bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFECT OF AUTOGRAFT TYPE ON RECOVERY OF KNEE EXTENSOR MECHANISM FUNCTION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: VandenBerg Curtis D. , Katzel Mia J. , Beltran Veronica , Conrad-Forrest Adriana S. , Wren Tishya A. L.
Published: July 2021

Background:

While multiple studies have shown clear benefits of autograft over allograft for anterior cruciate ligament reconstruction (ACLR) in young athletes, disagreement remains regarding the optimal autograft choice. Recovery from ACLR may be influenced by autograft type, which can include iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), or patellar tendon (PT) depending on skeletal maturity and surgeon preference.

Hypothesis/Purpose:

This study compared knee joint function among pediatric athletes with different types of ACLR autografts. We hypothesized that knee extensor function would recover faster for graft types that did not disrupt the knee extensor mechanism (i.e., IT and HT vs. PT and QT).

Methods:

This retrospective study examined 138 pediatric athletes (73 female; mean age 15.5, SD 2.2, range 8-21 years) who had undergone sports biomechanical testing in our motion analysis laboratory following recent unilateral ACLR (mean 7.7, range 3-18 months post-surgery). All reconstructions used autografts including 20 IT, 26 HT, 37 QT, and 55 PT. Lower extremity sagittal plane kinematics and kinetics were measured during vertical drop jump landing (41 cm height) and 45° cutting. Maximum knee flexion angles, internal knee extensor moments, and energy absorption during the landing phase (initial contact to peak knee flexion) of each movement were compared among graft types and sides (ACLR vs. contralateral) using linear mixed models with sex, age, and time since surgery as covariates.

Results:

Knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during drop jump and for QT and PT during cutting (p<0.001). All graft types exhibited lower knee extensor moments and energy absorption on the operated side (p<0.05). This asymmetry was most pronounced for QT and PT and least pronounced for IT (Figure 1.1). Loading on the operated limb decreased from IT to HT to QT and PT, while loading on the contralateral limb increased similarly. Asymmetry of kinetics was significantly lower for IT compared with both QT and PT during both movements (p<0.01). Similar patterns were observed for HT but were not always statistically significant. No differences in asymmetry were observed between IT and HT or between QT and PT.

Conclusion:

Young athletes with IT and HT autografts exhibit greater engagement of the knee extensors during dynamic loading than peers with PT or QT autografts in the 18 months following ACLR. This may be due to extensor mechanism donor site morbidity associated with PT and QT grafts.

Tables/Figures:

[Figure: see text]
OPEN REDUCTION OF MEDIAL EPICONDYLE FRACTURES IN CHILDREN AND ADOLESCENTS: SUPINE VERSUS PRONE POSITION
Authors: Baghdadi Soroush , Harwood Kathleen , Arkader Alexandre , Lawrence John Todd
Published: July 2021

Background:

Operative treatment of medial epicondyle (ME) fractures can be performed in either supine or prone position. In the supine position, visualization and fixation of the fracture is difficult. However, the prone position requires extensive patient repositioning but may improve visualization.

Purpose:

The purpose of this study was to compare the results of ORIF of ME fractures between supine and prone positions.

Methods:

In a retrospective review, patients <18 who underwent open reduction of an acute ME fracture from 2011-2019 were identified. Results and complications were compared between the supine and prone positions.

Results:

204 patients were included, with a mean age of 11.7 years. 133(65.1%) were sports injuries, and 67(32.8%) had concomitant dislocation, with 17(8.3%) having an incarcerated fracture. 122(60%) patients were in the supine group, and 82(40%) in prone. The mean wheels in-wheels out time was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Mean tourniquet time was 53.1 and 55 minutes in supine and prone positions (P=0.4). C-arm usage was 27.9 and 26.9 seconds in the supine and prone groups, respectively (P=0.7). Displacement of the fracture on the first post-operative x-rays was 2.06 and 1.1 millimeters for the supine and prone groups (P<0.001). A total of 39(19%) patients had some ROM limitation at follow-up, with the majority (33 patients) having <10° loss of ROM. Five patients (2.5%) underwent 7 reoperations due to stiffness, 2 patients due to tardy ulnar nerve palsy, 2 due to non-union, and 53(26%) had a surgical hardware removal. Surgical position was not predictive of complications/reoperation. All of the nine surgeons (out of 16) who have operated at least one patient in the prone position have changed their preferred surgical position to prone.

