bluuebunny/crossref_metadata_2025 huggingface dataset:
GENDER DIFFERENCES IN REPORTED RECOVERY TIME FROM SPORTS-RELATED CONCUSSION IN DUAL GENDER SPORTS FROM 2012-2017
Authors: Burkhart SO , Ellis CS , Jones CA , Smurawa TM , Polousky JD
Published: April 2020

Background:

Sport-related concussion (SRC) is one of the leading injuries among athletes. Previous epidemiological studies have reported incidence rates of concussion among dual gender sports in which both males and females participate including; soccer, basketball, and baseball/softball yet minimal research has been conducted on differences in recovery time following concussion in the dual gender sports mentioned above.

Purpose:

The purpose of this study was to examine injury reporting trends associated with recovery time from concussion in dual gender sports from 2012-2017.

Methods:

Athletes with a reported SRC, ages 12 to 18 participating in baseball, softball, basketball, and soccer from 2012 to 2017 were included in the current study. Injury and exposure data was extracted and analyzed from the Rank One Health Injury Surveillance Database (ROH ISD). SRC counts, percentages, and recovery time in days were reported based on extracted data. All demographic and raw data were summarized using descriptive statistics with point estimates and 95% confidence intervals calculated for all end points. Independent sample t-tests were performed at <0.05 to measure significant differences between groups.

Results:

1,306 athletes (males=583, females=723) with an SRC and corresponding date of return to play recorded in the ROH ISD and participating in dual gender sports were analyzed. 242 baseball/softball SRCs (male=103, mean recovery days=17.82; female=139, mean recovery days=22.12), 458 basketball SRCs (male=187, mean recovery days=20.16; female=271, mean recovery days=23.29), and 606 soccer SRCs (male=193, mean recovery days=19.96; female=413, mean recovery days=23.71) were included. A statistically significant difference in recovery time was observed in male and female soccer SRCs ( t=2.09, p=0.02). No significant differences were observed in recovery time in baseball/softball ( t=1.59, p=0.057) and basketball ( t=1.49, p=0.068).

Conclusions:

This is the first study of its kind to examine gender differences in report recovery time from SRCs in dual gender sports where both males and females participate. Significant gender differences were observed in reported recovery time in soccer athletes. Sports specialization, level of play, injury education level among participants, and training regiments could all be potential causes for the observed differences. Further research is warranted to explore these gender differences and identify potential causes for these findings.
USING MOVEMENT SCREENING TESTS AND BIOMECHANICAL ANALYSIS TO DIFFERENTIATE POST-CONCUSSION PEDIATRIC SOCCER ATHLETES FROM HEALTHY CONTROLS
Authors: Burkhart Scott O.
Published: April 2020

Background:

Recently, 2 controlled prospective studies of collegiate student-athletes identified 1.6 to 2.5 increased risk of subsequent lower extremity injury following concussion (Books et al., 2016; Lynall et al., 2015). The purpose of the study is to determine the potential clinical utility and application of the Functional Movement Screen (FMS), Y Balance Test (YBT), Tuck Jump Assessment (TJA), and Landing Error Scoring System (LESS) in a sample of post-concussion soccer athletes and a sample of healthy age and gender matched soccer athlete controls to identify differences. Differentiation was defined as significance in raw score performance on the FMS, YBT, TJA, LESS. Prospective data was collected on lower extremity injury within 6-months post-concussion.

Methods:

The study participants were administered the FMS, YBT, TJA, and LESS in successive order by a licensed athletic trainer. All measures were administered in a biomechanical lab setting. Post-concussion soccer athletes were administered the FMS, YBT, TJA, and LESS after receiving formal medical clearance from a licensed physician. Post-concussion soccer athletes were matched with healthy soccer athlete controls by age, gender, and years of participation. All study participants were administered screening measures at rest. All demographic and raw data were summarized using descriptive statistics with point estimates and 95% confidence intervals calculated for all end points. Independent sample t-tests were performed at <0.05 to measure significant differences between groups.

Results:

50 (17 female, 33 male; mean age=14.1; mean years of participation=6.8) post-concussion soccer athletes and 50 (17 female, 33 male; mean age=14.3; mean years of participation=6.7) matched soccer athlete controls were administered the FMS, YBT, TJA, and LESS. Significant differences were observed between the post-concussion and control groups on FMS Deep Squat ( t=-9.76, p=<0.001), Inline Lung ( t=-8.43, p=<0.001), and LESS total score (t=-9.21, p=<0.001). No other significant differences were observed.

Conclusions:

The current study identified the FMS, YBT, TJA, and LESS as potential movement screening tests in which differences could be observed in a sample of post-concussion and healthy control soccer athletes. Results from the current study identified specific differences between groups with respect to movement screening test performance on the FMS Deep Squat, Inline Lunge, and LESS total score. Further research is warranted to clearly define the observed differences. Clinicians should consider these findings when providing recommendations and discussing recovery in concussion patients.
PERIACETABULAR OSTEOTOMY IN ACTIVE DUTY U.S. MILITARY PERSONNEL: A SINGLE CENTER’S EXPERIENCE WITH A MINIMUM OF TWO YEARS FOLLOW-UP
Authors: Murtha Andrew S. , Schmitz Matthew R.
Published: April 2020

Background:

The primary focus of periacetabular osteotomy (PAO) literature has been survivorship until hip arthroplasty. This endpoint overlooks its impact on young, active patients.

