0.001), tibial physis width (p<0.001), and medial femoral condyle (MFC) width (p<0.001) and height (p<0.001). Growth in femoral PCL height (p=0.02), femoral PCL footprint to femoral physis height (p=0.004), tibial PCL insertion width (p<0.001), tibial PCL footprint to tibial physis height (p<0.001), and tibial epiphysis height (p=0.003) and width (p<0.001) was only statistically significant between the youngest and intermediate groups. Only MFC height (p=0.03) and width (p=0.001), femoral PCL height (p=0.05), and tibial physis width (p=0.02) were significantly larger in the oldest compared to the intermediate group. Intrasubstance PCL width did not demonstrate significant age-related change (Table 2). Intrarater reliability for all measurements was excellent; interrater reliability was variable.

Conclusions:

Morphological changes of the pediatric PCL and associated osseous anatomy vary by skeletal age throughout childhood and adolescence. These changes were most pronounced in preadolescents with open physes (ages 7-12 years) compared to adolescents with closing physes (ages 13-15 years), who demonstrated slowed or plateaued growth in most dimensions. These skeletal age-dependent transformations of the PCL and surrounding osseous anatomy may guide surgical planning and inform injury risk prediction and prevention in this active population. [Table: see text][Table: see text]
Factors Influencing Operative Management of Adolescent Proximal Humerus Fractures
Authors: Chan Jason , Para Ashok , Hernandez Vanessa , Nagel Sarah , Crawford Lindsay , McCormick Sekinat , Edobor-Osula Folorunsho
Published: May 2022

Background:

Controversy exists in the treatment of adolescent proximal humerus fractures as patients reach skeletal maturity. No universally agreed upon treatment algorithm currently exists for this population.

Purpose:

The purpose of this study is to determine risk factors that may pre-dispose a patient to have surgical treatment over non-operative treatment.

Methods:

This is an IRB approved multi-center retrospective cohort study of adolescent proximal humerus fractures treated by three pediatric orthopaedic surgeons at three academic hospitals. Adolescent was defined at ages 12-17. Variables analyzed include age, weight, mechanism of injury, treatment, associated injury, Neer-Horowitz (NH)grade, neck-shaft angle of the AP, axillary lateral and scapular Y view. Two-sample T-test was used to analyze continuous variables and categorical variables were analyzed using Chi-square test.

Results:

A total of 76 patients met inclusion criteria. 38.2% of patients received operative management. 28/76 (37%) fractures were classified as NH1, 22/76 (29%) as NH2, 12/76 (16%) as NH3 and 14/76(18%) as NH4. 4% of NH1, 17% of NH2, 100% of NH3, and 100% of NH4 fractures were treated operatively (p<0.001). When these fractures were simplified into <1/3 (NH1,2) or >1/3 displaced (NH3,4), the latter group had operative intervention more often (83% vs 4%) with risk ratio (RR) of 9.23 (P<0.001). Patients who were treated operatively were older (14.1yrs) than those who were managed non-operatively (13.3yrs) (p=0.01). Of the patients in the operative group, those who were treated with ORIF were older (15.2yrs) than those who were treated via percutaneous methods (13.8yrs) (p=0.01). Adolescents who were pedestrian struck were more likely to undergo operative management than other mechanisms RR=2.2 (p<0.01). Those who were polytraumatized more likely to undergo operative management than those with isolated injuries RR= 1.9 (p=0.02). Patient gender, BMI, weight, initial neck/shaft angulation and race were not found to be predictive of operative intervention.

Conclusion:

At the time of injury, factors that predispose an adolescent patient with a proximal humerus fracture to operative intervention are increased age, greater fracture displacement, pedestrian struck mechanism and being polytraumatized. These findings suggest that higher energy mechanisms of injury are predictive factors for operative intervention in adolescent proximal humerus fractures.
Sinding-Larsen-Johansson Disease: Analysis of the Associated Factors in the Largest Cohort to Date
Authors: McCormick Kyle L. , Tedesco Liana J. , Bixby Elise C. , Swindell Hasani W. , Popkin Charles A. , Redler Lauren H.
Published: May 2022

Background:

Sinding-Larsen-Johansson Disease (SLJ) is an overuse disorder seen in skeletally immature adolescents, on the same spectrum as Osgood-Schlatter disease (OSD). SLJ is caused by weakness at the tibial tubercle apophysis, leading to stress at the patellar apophysis. Like other overuse disorders, the mechanism behind this is thought to be quadriceps tightness. However, there is a paucity in research done on SLJ, with the vast majority of research being case reports. To our knowledge, we are able to present the largest cohort to date of 40 knees in 29 patients.