Conclusion:

With the largest study population in the literature, the results of our study show that surgical stabilization of medial epicondyle fractures is safe, with minimal complications. While the prone position requires additional time in the operating room, presumably for positioning, the surgical procedure takes the same time and the prone position allows for a more accurate reduction. While the clinical significance of a 1mm difference in reduction quality is unknown, the observation that no surgeon that has tried the prone position had ever gone back to the supine position suggests that the surgical procedure is technically easier in this position.
ATHLETIC IDENTITY IN YOUTH ATHLETES: A SYSTEMATIC REVIEW
Authors: Edison Bianca , Rizzone Katherine , Christino Melissa
Published: July 2021

Background:

Athletic identity (AI) is an important part of the sporting culture that ties in multiple components of how an individual relates to their sport. Adult-based research has described positive and negative sequelae from adopting a robust AI, but there has been less studied on this social trait in younger age groups.

Purpose:

To systematically review the literature to investigate and describe epidemiological characteristics of athletic identity in athletes younger than 22 years old.

Methods:

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group (PRISMA) guidelines. PubMed, Embase, PsycInfo were searched to identify studies that quantitatively assessed athletic identity. Three independent reviewers performed data extraction and quality assessment. Study eligibility criteria included English-language publications from 1945-present with an athletic identity outcome in individuals 22 years old and younger. Assessment for study bias was evaluated using the Appraisal Tool for Cross-Sectional Studies (AXIS).

Results:

Ten studies met the study’s inclusion criteria, eight were cross-sectional design, one was a case series, and one involved a longitudinal design. For these studies, three out of the ten were deemed good quality by AXIS and the remainder were of fair quality. Eight of the ten studies utilized the Athletic Identity Measurement Scale and two utilized the Athlete Identity Questionnaire. Constructs examined include sports and physical activity participation, mental health, sports-related injury, and demographics such as gender and ethnicity. Scores did not vary by gender, but did by race/ethnicity. Two studies found that adolescence was a time of increased athletic identity as opposed to later in one’s training. The studies that focused on mental health and AI showed higher levels may have a protective effect against burnout, but in injured athletes, it may increase the likelihood of depression. In a study examining AI and injury, there was a bimodal association of both low AI and high AI athletes having higher risk of injury.

Conclusions:

Our systematic review of the literature resulted in very heterogeneous results, preventing analyses of common measures and outcomes. There was cross-study evidence that in adolescence, the transition to a higher level of play can be correlated with a stronger sense of athletic identity. Several studies examined the effect athletic identity can have on the mental health of youth. Further study is needed in pediatric athletes to better understand the relationship between AI and different components of sport.
CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP
Authors: Allahabadi Sachin , Pandya Nirav K.
Published: July 2021

Background:

Medial patellofemoral ligament (MPFL) reconstruction has gained popularity as a tool to manage recurrent patellar instability. The use of allograft for reconstruction includes benefits of quicker surgical time and obviating donor-site morbidity. In anterior cruciate ligament (ACL) reconstruction hesitancy exists to use allograft in younger patients based on data demonstrating higher graft failure rates. However, a similar trend of allograft failure has not been demonstrated for reconstruction of the MPFL, which has a lower tensile strength than that of the ACL.

Hypothesis/Purpose:

The purpose of this study is to evaluate outcomes including recurrent instability after MPFL reconstruction utilizing allograft tissue in pediatric and adolescent patients.