Hypothesis/Purpose:

This study sought to assess the impact of the PAO on the careers of active duty members of the United States Armed Forces.

Methods:

A retrospective review identified 38 patients who underwent PAO performed by a single surgeon at an academic, military medical center from January 2014 through April 2017. Twenty-one of the patients were active duty United States military service members (16 female, 5 male) and had a minimum 28 months of post-operative follow-up at the time of review. Preoperative and postoperative duty restrictions were noted and referrals to the U.S Army and U.S. Air Force Medical Evaluation Boards (MEB) were queried.

Results:

The average age at surgery was 25.6 years (range, 19-40y). Preoperatively, sixteen patients (94.1%) were on duty restrictions, one had been referred to the MEB, and records were not available on three patients who separated from the military prior to review. Average follow-up was 3.4 years (range, 2.3 – 5.4y). Among the patients without a preoperative MEB referral, 85.0% remained on active duty (n = 12) or completed their military service commitment (n=5). Of the fourteen patients with temporary duty restrictions preoperatively, 35.7% (n=5) were relieved of their restrictions and returned to full duty and 50% (n=7) were retained on active service with permanent duty restrictions. Such permanent duty restrictions typically consisted of modifications to the aerobic component of the semiannual military fitness testing. Six patients (28.6%) were referred to the MEB including one who was referred prior to PAO. Of these patients, two were deemed fit to retain on active service with permanent duty restrictions, two were medically separated for non-hip conditions, and two were medically separated for a hip condition. The average Veteran Affairs (VA) disability score related to hip pathology in patients referred to MEB was 16% (range 0-40%).

Conclusion:

This is the first study to look at the PAO in active duty military service members. In patients with symptomatic acetabular dysplasia, PAO may provide an opportunity to relieve preoperative duty restrictions and allow for continued military service. Further study with the inclusion of patient reported outcomes are necessary assess the impact of the procedure in this active patient population.
INFLUENCE OF LOWER EXTREMITY STATIC ALIGNMENT ON DYNAMIC KNEE VALGUS IN ADOLESCENTS FOLLOWING ACL RECONSTRUCTION
Authors: VandenBerg Curtis D. , Mueske Nicole M. , Abousamra Oussama , Feifer Daniel , Sarkisova Natalya , Katzel Mia J. , Pace J. Lee , Wren Tishya A. L.
Published: April 2020

Background:

Dynamic limb valgus, particularly high knee abduction moments, are a known risk factor for anterior cruciate ligament (ACL) injury. High knee abduction moments may result from poor static anatomic limb alignment, faulty biomechanics, or a combination of both. The distinction is important because anatomic limb alignment is difficult to change, while dynamic factors can be addressed through neuromuscular or biomechanical training.

Hypothesis/Purpose:

This study assessed the influence of static (lower extremity anatomic alignment) and dynamic (kinematic and kinetic) factors on external knee abduction moments during side-step cutting in uninjured adolescent athletes.

Methods:

This retrospective study included 43 adolescents with recent unilateral ACL reconstruction (mean age 15.3 years, SD 2.0, range 10-21; 17/43 female; 3-12 months post-surgery, mean 6.5, SD 2.1). Frontal plane hip to ankle imaging (EOS) was used to measure mechanical axis deviation (perpendicular distance from the center of the femoral condyles to the mechanical axis line connecting the center of the femoral head to the center of the talar dome) and tibial-femoral angle. Femoral anteversion was measured during physical examination. 3D motion capture provided lower extremity kinematics and kinetics during quiet standing and during the loading phase (initial contact to peak knee flexion) of an anticipated 45° side-step cut, with 2-3 trials per limb averaged for analysis. Relationships among imaging, static motion capture, and dynamic motion capture measures were investigated using correlation, and backward stepwise linear regression was used to evaluate potential predictors of average dynamic knee abduction moment.

Results:

Dynamic knee abduction moment was best predicted by a combination of dynamic measures: knee and hip abduction, external knee rotation, lateral trunk lean towards the planting foot, and ankle inversion during cutting (Table 1.1). Although EOS frontal plane tibial-femoral angle was correlated with dynamic knee abduction moment (r=0.24, p=0.02), no static/anatomic variables entered the model once the dynamic measures were included.

Conclusion:

Knee abduction moments during side-step cutting were related to dynamic factors reflecting frontal plane trunk, hip, knee, and ankle motion, as well as external knee rotation. Static (anatomic) lower limb alignment did not influence knee abduction moments once these dynamic factors were considered. Knee abduction moments and ACL injury risk are therefore not dictated by anatomic alignment and can be altered through neuromuscular/biomechanical training. [Table: see text]
PEDIATRIC ORTHOPEDIC RADIOGRAPH REDUCTION: A QUALITY IMPROVEMENT INITIATIVE
Authors: Lander Sarah , Michels Julie , Brayer Anne , Obudzinski Sarah , D’amore Taylor , Chess Mitchel , Wakeman Derek , Cook P. Christopher , Sanders James
Published: April 2020

Background:

Children are more vulnerable to ionizing radiation which increases health risks later in life including cancer. An interdepartmental team developed an algorithm to guide providers ordering extremity radiographs in pediatric patients with musculoskeletal (MSK) injuries.