Hypothesis/Purpose:

Our aim was to utilize this large cohort to look at the demographics, clinical presentation and radiographic evidence of the disease, and begin to evaluate trends in SLJ.

Methods:

A case control study was conducted utilizing pediatric patients from our institution seen between 2013 and 2019 diagnosed with SLJ. The following variables were collected: demographics, clinical presentation, sporting activities, radiological evidence of effusion and fragmentation, and posterior tibial slope.

Results:

A total of 40 knees in 29 patients were analyzed. 38% (11/29) of patients presented with bilateral disease. The mean age of presentation was 12.1 ± 1.4 years. 62% of patients were male, with an average BMI of 19.7 ± 2.9. 41% presented with concomitant overuse injuries, predominantly OSD (31%) and Sever’s Disease (7%). All of the patients played sports; basketball and soccer were the most common (27.6% each). While some patients presented with symptoms that forced them to modify their activity level (35%), the vast majority (65%) had symptoms considered “mild,” with no changes to daily activities. Most patients (96%) had stable ligamentous exams. 100% of x-rays showed evidence of an effusion. The average posterior tibial slope was 8.2 ± 2.1°, with an average fragmentation of 0.8. We found no correlation between posterior tibial slope and severity of symptoms (p = 0.75) or between posterior tibial slope and fragmentation of the tibial apophysis (p = 0.70).

Conclusion:

Most patients with SLJ present with unilateral disease. Additionally, close to half of patients presented concomitantly with other overuse disorders. These patients are consistently athletes, but the disease predominantly did not cause a change in daily activities. We also found that patellar effusion was universally present in our cohort. More work needs to be done to determine factors associated with SLJ, but we believe this is the strongest and largest analysis to date of the patients presenting with this disease.
Elective Sports Surgery Leads to Postoperative Weight Changes in Pediatric Patients
Authors: Huang Sharon G. , Ellis Henry B. , Worrall Hannah , Ramo Brandon A. , Wilson Philip L.
Published: May 2022

Background:

Patients who undergo orthopaedic surgeries often have activity restrictions during postoperative recovery. It is unknown whether these extended periods of reduced activity lead to postoperative weight changes in pediatric patients.

Purpose:

The purpose of this study was to evaluate changes in body mass index (BMI) percentile in children and adolescents following primary sports surgeries.

Methods:

After institutional review board (IRB) approval was obtained, institutional records for utilized current procedural terminology (CPT) codes were used to identify patients who underwent elective sports surgery at a single pediatric orthopaedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative BMI measurements were excluded. Demographic characteristics, height, weight, and BMI at every follow-up visit within 30 months of surgery were collected. To account for expected growth with age, BMI percentiles were calculated. Statistical analysis of changes in BMI percentile at follow-up intervals of 3-7 months, 9-18 months, and 24-30 months after surgery was performed. Analyses were also performed based on preoperative BMI category (underweight, normal-weight, overweight, or obese, per Centers for Disease Control definitions) and upper- or lower-extremity surgery.

Results:

A total of 468 patients (50.4% female, average age 14.5 years) were available for study. Seven patients (1.5%) were underweight at the time of surgery, 262 normal-weight (56%), 87 overweight (18.6%), and 112 obese (23.9%). Sixty-nine surgeries were performed on the upper extremity, while 399 were on the lower extremity. While on average patients demonstrated a tendency to increase BMI percentile at each follow-up interval, these values did not reach significance. However, analysis by preoperative BMI category revealed that at 24-30 months after surgery, normal-weight patients had increased BMI percentile by 6.74 points ( p = .041) compared to baseline, while overweight patients had decreased BMI percentile by 17.65 points ( p = .020) (Table 1). By final follow-up, 32 of 262 initially normal-weight patients had increased their weight category to overweight or obese, while 40 patients who were initially overweight or obese had favorable decreases in weight category.