Methods:

A retrospective review was performed to identify patients of a single surgeon with MPFL reconstructions with allograft for recurrent patellar instability with minimum two-year follow-up. Surgical management was recommended after minimum six weeks of nonoperative management including bracing, physical therapy, and activity modification. Pre-operative x-rays were evaluated to assess physeal closure, lower extremity alignment and trochlear morphology, and Insall-Salvati and Caton-Deschamps ratios. MRIs were reviewed to evaluate the MPFL, trochlear morphology, and tibial tubercle trochlear groove distance (TT-TG). The allograft was fixed with a bioabsorbable screw. Descriptive statistics were used to characterize data. The primary outcome was recurrent instability.

Results:

20 patients (23 knees) 14 females (17 knees) with average age 15.8 years (range: 11.5-19.6 years) underwent MPFL reconstruction with allograft with average follow-up of 3.6 years (range: 2.2-5.9 years). Physes were open in 8 knees. Average Insall-Salvati ratio was 1.08 ± 0.16 and Caton-Deschamps index was 1.18 ± 0.15. Eighteen patients were noted to have trochlear dysplasia pre-operatively and TT-TG was 15.4 ± 3.9 mm. The three knees (13.0%) with complications had open physes – two (8.7%) had recurrent instability requiring subsequent operation and one sustained a patella fracture requiring open reduction internal fixation. The average Insall-Salvati of these three patients was 1.26 ± 0.21, Caton-Deschamps was 1.18 ± 0.21, and TT-TG was 18.3 ± 3.5mm. There were no growth disturbances noted post-operatively.

Conclusion:

MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at mid-term follow-up with few complications and low rate of recurrent instability. Anatomic factors for may contribute to recurrent instability and complications post-operatively, though larger numbers are needed for statistical analyses. Further prospective and randomized evaluation comparing autograft to allograft reconstruction is warranted to understand graft failure rates.
CHARACTERISTICS OF SPORTS BRA PREFERENCES IN ADOLESCENT FEMALES
Authors: Rizzone Katherine H. , Edison Bianca , Chung Jane , Ichesco Ingrid K. , Coleman Nailah
Published: July 2021

Background:

For many active females, a sports bra is an essential piece of equipment to comfortably participate in sports. Appropriately fitted, it allows the wearer to focus on the physical activity, rather than their body. While the number of young females participating in sports has continued to increase over recent decades, there is a paucity of literature on this important element of sports gear.

Purpose:

To characterize the usage and preferences of specific sports bra characteristics in an active female cohort

Methods:

This cross-sectional, multiceter survey study was conducted at five geographically distinct academic centers. The 19-item measure was administered via REDCap during sports medicine clinic visits. Face and content validity were established through iterative editing of the measure after feedback from area experts and a small sample of the targeted study cohort prior to initial administration. Females aged 13-22 were recruited. Chi-square and t-tests were utilized to assess differences between subgroups.

Results:

A total of 244 respondents completed the questionnaire. Mean age was 15.9 +/-2.8 years, 17.6% of the cohort was non-white and 10.3% identified as Latina. Mean BMI was 22.9 +/- 4.9, 25.8% were overweight and 11.9% were obese. The most common non-sports bra cup sizes were B (32.0%), A (17.3%) and C (17.3%). Nearly a fourth (23.7%) of the respondents reported that lack of bra support or breast discomfort had prevented them from exercising or being physically active. This was more commonly reported by those who were overweight (28.6%, BMI=25-29) or obese (37.9%, BMI>30) (p=0.08). Almost a quarter of white respondents reported breast discomfort preventing physical activity (23.6%); 20% of Black respondents and 32% of Latina respondents answered affirmatively to this question (p=0.11). Respondents that were bra size C or larger reported that their physical activity was negatively impacted by breast discomfort or lack of support 47.4% of the time, whereas only 15.8% of those with a bra size B or smaller reported the same (p<0.01). The most important factor in sports bra selection was amount of support (44.8%).