Purpose:

Reduce unnecessary pediatric radiation/extremity radiographs through development and implementation of an interdepartmental designed algorithm. Determine utility, safety, and efficacy of the algorithm through retrospective and prospective analysis.

Methods:

Our study was performed at an academic pediatric trauma center. An interdepartmental committee including pediatric orthopedic surgery, emergency medicine, trauma, and radiology providers created a MSK injury imaging algorithm (Figure 1). We retrospectively validated the algorithm for efficacy and safety through chart review of pediatric patients seen in the ED with MSK extremity injury, identified through CPT code, from 6/24/2016 through 8/31/2016. We determined the number of extra radiographs per patient and identified if injuries would be missed utilizing our protocol. After retrospective validation, guideline implementation was undertaken through multidisciplinary education. The imaging guideline was prospectively implemented in the pediatric ED from 6/24/2018 through 8/31/2018. We continued to prospectively evaluate through selecting one week every month over the following eight months to determine sustainability of the implemented algorithm.

Results:

Our interdepartmental team in 2016 developed a pediatric MSK radiograph protocol (Figure 1). A retrospective chart and radiograph review of 295 pediatric patients between 6/24/2016 through 8/31/2016 was analyzed correlating physical examination to appropriate radiographs. Utilizing the protocol, the review revealed an average of 2.75 extra radiographs per patient. No injuries were missed. Providers including orthopedic and emergency medicine attendings, mid-levels, and residents were educated through meetings, emails, and having the protocol posted and easily accessible. Our protocol was implemented 6/24/18 and underwent prospective enrollment and review through 8/31/18 which revealed a reduction to 0.72 radiographs per patient (P-value <0.001) (Figure 2). Eight month follow up revealed a sustainable reduction in extra radiographs per patient (Figure 3).

Conclusion:

Reduction of unnecessary radiation to pediatric patients with MSK extremity injuries was accomplished through development and implementation of a safe and effective imaging algorithm. The multidisciplinary approach combined with widespread education of pediatric providers improved buy-in driving a sustainable system improvement.

[Figure: see text][Figure: see text][Figure: see text]
OCULOMOTOR FUNCTION IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION
Authors: Zaslow Tracy , Mueske Nicole M. , Yu Gene J. , Conrad-Forrest Adriana , Edison Bianca , Wren Tishya A. L.
Published: April 2020

Background:

Visual impairments affect up to 90% of patients post-concussion. These impairments may include deficits in fixation accuracy, smooth pursuit, saccadic latencies, vergence, accommodation, and vestibule-ocular reflexes. Quantitative assessment of oculomotor function may provide a sensitive and objective measure of concussion diagnosis and recovery since coordinated eye movements require the use of diverse and widely dispersed areas of the brain. This study quantified oculomotor function over time in adolescents following concussion.

Hypothesis/Purpose:

We hypothesized that adolescent concussion patients would demonstrate deficits of oculomotor function that would resolve by the time of return to play (RTP) and remain stable after RTP.

Methods:

13 adolescent athletes diagnosed with mild to moderate concussion (7 male; mean age 15.1, SD 2.1, range 10-17 years) were prospectively evaluated at their initial visit (mean 18, range 4-43 days post-concussion), at the time of clearance to RTP (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days after RTP). 11 controls without past concussion or injury (3 male; mean age 12.3, SD 3.1, range 8-17 years) were also tested at similar time points. Eye tracking was recorded as participants followed a target moving on a screen in predefined patterns related to sinusoid and trapezoid smooth pursuit, vergence, saccade, and anti-saccade. Metrics characterizing the speed, accuracy, and variability of tracking were compared between groups and visits using t-tests and linear mixed-effects regression.

Results:

At their initial visit, patients tended to have greater overshoot and greater variability in tracking compared with controls (Table 1.1). Overshoot and variability of tracking during sinusoid smooth pursuit (both overall variability and variability of overshoot) decreased from initial visit to RTP (Table 1.2). Undershoot during sinusoid smooth pursuit tended to decrease from RTP to 1-month follow-up. The rate of convergence in the distance vergence task increased while the rate of divergence decreased between these time points.

Conclusion:

The main oculomotor deficits observed in concussed adolescents related to overshoot and variability of tracking during sinusoid smooth pursuit. These deficits resolved by the time of RTP and generally remained stable or continued improving after RTP. These results suggest that oculomotor function recovers sufficiently under current conservative treatment protocols.

[Table: see text][Table: see text]
SINGLE-LEG HOP TESTING AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IS NOT PREDICTIVE OF GRAFT RUPTURE IN ADOLESCENT PATIENTS
Authors: Yao Jie J , Snetselaar Jordan , Schmale Gregory A. , Saper Michael
Published: April 2020

Background:

Safe return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is difficult to determine in adolescent patients. Return of strength and dynamic knee stability can be assessed with functional single-leg hop testing as part of a formal RTS assessment. However, it is unclear whether performance during single-leg hop testing can predict future ACL graft rupture.