Conclusion:

Children and adolescents undergoing primary sports surgeries may experience postoperative changes in BMI percentile. Normal-weight patients tend to increase weight, while overweight patients may decrease weight over 2.5 years after surgery. [Table: see text]
Establishing A Crosstalk Between Pediatric and Adult Promis Domains in Sports Medicine
Authors: Block Andrew M. , Minaie Arya , Merklein Meghan , Nepple Jeffrey
Published: May 2022

Introduction:

Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in athletes participating in orthopedic research and clinical care. PROMIS domains are separately validated in both pediatric (<18 years) and the adult (>18 years) populations. However, the utilization of PROMIS in the adolescent athlete is complicated by the inability to convert between pediatric and adult PROMIS domains.

Purpose:

This study sought to establish conversion factors to transition between pediatric and adult values of the commonly tested PROMIS domains.

Methods:

This study consisted of 100 participants, aged 14-21 years old, who presented to orthopedic outpatient clinics with lower extremity complaints in various stages from initial presentation to postoperative recovery (excluding any within three months of surgery). All participants completed both adult and pediatric versions of the following PROMIS domains: Adult/Pediatric Mobility, Adult/Pediatric Pain Interference (PI), and Adult Physical Function (PF). Linear regression was utilized to determine a conversion factor between the two age groups within each domain by the mean difference. To evaluate the clinical significance of this difference, a 5-point threshold (representing minimally clinically important difference) between the two scores was set and 1-sided t-tests were performed.

Results:

Overall, 50 pediatric patients (mean age of 15.6 ± 1.1) and 50 young adult patients (18.9 ± 1.0) were included. Each group had roughly the same ratio of males to females (18:32 v. 17:33 for the pediatric and adult groups, respectively). Adult and Pediatric domains were all strongly correlated (range of r=0.85-0.87). In both groups, subjects scored higher on Adult domains than Pediatric domains (mean difference ranging from 4.2-6.3 points), all of which were significantly different (p<0.05 for all domains). When assessed for clinical significance, only Mobility and Pain Interference performance in the pediatric group were found to be significantly different (mean difference of 5.8 and 5.4, respectively). To convert between the scores for both populations, the following were calculated: Adult Mobility to Pediatric Mobility -4.2, Adult Physical Function to Pediatric Mobility -6.3, and Adult Pain Interference to Pediatric Pain Interference -4.3.

Conclusion:

This study demonstrated that while Adult and Pediatric domains are highly correlated, over half of patients demonstrated clinically significant differences between scores. This study established correction factors to allow conversion between Pediatric and Adult PROMIS domains with high correlation.
Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Ehlers-Danlos Syndrome
Authors: Nemunaitis James , Parikh Shital N
Published: May 2022

Background:

Ehlers-Danlos syndrome (EDS) -hypermobility type is characterized by generalized hyperlaxity which is considered to be a risk factor for patellar instability. Surgery is discouraged in this subset of patients due to high rates of failure. The outcomes following isolated Medial Patellofemoral Ligament Reconstruction (MPFLR) for patellar instability in EDS population has not been reported.

Purpose:

To analyze re-dislocation rates and patient-reported outcomes of isolated MPFLR for recurrent patellar instability in adolescents with EDS. The second purpose of the study was to compare allograft vs autograft for MPFL reconstruction in this specific population.

Methods:

Between 2010 and 2016, 21 knees in 16 consecutive patients underwent isolated MPFLR reconstruction for recurrent patellar instability. The diagnosis of EDS-hypermobility type, was confirmed by genetics for all patients, with Beighton score as the chief determinants. All patients underwent isolated MPFL reconstruction with hamstring tendon graft. Recurrent dislocation rate and patient-reported outcomes, including Pedi-IKDC, Kujala Score, HSS Pedi-FABS, Banff Instability Instrument 2.0, and KOOS Knee Survey were collected at minimum 2 year follow-up.