Conclusions:

Breast discomfort and lack of bra support may be an important barrier for young females of specific populations in meeting physical activity recommendations, which could lead to increased weight accrual, thus perpetuating the cycle of discomfort and lack of activity. Further research is needed to understand the issues related to sports bra preferences and usage to help inform future enhancement initiatives for this essential piece of sporting equipment.
EARLY STRENGTH TESTING AFTER ACL RECONSTRUCTION IMPACTS ISOKINETIC STRENGTH PERFORMANCE AT TIME OF RETURN TO SPORT
Authors: Weaver Adam , Roman Dylan , Mosha Maua , Giampetruzzi Nicholas
Published: July 2021

Background:

The standard of care in ACL reconstruction (ACLR) typically involves standardized strength testing at 6 months or later to assess a patient’s readiness to return to play (RTP) using isokinetic and isometric testing, and functional strength testing. Recent literature suggests that isokinetic knee extension strength should demonstrate 89% limb symmetry index (LSI) or greater prior to returning to sport. However, there is little known on the effects of strength testing early in the rehabilitation process and the relationship to strength test performance at time of RTP.

Purpose:

The purpose of this study was to examine how early post-operative strength test performance impacts isokinetic strength outcomes at RTP testing in adolescents.

Methods:

The retrospective cohort study included patients undergoing primary ACLR between 12 and 18 years of age, early post-operative strength measures, and isokinetic dynamometer strength at RTP from July 2017 and April 2019. Data was dichotomized into desired outcomes at 3 months: >70% isometric knee extension LSI, > 20 repetitions on anterior stepdown test (AST), > 90% LSI Y Balance. At RTP testing, isokinetic knee extension strength data was categorized into >89% LSI at 3 speeds (300, 180, 60°/sec). Chi square testing and odds ratio statistics were used to examine association and its magnitude.

Results:

63 patients met inclusion criteria (38 females; 15.37±1.66 years old). >70% LSI isometric knee extension strength at 3 months showed a significant association (Table 2) and demonstrated the strongest odds of having >89% LSI on isokinetic strength tests at all 3 speeds at RTP with 180°/sec being the highest (OR=14.5; 95% CI=4.25,49.43; p= <0.001). Performance on AST showed a significant association (χ2 (1, n=63) = 17.00, p <0.001), and highest odds at 180°/sec (OR=4.61; 95% CI = 1.59, 13.39, p=<0.001) and 60°/sec (OR= 3.07; 95% CI = 1.10, 8.63, p= 0.04). Combination of performance on isometric strength tests and AST showed a significant association to isokinetic strength at all three speeds, but less predictive then isometrics in isolation. (Table 2). There was no significant relationship between YBR LSI at 3 months and isokinetic strength at 6 months.

Conclusion:

Standardized strength testing early in rehabilitation can help identify patients that will successfully complete RTP testing. Our results suggest that isometric knee extension strength and timed anterior stepdown test provide meaningful clinical information early in the rehabilitation process. This data also suggests that the use of YBAL for predicting isokinetic strength performance is limited.

[Table: see text][Table: see text]
ESTIMATED PERFORMANCE FOR AGE: A NOVEL CRITERION FOR RETURN TO SPORT AFTER ANTERIOR CRUCIATE RECONSTRUCTION AND ITS PERFORMANCE COMPARED TO LIMB SYMMETRY INDICES
Authors: Magill John , Vance Danica , Risoli Thomas , Green Cynthia , Reinke Emily , Reiman Michael , Thorburg Kristian , Riboh Jonathan
Published: July 2021

INTRODUCTION:

The use of physical performance tests (PPT) for assessing readiness for return to sport (RTS) after ACL reconstruction in children is typically assessed based on a limb symmetry index (LSI). However, recent data show that: 1) healthy pediatric athletes have significant limb asymmetries at baseline and 2) the non-operative limb deconditions after ACLR, so return of LSI is not synonymous with return to pre-injury performance. We previously established a cohort of 100 healthy pediatric athletes and created growth curves for performance on 7 common PPT, allowing for the calculation of a performance percentile (PP) for any given individual based on their age. The current study explores the use of PP in a cohort of pediatric patients 6 months out from ACLR. We hypothesized that return to expected performance for age (EPFA, defined as the 50th percentile of performance among healthy volunteers of a given age) would be a more stringent criterion than 90% LSI.