Hypothesis/Purpose:

To investigate differences in single-leg hop testing between adolescent patients who experienced a graft rupture after ACL reconstruction and those that did not.

Methods:

A retrospective review of adolescent patients whom underwent primary ACL reconstruction with a hamstring (HS) autograft identified 16 patients (10 girls, 6 boys) with single-leg hop testing data prior to graft failure. A nearest neighbor match algorithm was used to age-, sex-, surgeon-, and graft-match 16 patients without graft rupture. All patients followed a standardized rehabilitation protocol following surgery. As part of a formal RTS test, assessment of function and dynamic strength/stability was performed using 4 different single-leg hop tests: single hop for distance, triple hop for distance, triple crossover hop for distance, and timed hop. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥ 90%. Bivariate analyses were performed to compare the two groups.

Results:

The mean age of the entire cohort at the time of surgery was 14.6 ± 1.5 years. Patients completed their RTS test at 29.0 ± 5.4 weeks. There were no statistically significant differences in demographics, graft size, or time to RTS test between groups. There were no statistically significant differences in LSIs on the single hop (p=0.90), triple hop (p=0.36), crossover hop (p=0.41), or timed hop (p=0.48). The mean LSIs on each of the four hop tests were 92.3 ± 14.7, 95.1 ± 6.1, 95.8 ± 7.1, and 98.6 ± 7.9, respectively. Passing rates were similar between groups (p=0.54).

Conclusion:

Performance on single-leg hop tests 6 months after surgery is not predictive of graft rupture following ACL reconstruction with HS autograft in adolescent patients. Further investigation of alternative RTS measures and different time frames for testing in this high-risk population is needed.
COMPARISON OF CLINICAL OUTCOMES BETWEEN INDIVIDUALS WITH MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AND ANTERIOR CRUCIATE LIGAMENT
Authors: Shingles Michael , Chov Chastity , Rogers Colleen , Lisee Caroline , Birchmeier Thomas , Triplett Ashley , Straus Michael W. , Kuenze Christopher
Published: April 2020

Background:

Return to sport is a commonly utilized outcome to denote clinical success for patients who have recently undergone medial patellofemoral ligament reconstruction (MPFLR) and ACL reconstruction (ACLR). However, there is a lack of clarity whether persistent functional and patient-reported deficits are consistent among young patients who have undergone these surgical procedures.

Purpose:

To compare patient-reported function, psychological readiness for sport, and functional symmetry between age and sex-matched individuals with recent MPFLR or ACLR.

Methods:

Fifteen participants with a history of MFPLR (sex= 8 women/7 men, age= 16.6±2.7 years, BMI= 23.2±4.1 kg/m2, months since surgery= 5.3±1.5) and 15 participants with ACLR (sex= 8 women/7 men, age= 17.1±2.8 years, BMI= 23.8±3.5 kg/m2, months since surgery= 5.9±0.8) enrolled in this cross-sectional research study. Participants were enrolled at the time of their final scheduled clinical visit. All participants completed the Tegner Activity Scale, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the ACL-RSI scale. Participants then completed knee extension-flexion isokinetic strength testing at 60°/s, isometric knee extension strength assessment at 90° of knee flexion, and a battery of single-leg hopping tasks including the single hop, triple hop, crossover hop, and single leg vertical jump from which limb symmetry indices (LSI) were calculated. Group comparisons for patient-reported outcomes, strength LSI, and single-leg hop LSI were made using independent samples t-tests and the odds of meeting ≥90% LSI, ≥90 IKDC score, or ≥64 ACL-RSI score were compared between groups using odds ratios and 95% confidence intervals.

Results:

Participants with MPFLR reported worse ACL-RSI scores (MPFL= 50.3±23.0, ACLR= 77.3±18.7, p= 0.001) and displayed worse isometric knee extension strength symmetry (MPFL= 70.5±13.4%, ACLR= 86.3±16.3%, p= 0.01) and crossover hop symmetry (MPFL= 88.6±12.0%, healthy= 98.4±9.1%, p= 0.04) when compared to participants with ACLR. The odds of a participant with ACLR achieving adequate symmetry were 1.50 (CI95%: 1.05, 2.15) times greater for isometric quadriceps strength and 5.33 times greater (1.03, 27.76) for crossover hop performance when compared to a participant with MPFLR. The odds of reporting ACL-RSI score ≥64 were 7.56 (1.50, 38.15) greater among participants with ACLR as compared to those with MPFLR.

Conclusion:

Patients with MPFL reconstruction experience worse persistent patient-reported and functional deficits during the terminal phases of rehabilitation as compared to individuals with ACLR. Specific focus on clinical focus on improving psychological readiness for sport and quadriceps strength may facilitate improved outcomes upon medical clearance for unrestricted activity among patients with MPFLR.
SEX AND AGE-BASED DIFFERENCES IN PEDIATRIC BASKETBALL INJURIES
Authors: Zynda Aaron J. , Liu Jie , Sabatino Meagan J. , Chung Jane S. , Miller Shane M. , Wilson Philip L. , Ellis Henry B.
Published: April 2020

Background:

There is limited epidemiologic data on pediatric basketball injuries and the correlation of these injuries with sex-based differences pre- and post-adolescence.