Results:

The mean age of the cohort was 15.4 years (range 13-18 years). All patients were females. 16 knees had atraumatic mechanism of patellar dislocation. 2 patients had an osteochondral fracture. 5 patients underwent bilateral MPFLR. 9 patients had prior surgeries on their knee; 6 were failed patellar stabilization procedures but only 1 was failed MPFLR. 14 knees had hamstring autograft and 7 had hamstring allograft. At minimum 2 years follow-up, 3 of 21 knees (14.2%) had recurrent dislocation. There were no other complications. The mean pedi IKDC, Kujala, Pedi-FABS, and BANFF scores were 66.62 (95% CI 8.52), 73.5 (95% CI 8.68), 6.73 (95% CI 2.86) and 57.15 (95% CI 10.24) respectively. The overall mean KOOS pain subscale was 73.85 (95% CI 9.95) and KOOS symptoms subscale score was 48.54 (95% CI 5.56). There were no significant differences in outcome scores and re-dislocation rates between autograft and allograft (p>0.5). There was no significant correlation between functional score and Beighton score.

Conclusion:

EDS-related patellar instability are primarily atraumatic in origin without an osteochondral fracture. Patients had significant improvements in function following isolated MPFLR at minimum 2 years follow-up. However, these functional improvements were less than historical controls. Re-dislocation rate of 14% is higher than normal population. EDS and joint hypermobility is not a contraindication to MPFLR but caution is recommended in managing patient expectations.
Physical Therapy Visit Utilization is Not Associated With Hop Test Performance After Acl Reconstruction in Pediatric and Adolescent Athletes: A Multicenter Study
Authors: Saper Michael , Butler Lauren , Giampetruzzi Nicholas , Greenberg Elliot , Link Meredith , Prati Victor , Weaver Adam
Published: May 2022

Background:

The relationship between physical therapy (PT) visit utilization and performance during single-legged hop testing after anterior cruciate ligament reconstruction (ACLR) in young patients is unclear.

Purpose:

To examine the effect of PT utilization on hop testing performance in pediatric and adolescent patients after ACLR.

Methods:

A retrospective review of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions was conducted. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a return to sport (RTS) test which included single-legged hop testing. PT frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6-12 months). PT visits were recorded up until the time of hop testing. To account for variability, the average number of visits attended per week during the observed time was calculated for each patient. The effect of PT visit rate on the odds of passing a hop test was assessed using multivariable logistic regression controlling for time to test, age, sex, and insurance status. Passing was defined as achieving a limb symmetry index (LSI) ≥ 90% on all available tests (single hop, triple hop, crossover hop, and timed hop, if performed), as well as passing just the single hop test. The primary predictor of interest included the average rate of PT visits at the time of hop test (≥1 visit per week vs. <1 visit per week).

Results:

289 patients were identified (mean age, 15.7 ± 1.9 years). The mean time from surgery to the first PT visit was 0.36 ± 0.24 months. RTS testing was performed at a mean of 8.0 ± 1.9 months. Patients averaged 0.98 ± 0.38 visits per week until the RTS test. Mean LSIs for the single hop, triple hop, crossover hop, and timed hop were 96.3 ± 8.2, 97.1 ± 6.5, 98.5 ± 7.8, and 98.2 ± 7.4, respectively. 68.9% of patients passed all performed test; 85.5% passed the single hop test. The weekly rate of PT visits had no statistically significant effect on the odds of passing all performed hop tests (OR, 0.98; 95% CI, 0.56-1.71) or the single hop test (OR, 1.05; 95% CI, 0.51-2.18). Furthermore, the distribution of PT visits did not affect hop testing performance (Table 1).

Conclusion:

The rate and distribution of PT visit utilization was not associated with hop testing performance in pediatric and adolescent patients after ACLR. [Table: see text]
Sport Participation and Specialization Characteristics in a Pediatric Sports Medicine Clinic
Authors: Worrall Hannah M. , Cooper Savannah , Jones Jacob C. , Miller Shane M. , Chung Jane S.
Published: May 2022

Background:

Recent trends in youth sports demonstrate athletes specializing in a single sport at younger ages in an effort to increase athletic success. Research suggests that increased training volume and early sport specialization are associated with increased injury risk, overuse injury, and athlete burnout. Although the exact threshold to avoid injuries has not been elucidated, some pediatric studies have shown increased risk of overuse injury with training more hours per week than their age in years.

Hypothesis/Purpose:

To determine if athletes presenting to a pediatric sports medicine clinic are participating in more hours per week than their age in years and associated factors related to sport participation.

Methods:

Data were prospectively collected from participants who presented to a tertiary sports medicine clinic for injury evaluation between October 2016-May 2021. Participants aged 5-<19 years who reported playing sports and had hours per week in their primary sport documented were included. Demographic and sport-related variables were reviewed. Participants were separated into two groups based on whether number of hours per week in their primary sport exceeded their age: UNDER (chronologic age and under) and OVER.

Results:

10,586 total participants: 8846 (83.6%) UNDER and 1740 (16.4%) OVER. There was no difference in age (13.7±2.6 vs 13.6±2.6 years, p=0.27) between the UNDER and OVER group. There were more males (49.7 vs 38.5%, p<0.0001) and more Hispanic or Latinos (20.2 vs 16.4%, p<0.0001) in the UNDER compared to the OVER group. Soccer (23.0%) was the most common primary sport for the UNDER group while gymnastics (27.1%) was for the OVER group. More participants considered themselves single-sport athletes (68.5 vs 54.1%, p<0.0001) and reported their highest level of competition as club/select/travel (52.0 vs 38.2%, p<0.0001) in the OVER group than the UNDER group. The OVER group reported a significantly higher number of sport participation hours per week than the UNDER group (20.5±8.2 vs 6.9±3.7 hours, p<0.0001, Figure 1), an additional year (6.8±3.2 vs 5.6±3.3 years, p<0.0001), and weeks per year participating in their primary sport (41.7±13.4 vs 32.0±15.5 weeks, p<0.0001).

Conclusion:

About 15% of athletes seen at the sports medicine clinic reported participating in more hours per week than their age. These athletes were more likely to report being single-sport athletes and participating in club-style teams. Understanding this information may aid providers in educating families in the OVER group about potential increased risk for injury due to high weekly participation volumes and sport specialization. [Figure: see text]
Ultrasound Assessment of Syndesmotic Injuries in a Pediatric Population
Authors: Heitz Pierre-Henri , Miron Marie-Claude , Beauséjour Marie , DiLiddo Lydia , Hupin Mathilde , Nault Marie-Lyne
Published: May 2022

Background:

Syndesmotic injuries have a higher prevalence in athletes and can present long-term complications particularly in pediatric population. Early diagnosis is necessary and can be done using various modalities, but, they either present poor sensitivity, poor clinical feasibility or are exclusively static. Ultrasound (US) could compensate for those drawbacks.

Hypothesis/Purpose:

The aim of this study was to determine (1) the benefit of direct visualization of the anterior-inferior tibiofibular ligament (AiTFL) and (2) tibiofibular clear space (TFCS) cut-off points regarding the integrity of the syndesmotic ligaments using US imaging.

Methods:

A prospective cohort study including all suspected syndesmotic injury in a pediatric population was done. Participants had both ankles assessed with US imaging for description of AiTFL integrity as our static assessment and for TFCS measures as our dynamic evaluation. For dynamic assessment, the distance between the distal tibia and fibula was first measure in neutral position then in external rotation for each ankle. This providing a total of five different TFCS combinations for receiver operating characteristics (ROC) curves analysis. Afterward, the syndesmotic ligament complex and deltoid ligament of the injured ankle were examined using MRI as the gold standard.