Purpose:

To describe sex and age-based injury rates associated with common pediatric basketball injuries.

Methods:

A descriptive epidemiology study was conducted utilizing publicly available injury data from the National Electronic Injury Surveillance System (NEISS) and participation data from the National Sporting Goods Association (NSGA). Data on pediatric basketball injuries from January 2012 – December 2018 in patients ages 7-17 years were extracted and used to calculate national injury incidence rates with 95% confidence intervals.

Results:

Over 7 years, 9,582 basketball injuries were reported annually in the NEISS in pediatric patients 7-17 years old, which corresponds to an annual national estimate of 294,920 visits. The 5 most common diagnoses were ankle strain/sprain (17.7%), finger strain/sprain and finger fracture (12.1%), concussion/head injury (9.4%), knee strain/sprain (4.5%), and facial laceration (3.3%). There was a notable increase in injury rate in adolescents when compared with childhood ages; 7- to 11-year-old category accounted for 19.1% of estimated injuries (56,242 injuries per year) and the 12- to 17-year-old category accounted for 80.9% (238,678 injuries per year). While boys accounted for the majority of injuries in both age groups [72.6% of all injuries (40,824 injuries per year) in the 7- to 11-year-old category and 74.4% of all injuries (177,572 injuries per year) in the 12- to 17-year-old category], overall, there was no significant difference in injury rate between boys and girls (boys: 91 injuries per 100,000 athlete days, 95% CI = 73-109; girls: 110 injuries per 100,000 athlete days, 95% CI = 92-128; p=0.140). Overall injury rates across the two age groups are reported in Table 1. Head injuries/concussions were a frequent cause of presentation (second only to finger injuries) in 7- to 11-year-olds, and occurred at a similar rate in girls and boys. In adolescents, ankle injuries were the most common injury overall, but there was a most notable increase in the rate of girls’ head and knee injury compared with their boy counterparts within these ages (Table 1).

Conclusions:

Ankle injuries continue to be the most predominant pediatric basketball injury. However, disproportionate rates of girls’ head and knee injuries during adolescent basketball suggest that style of play and knee injury prevention programs should target girls participating in youth basketball.

[Table: see text]
THE EPIDEMIOLOGY OF TIBIAL SPINE FRACTURES IN CHILDREN: A MULTICENTER INVESTIGATION
Authors: LaValva Scott M , Aoyama Julien T , Adams Alexander J , Nako Sprikena , Mistovich R Justin , Yen Yi-Meng , Ellis Henry B , Lee R Jay , Fabricant Peter D , Green Daniel W , Cruz Aristides I , McKay Scott , Schmale Gregory A. , Ganley Theodore J
Published: April 2020

Background:

Tibial spine fractures (TSFs) are intra-articular avulsion fractures of the intercondylar eminence which tend to afflict younger, skeletally immature patients. Given the relatively rare nature of these injuries, the epidemiology is not well-understood. There have been several estimates reported from single centers, though the potential for historical and regional variability in activities and risk factors limits the generalizability of their findings. Thus, the aim of the present investigation was to characterize the epidemiology of TSFs using pooled multicenter data.

Hypothesis/Purpose:

Report on the epidemiology of tibial spine fractures.

Methods:

This study was a retrospective analysis of patients with TSFs who were evaluated and treated at one of ten different sites across the United States. Information regarding patient demographics, injury mechanism, and imaging reports were collected. Fractures were classified according to the modified Meyers and McKeever method which groups the injuries as non-displaced (Type I), minimally displaced with an intact hinge (Type II), completely displaced (Type III), or completely displaced and comminuted (Type IV). Descriptive analyses were performed to evaluate the epidemiology of these fractures across the country.

Results:

We identified 469 patients (69% male; mean age 12.1 + 2.9 years) with TSFs over an eight-year period. 73% of patients were 14 years or younger. With respect to fracture severity, 5% of patients were Meyers and McKeever Type I, 35% Type II, and 50% Type III, and 10% Type IV. Overall, 60% of the fractures were completely displaced (Types III and IV). The most common mechanism of injury was a contact injury (48%), while 46% reported a non-contact twisting injury. With regard to activity at the time of injury, over half (53%) of patients were involved in sports and 14% of patients were biking recreationally. Less common causes included a fall from height (9%), motor vehicle accident (4%) recreational running (3%), and horseplay (3%). Of those injured playing sports, football (35%), skiing (21%), basketball (10%), and soccer (10%) accounted for almost 80% of the injuries in this cohort.

Conclusion:

Ultimately, our study represents the first multicenter analysis of the epidemiology of tibial spine fractures. The patient demographics and mechanism of injury for these injuries appears relatively consistent across geographic distributions. However, the recent rise in youth sports participation, single sport specialization, and year-round play in pediatric athletes appears to have generated a new principal risk factor for this injury in sports participation as opposed to the historically-described biking accidents.