Results:

A total of 26 participants with suspected syndesmotic injuries were included. Mean age was 14.8 years (SD = 1.3 years). Mean time between trauma and US imaging was 56 days (SD = 43.9 days). Sensitivity and specificity of direct visualization of the AiTFL were respectively 0.79 and 1.00 with four false negative tests only found on partial tears. Only two TFCS combinations had an area under the curve (AUC) greater than 0.7 and were then considered for further analysis. The two combinations were the TFCS difference between the injured and uninjured ankle in neutral position (TFCS N I-U) and external rotation (TFCS ER I-U). Cut-off points were ranging from 0.23 mm to 0.37 mm for TFCS N I-U and from 0.11 mm to 0. 30 mm for TFCS ER I-U using ROC curve analysis.

Conclusion:

US imaging does bring an added value as a screening tool for direct visualization of the AiTFL in pediatric patients by having a good sensitivity, an excellent specificity, a low cost and being easily accessible. The complementary use of dynamic evaluation using TFCS measures could also identify dynamic instability. Cut-off points determined in this study had good sensitivity and specificity but, by being under one millimeter, further studies using dynamic US imaging are needed.
Elevated Anxiety and Depression Symptoms in Injured and Uninjured Adolescents
Authors: Young Julie A. , Allison Ellee , Mohr Drew , Bonny Andrea E. , Valasek Amy E. , Onate James A.
Published: May 2022

Introduction:

Musculoskeletal injuries are common among adolescents with roughly half reporting an injury in the last year. Injury impairs function, but it may impact psychological or behavioral well-being as well. Mental health concerns such as anxiety and depression can negatively affect an adolescent’s quality of life. As mental health disorders are being seen more frequently in the young population it is important to understand their relationship with injury. Athletes who are no longer able to participate in their normal activities due to injury may have elevated symptoms of anxiety and depression from this sudden lifestyle change. The purpose of this study was to determine if a musculoskeletal injury is associated with elevated anxiety and depression in adolescent athletes.

Methods:

Adolescents between the ages of 12-18 from sports medicine clinics presenting with musculoskeletal injuries were age and sex matched to non-injured adolescents from high school health and weight training classes as well as adolescent medicine clinics. The General Anxiety Disorder-7 and Patient Health Questionnaire-9 were used to assess for anxiety and depression symptoms, respectively. Scores of ≥5 on each questionnaire were considered elevated. Chi-Square analyses analyzed the differences in proportions of elevated anxiety and depression in the injured and uninjured participants.

Results:

Matched data was available for 108 participants, 54 in each group. Average age was 15.99± 1.58 and 83% were females. Overall, 41% reported elevated anxiety symptoms and 36% reported elevated depressive symptoms. There were no differences in the proportion of injured adolescents that had elevated anxiety or depression compared to uninjured adolescents (p=.386 and p=.071, respectively).

Discussion:

Elevated anxiety and depressive symptoms are common among injured and non-injured adolescents. High rates in our sample could be impacted by the predominance of female participants, as female are more likely to experience this symptomology than males. It is possible that the severity of the injury may influence anxiety and depression symptoms, which we did not assess. In addition, participants were enrolled during COVID-19, which may have influenced the rates of elevated anxiety and depression symptoms. Elevated anxiety and depressive symptoms are associated with high levels of functional impairment. Therefore, adolescents should be routinely assessed for anxiety and depression, regardless of injured status.
Track and Field Injuries in Children and Adolescents Presenting to us Emergency Departments-An Updated Review of the National Electronic Injury Surveillance System
Authors: Caldwel Kyra , Houlihan Nathan , Whitfield Taraje , Williams Brendan A.
Published: May 2022

Background:

Running is a highly popular activity that fosters healthy lifestyle habits in athletes of all ages. Track and field is a popular competitive youth sport with injuries estimated at 0.84 per 1000 athlete exposures among high school athletes. Injury patterns have been noted to vary by age and differ from those sustained in adult runners. Prior work has examined the epidemiology of youth track and field and running related injuries, but data from the recent decade in the setting of increasing sport specialization and year-round participation is lacking.

Purpose:

To examine the evolving epidemiology of track and field and running related injuries prompting emergency department presentation.

Methods:

A retrospective review of data obtained from the National Electronic Injury Surveillance System (NEISS) database was performed identifying children 10-18 with injuries associated with the Track & Field/Running product code (5030) from 2008-2020. National injury estimates were calculated annually and overall. Descriptive statistics were utilized to summarize injury characteristics of the entire cohort. Annual injury estimates were calculated to identify trends over the study period, which included the 2020 season interrupted by the COVID-19 pandemic.

Results:

We identified 8,399 track and field associated NEISS cases occurring from 2008-2020 representing a national estimate of 271,788 injuries [95% Confidence Interval: 250,288 to 294,24]. The majority (52%) of injuries occurred among patients 15 to 18 years of age. Injuries occurred most frequently in the lower extremity (52%) and most commonly involved the ankle (17%) and knee (15%). Sprain/strains were the most frequent injury type (40%). The majority of patients (97%) did not require hospitalization. Injury estimates of each demographic and injury characteristic with 95% confidence intervals are reported in Table 1. There was a rising annual frequency of track and field injuries seen peaking in 2017 with a notable decline in 2020 during the COVID-19 pandemic.

Conclusion:

Track and field injuries requiring emergency department presentation appear to be increasing from prior study estimates, but demonstrate similar distribution of injury characteristics. Severe injuries requiring hospitalization remain rare. The majority of injuries involve the knee and ankle and involve older adolescents. This data provides meaningful data for providers caring for and counseling adolescent athletes. [Table: see text]
Sport Specialization and Exposure in a Tertiary Concussion Program
Authors: Storey Eileen P. , Master Stephen R. , Brown Naomi J. , Magrini Danielle M. , Renjilian Chris B. , Turner Christian D. , Vernau Brian T. , Ganley Theodore J. , Arbogast Kristy B. , Grady Matthew F. , Master Christina L.
Published: May 2022

Background:

Sport specialization is an important area of focus within pediatric sports medicine with studies relating specialization to the rising incidence of sport-related injuries. The relationship between sport specialization and concussion remains unexplored.

Hypothesis/Purpose:

The objective of this study was to assess the prevalence of sport specialization and its relationship to concussion in athletes seen in a tertiary concussion program.

Methods:

Athletes completed a sport specialization questionnaire as part of a comprehensive intake questionnaire and were classified into low, moderate, or high specialization groups using a previously published 3-point scale. Categories were derived from their responses to 3 binary questions: 1) Have you quit other sports to focus on 1 sport? 2) Do you train >8 months out of the year in 1 sport? 3) Do you consider your primary sport more important than other sports?

Results:

Of the 1,098 athletes, ages 8-19 years, who completed the questionnaire, 572 (52%) were female, 718 (65.5%) had a sports-related concussion (SRC) and 439 (40%) had a prior history of concussion. The cohort was categorized into low (n=568, 51.7%), moderate (n=339, 30.9%), or high (n=191, 17.4%) sport specialization groups. Athletes reported their primary sport was more important than other sports (702, 64%) and training >8 months out of the year in 1 sport (594, 54%) more commonly than quitting other sports to focus on 1 sport (270, 25%). Sport specialization differed by primary sport (Figure 1), but did not significantly differ when primary sport was grouped by level of contact (p=0.47). Sport specialization did not significantly differ by sex, race, or ethnicity, but significantly differed by insurance (p=0.014) and age (p=0.0001), with greater specialization among those with private insurance and adolescents, respectively. Moderately or highly specialized athletes were significantly more likely than less specialized athletes to present with a SRC compared to a non-SRC (p<0.0001) and to report prior history of concussion (p=0.005). After controlling for demographic and sport participation factors, only endorsement of training more than 8 months out of the year in one sport was significantly associated with SRC (p=0.001) and prior concussion (p=0.007).