[Table: see text][Figure: see text]
COMPARING RATES OF TIBIAL SPINE FRACTURES TO ACL TEARS: A 7-YEAR TREND
Authors: Aoyama Julien T , LaValva Scott M , Bram Joshua T , Reese Thomas , Ganley Theodore J
Published: April 2020

Background:

Sometimes referred to as the “pediatric” ACL injury, tibial spine fractures, although less commonly seen, are believed to share the same injury mechanism as anterior cruciate ligament (ACL) tears. And while incidence rates of pediatric ACL tears have been known to be increasing in recent years, to our knowledge, trends in incidence rates of tibial spine fractures (TSFs) in the pediatric population have not yet been reported in the literature. With sport specialization in children becoming a more commonly discussed topic, our goal was to report on the incidence rates of TSFs over a 7-year span at a single-center, and to compare rates of injury in these two conditions by sport and other patient characteristics.

Hypothesis/Purpose:

TSF and ACL injuries are both on the rise but draw from different populations.

Methods:

Retrospective comparison study of all patients presenting between 1/1/2010 and 1/1/17 with a TSF or an ACL tear at a single pediatric hospital. Medical records were queried for TSFs and ACL tears using ICD-10 and ICD-9 codes. Incidence rates over time were compared against one another. Incidence rates were further stratified based on sex, race, age, BMI, and sport/mechanism of injury, and bivariate analyses were performed to find significant differences between groups.

Results:

43 patients with a TSF and 947 patients with an ACL tear were identified. Graphical analysis showed an upward trend in the yearly incidence of both injuries, particularly in the last two years. TSF age ranged from 3 to 17 years with an average of 12.5 ± 2.8 years. ACL tear age ranged from 6 to 24 years with an average of 15.2 ± 2.3 years. Comparisons of sport, age, sex, and BMI were all found to have significant differences (p < .001 for all) between the two injuries. Race was not found to be significantly different between the two injuries.

Conclusion:

Our data supports the hypothesis that, similar to ACL tears, incidence rates of TSFs have been increasing in recent years. Injury during sport was found to be significantly different between the two injuries, with football being the most common sport for TSFs and soccer being the most common sport for ACL tears. ACL tears also draw from a slightly older age population (15.2 ± 2.3 years) than TSFs (12.5 ± 2.8 years), and TSFs are more commonly seen in males and those with lower BMI when compared to ACL tears.
RECOVERY FOLLOWING ACL RECONSTRUCTION IN MALE VS. FEMALE ADOLESCENTS: A MATCHED, SEX-BASED COHORT ANALYSIS OF 543 PATIENTS
Authors: Maguire Kathleen , Sugimoto Dai , Micheli Lyle J. , Kocher Mininder S. , Heyworth Benton E.
Published: April 2020

Background:

The subject of sex-based differences in postoperative recovery after anterior cruciate ligament reconstruction (ACLR) between males and females has been incompletely investigated, with no published comparative analyses specifically in adolescent sub-populations, which represent those most affected by ACL injury.

Purpose/Hypothesis:

To compare the 6-month postoperative functional recovery following ACLR between adolescent males and females. We hypothesized that significant differences in postoperative strength, dynamic balance, and functional hop test performance would be seen between the sexes.

Methods:

All adolescent athletes with closed or closing growth plates who underwent ACLR at a single institution between May 2014 and May 2018 and who underwent functional return-to-sport (RTS) testing between 5-8 months post-operatively were considered for inclusion in this IRB-approved study. To control for potential graft-based rehabilitation differences or donor site morbidity as confounders, only primary ACLRs performed with hamstring autograft were included. Exclusions were previous knee surgery (contralateral or ipsilateral knee), concomitant injury other than meniscus tear, allograft supplementation, and incomplete medical records. Limb Symmetry Indexes (LSI) for strength (quadriceps, hamstrings, hip abductors, hip extensors), dynamic Y-balance (anterior, posterolateral and posteromedial distance), and functional hopping (single hop, triple hop, and cross-over hop for distance, and 6-meter timed hop) were compared between groups. To account for differences in physical characteristics between the sexes, one-way between group multivariate analysis of covariance (MANCOVA) was used, with p = 0.05.

Results:

Amongst 543 subjects (211 male, 332 female), there was no significant difference in age, BMI, incidence of concomitant meniscal pathology, use of regional anesthesia blocks, or time to functional testing between cohorts. However, height and weight differences were incorporated in the MANCOVA model. Females demonstrated a statistically significant greater deficit in quadriceps strength LSI compared to males (Table 1). Both males and females demonstrated 33% hamstring strength deficits, with no statistically significant sex-based differences in dynamic balance or functional hop testing, though single leg hop deficits were less severe in males, which trended towards significance (-4% vs. -8%, p=0.062).

Conclusion:

Females demonstrated greater quadriceps strength deficits than males at 6 months post-ACLR with hamstring autograft, which may translate into greater functional hop testing deficits. Severe hamstring strength deficits persist in both males and females at this time point, underscoring the potential importance of mitigating risk of ACL re-tear by delaying return to play until a later time point with more normalized, symmetric, performance-based metrics.