Conclusion:

Sport specialization is prevalent among youth athletes with concussion. Training >8 months out of the year in a single sport is associated with SRC and prior history of concussion. Further research is warranted to evaluate how exposure among specialized athletes relates to concussion.
How Principals’ Perceived Resource Needs and Job Demands Are Related to Their Dissatisfaction and Intention to Leave Their Schools During the COVID-19 Pandemic
Authors: Kaufman Julia H. , Diliberti Melissa K. , Hamilton Laura S.
Published: May 2022

School principals are facing greater challenges during the COVID-19 pandemic than they have ever faced, which has implications for whether they can conduct their work productively and remain in their jobs over the long term. This article draws on a unique, nationally representative, longitudinal panel of K–12 public school principals across the United States to examine principals’ self-reported resource needs and job demands during the COVID-19 pandemic as well as how those resource needs and demands are related to principals’ dissatisfaction and their intention to leave their job. Although principals’ reported resource needs (which increased over time) and teacher shortages were consistently related to dissatisfaction and intention to leave, various other job demands were predictors of dissatisfaction but not the intention to leave. These results have several implications for supporting and retaining principals as well as the teachers they serve.
State Higher Education Funding During COVID-19: Lessons From Prior Recessions and Implications for Equity
Authors: Rosinger Kelly , Kelchen Robert , Baker Dominique J. , Ortagus Justin , Lingo Mitchell D.
Published: May 2022

States provide substantial support for higher education through appropriations to public colleges and universities that can be used to maintain relatively low tuition levels and funds for financial aid. Higher education often receives disproportionate cuts during recessionary periods, and it faces potentially unprecedented reductions in coming years amid a pandemic that has left some states with revenue shortfalls. How states approach higher education cuts has the potential to exacerbate existing inequities among racially minoritized and low-income students and historically underfunded institution types. In this study, we document trends in higher education funding over time and use latent profile analysis to identify distinct approaches states have taken to higher education funding. We then examine the trajectories of higher education funding within each approach over time, particularly during prior recessions. We conclude by discussing the implications of each approach for equity, particularly in light of states’ early responses to the current economic downturn.
Postpartum Experiences of Early Skin-to-Skin Contact and the Traditional Separation Approach After a Very Preterm Birth: A Qualitative Study Among Mothers
Authors: Føreland Anne Marit , Engesland Helene , Kristoffersen Laila , Fegran Liv
Published: May 2022

Traditional care immediately after very preterm birth separates the mother and child by the transfer of the infant to the neonatal intensive care unit. A nonseparation approach is currently being considered, allowing early skin-to-skin contact in the delivery room/postoperative care unit. This study aimed to explore mothers’ experiences of early skin-to-skin contact and traditional care. A qualitative study using individual semi-structured interviews with five mothers from each of the two groups was conducted. Content analysis revealed that both groups’ experiences were characterized by (i) mothers’ need to be affirmed of their infants’ vitality, (ii) bonding challenges, and (iii) benefits of skin-to-skin contact. We suggest that early skin-to-skin contact after very preterm births is crucial for the bonding process and mothers’ feelings of safety and well-being. When early skin-to-skin contact is infeasible, our findings reveal the significance of photos, information, and the father’s presence at the time of postpartum separation.
Disparity and Multimorbidity in Heart Failure Patients Over the Age of 80
Authors: Blach Anna , Pangle Amanda , Azhar Gohar , Wei Jeanne
Published: May 2022

Background: Healthcare is currently struggling to provide access and coverage for an increasingly diverse aging population who frequently have multiple co-morbid conditions complicating their care and medical management. Methods: This retrospective study analyzed the prevalence and distribution of common co-morbid conditions (hypertension, dyslipidemia, dementia, and diabetes mellitus) in 316 elderly heart failure patients (age range 80–103; mean 87 ±4.9). Results: Chart review analysis showed a racial distribution of 65 African American versus 251 Caucasian patients (21 vs. 79%). Hypertension was comparable in both groups (98.5% African American vs. 92.4% Caucasian). Dyslipidemia, diabetes and dementia diagnoses were all approximately 20% higher in African American versus Caucasian patients. The concurrent presence of all four conditions was approximately three times more prevalent in African Americans (18.5%) versus Caucasians (7.2%). Conclusion: Our study is unique for studying disparity in octogenarian and nonagenarians residing in a rural setting. Our results also highlight the importance of making a special effort to engage older African American patients in seeking healthcare. In addition, strategies must be designed to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.