[Table: see text]
FEASIBILITY AND RELIABILITY OF MUSCULOSKELETAL ULTRASOUND MEASUREMENT OF THE MEDIAL PATELLOFEMORAL LIGAMENT
Authors: Stracciolini Andrea , Boucher Laura , Jackson Sarah , Brown Naomi , Magrini Danielle , McKee-Proctor Maxwell , d’Hemecourt Pierre , Delzell Patricia
Published: April 2020

Background

The medial patellofemoral ligament (MPFL) is an important soft tissue constraint to preventing patellar dislocations in young athletes. The anatomy of the MPFL has been investigated in cadaveric studies and magnetic resonance studies. No studies to date have provided anatomical data of the MPFL on ultrasonography.

Purpose

To investigate the feasibility of musculoskeletal ultrasonography for the evaluation of the MPFL, and to determine interrater and intrarater reliability for MPFL ultrasound measures.

Methods

Ten control participants (20 knees) 20 to 50 years underwent ultrasonography performed by 3 researchers (musculoskeletal ultrasound radiologist, athletic trainer/biomechanist, primary care sports medicine physician) from 3 different institutions for interrater reliability testing. Intrarater reliability testing was performed at 2 separate institutions by 4 physicians, each performing the same knee ultrasound protocol on 20 knees in 10 study participants 2 to 3 weeks apart. In total, 180 images were created for interrater reliability, and 480 images for intrarater reliability. Examinations were performed with linear high-frequency transducers (10-18 MHz) with the participant in the supine position and the extremity flexed at 45°. Measurements included ligament length (long axis to ligament) from the patellar to the femoral attachment sites, ligament width (short axis to ligament) at the patellar attachment, and ligament thickness (long axis to ligament) midway between the patella and femur. Mean and SD were calculated for all measurements. Intraclass correlation coefficient (ICC) analysis was used to assess intrarater and interrater reliability. ICC values < 0.40 indicated poor reliability, whereas those between 0.40 and 0.75 indicated fair to good reliability, and those > 0.75 indicated excellent reliability.

Results

The mean US value for MPFL length was 44.83mm (SD 6.68), mean thickness 2.66mm (SD 0.85), and mean width 11.76mm (SD 2.99). The overall ICC values for interrater reliability testing indicated fair to good reliability for length measures (0.7) and poor reliability for thickness (–0.1) and width (0.3; Table 1.1). Overall ICC values for intrarater reliability indicated fair to good reliability for length (0.5), excellent for thickness (0.9), and poor reliability for width (–0.3; Table 1.2).

Conclusions

Musculoskeletal ultrasonography is a feasible and reliable office-based method of measuring MPFL length and thickness. These quantitative measures set the groundwork for establishing normative anatomical measures of the MPFL in athletes and establish a protocol for testing and measuring the MPFL using musculoskeletal ultrasonography.

[Table: see text][Table: see text]
DOES THE NUMBER OF PATELLOFEMORAL INSTABILITY EPISODES CORRELATE WITH THE PREVALENCE AND SEVERITY OF CHONDRAL AND OSTEOCHONDRAL LESIONS IN PEDIATRIC AND ADOLESCENT PATIENTS?
Authors: Patel Karan , Kalia Vivek , Salka Nabeel , Crawford Eileen
Published: April 2020

Disclosures:

None

Background:

Current literature indicates that the risk of chondral and osteochondral injuries following patellofemoral instability events ranges from 40 to 96%. It is unclear based on current literature if there is an association between the number of instability events and the prevalence and severity of chondral and osteochondral injuries.

Hypothesis/Purpose:

The purpose of this study was to investigate the prevalence and severity of chondral and osteochondral injury following patellar dislocations based on number of dislocations and accounting for other patellofemoral instability risk factors (patella alta, trochlear dysplasia, growth status).

Methods:

Retrospective chart review was performed for patients under the age of 18 years with a prior history of traumatic patellar dislocation, documented number of instability events, and MRI available for review. Patients were grouped into those with 1 dislocation and >1 dislocation. A priori power analysis based on previous literature demonstrated a required minimum of 82 patients in each group (alpha=.05, power=90%, p1= 70%, p2=90%). Chart review was performed on all patients with diagnosis of patellofemoral instability for past 3 years to determine inclusion and record number of dislocations. MRI and radiographs were independently reviewed by a Musculoskeletal Radiologist and Orthopaedic Surgeon. Chondral injury severity (none, partial thickness, full thickness, osteochondral), location of injury, skeletal maturity, Caton-Deschamps index (CDI), and sulcus angle were recorded. Any discrepancies were settled by review by senior author. Poisson multivariate regression, chi-square, and descriptive statistics were used as appropriate.

Results:

99 patients were included in each group. There was no statistically significant difference in the prevalence of chondral injury between patients with one dislocation versus more than one dislocation (64.65% versus 55.56%, p=.19) (Table 1). Multivariate regression analysis determined that no factor (patella alta, trochlear dysplasia, skeletal maturity, number of dislocations) was associated with prevalence of chondral injury. Multivariate regression analysis determined patella alta (CDI >1.3) was a significant factor in severity of chondral injury (p=.016).

Conclusion:

A history of multiple patellar dislocations is not associated with a higher prevalence or increased severity of chondral injury compared to a single patellar dislocation event. In patients with patella alta, a lower threshold for surgical management may be warranted due to its association with more severe cartilage injury, if not already present.

[Table: see text]
KINESIOPHOBIA IS RELATED TO BRAIN ACTIVITY FOR KNEE MOTOR CONTROL IN PEDIATRIC PATIENTS WITH PATELLOFEMORAL PAIN
Authors: Diekfuss Jed A. , Grooms Dustin R. , Coghill Robert C. , Nissen Katharine S. , Saltman Anna J. , Berz Kate , Logan Kelsey , Gubanich Paul , Bonnette Scott , Foss Kim D. Barber , Slutsky Alexis B. , Dudley Jonathan A. , Yuan Weihong , Leach James L. , Myer Gregory D.
Published: April 2020

Background:

Patellofemoral pain (PFP) is a chronic knee condition that affects over 1 in 4 physically-active girls. PFP symptomology contributes to dysfunctional motor control and heightened kinesiophobia (i.e., fear of pain/movement). Both chronic pain and kinesiophobia induce substantial changes throughout the central nervous system (CNS) in many populations who experience pain (e.g., low back pain), but such relationships have not been explored in pediatric patients with PFP. As current treatment approaches for PFP generally fail to provide complete symptom mitigation, identifying the mechanisms by which kinesiophobia exacerbate PFP and disrupt the CNS could provide mechanistic neural pathways to guide novel, brain-based treatments for pain relief.

Hypothesis/Purpose:

The purpose of this study was to determine the relationship between kinesiophobia and brain functional activation during a knee motor control task in pediatric patients with PFP.

Methods:

Girls clinically diagnosed with PFP ( n = 15; 14.3 ± 3.2 yrs) were positioned supine in a 3 Tesla magnetic resonance imaging (MRI) scanner and completed a series of unilateral 45° knee extension/flexion movements during functional MRI (fMRI). Patients completed this open kinetic chain movement at a frequency of 1.2 Hz (Figure 1.1). Patients also completed the Tampa Scale of Kinesiophobia (TSK; scores range from 0 – 68, with scores greater than 37 indicating high kinesiophobia). Correlation analyses were performed to determine whether kinesiophobia was associated with brain activity during the motor task. Statistical corrections were made to account for multiple, voxel-wise comparisons.

Results:

Study patients exhibited high kinesiophobia, with a mean TSK score of 38.27 (SD = 5.79). Neuroimaging analyses revealed that greater kinesiophobia was directly associated with increased brain activity in a cluster located within the occipital pole/cuneus, supracalcarine cortex, and intracalcarine cortex (p < .001, z-max = 4.30; Figure 1).

Conclusion:

The results revealed that the degree of kinesiophobia was related to the magnitude of visual-related brain activity for knee motor control. As perceived fear of movement increases, patients with PFP may recruit additional visual resources to compensate for pain-disrupted somatosensory processing. Future interventions that promote sensorimotor engagement and reduce visual feedback for motor control (i.e., dynamic movements with occluded vision) may be beneficial to reorganize neural processes, decrease kinesiophobia, and restore an active lifestyle in young girls with PFP.

Tables/Figures: [Figure: see text]
RE-TRAINING IS INEFFECTIVE IN IMPROVING RELIABILITY OF TIBIAL SPINE MEASUREMENTS AND CLASSIFICATION
Authors: Ellis Henry B. , Zynda Aaron J. , Cruz Aristides , Sachleben Brant , Sargent Catherine , Green Daniel , Warnick Drew , Schmale Gregory , Jagodzinski Jason , Rhodes Jason , Mistovich Justin , Fabricant Peter D. , McKay Scott , Yen Yi-Meng , Ganley Theodore
Published: April 2020

Background:

Treatment decisions for patients with tibial spine fractures heavily rely on radiographic measurements. Therefore, it is important to establish reliability of these parameters to assist with standardizing classification and subsequent treatment decisions.

Purpose:

To improve upon and subsequently validate a proposed measurement system following a live, in-person case review, re-training, and implementation of a new classification of tibial spine fractures.

Methods:

Following unacceptable classification reliability amongst the tibial spine research interest group when using the original Meyers & McKeever (M&M) classification, a one-hour, live, in-person case review (n=10) of tibial spine fractures with collective agreement on measurements and classification was performed. Based on discussion, a modification of the original M&M classification was developed to specifically define verbiage that lead to unacceptable variance in the original reliability testing. These included a quantitative definition of posterior hinge and the presence of comminution (Figure 1). New reference guidelines were provided to each reviewer demonstrating specific measurements and modified M&M classification prior to subsequent case review along with a new set of randomized, de-identified images. Forty subjects were included, determined as a precedent based on previous reliability studies. Data were analyzed using kappa and ICC for categorical and continuous variables, respectively.

Results:

Overall, data from 6 surgeon raters were included on a total of 40 cases. Amongst these raters, all variables demonstrated poor interobserver reliability: maximal posterior displacement (ICC=0.23, 95% CI=0.11-0.38), modified M&M classification (Cohen’s Kappa=0.25), amount of comminution (Cohen’s Kappa=0.27), and recommended treatment (Cohen’s Kappa=0.19).

Conclusion:

Reliability of radiographic measurements and a modified classification for tibial spine fractures remains unacceptable even amongst a group of surgeon experts. A new classification schema may be needed to help reliably guide treatment decisions for patients with tibial spine fractures.

[Figure: see text]