METHODS:

We performed a retrospective analysis of a prospective cohort of consecutive patients (< 19 years) undergoing ACL reconstruction between 2016-2019. Patients were excluded if they did not have RTS testing 6 months after surgery (+/- 6 weeks). RTS testing consisted of 7 PPT (Figure 1). Patients were then categorized into passing and failing groups based on two cutoffs: 1) LSI > 90% and 2) PP > EPFA (50th percentile). The prevalence of passing based on these two criteria were compared using contingency analysis. A multivariable linear regression was performed to assess the effects of demographic variables on PP.

RESULTS:

Sixty-three patients were included (57% male, mean age 14.2 ± 2.4 years). Mean time from surgery to RTS testing was 181.5 ± 15.1 days. More patients were able to achieve 90% LSI than EPFA for all PPT except the timed hop (Figure 1). On average, 58% met LSI > 90% compared to only 41% meeting EPFA. Reaching 90% LSI correlated weakly with reaching EPFA for 4 of the 7 PPTs. However, of patients that would have passed based LSI, only 36.2-63.2% would have passed based on meeting EPFA (Figure 2). There was no consistent effect of age, sex, or graft type on PP.

CONCLUSION:

Six months after ACL reconstruction, fewer pediatric athletes can meet EPFA than can meet 90% LSI. Additionally, PP does not clearly correlate with LSI, suggesting that these criteria provide complementary information. Future studies investigating the use of EPFA as a cutoff for RTS are warranted.

[Figure: see text][Figure: see text]
PATELLOFEMORAL JOINT CARTILAGE RESTORATION WITH PARTICULATED JUVENILE ALLOGRAFT IN PATIENTS UNDER 21 YEARS OLD: POSTOPERATIVE MRI ANALYSIS AND RETURN TO SPORT RATES
Authors: Dawkins Brody J. , Stein Beth E. Shubin , Mintz Douglas N. , Fabricant Peter D. , Gomoll Andreas H. , Strickland Sabrina M. , Aitchison Alexandra H. , Green Daniel W.
Published: July 2021

Background:

Patellofemoral joint cartilage defects are difficult to treat due to their unique thickness and topography. Numerous cartilage restoration techniques are available to surgeons treating articular cartilage defects. However, patellofemoral joint restoration historically produces worse outcomes than tibiofemoral joint restoration. One cell-based option is particulated juvenile allograft cartilage (PJAC), though literature regarding the efficacy of this treatment is sparse, especially in patients under the age of 21 years.

Hypothesis/ Purpose:

The aim of this study is to investigate postoperative outcomes of PJAC for patellofemoral chondral defects using MRI and return to sport rates in this active, high-demand patient population.

Methods:

Patients at an urban tertiary care musculoskeletal institution who underwent PJAC for patellofemoral joint cartilage restoration were identified through records review. Patients 21 years old or younger with minimum clinical follow-up of 1 year and postoperative MRI at a minimum of 6 months after surgery were included. Cartilage restoration was assessed by MRI using the International Cartilage Repair Society’s standardized system. Sport activity was collected from medical records.

Results:

Thirty-six knees in 34 patients with a mean age of 16.1 ± 3.1 years old (range 10—21 years old) were analyzed. Mean follow-up was 32.1 months. Defects were located on the patella in 25 knees, and trochlea in 11 knees (Figure 1). There were no bipolar lesions in the cohort. Mean defect size was 2.47 cm2. Twenty-four knees (66.7%) were graded either ‘normal’ or ‘nearly normal’, and 28 knees (77.8%) had greater than 50% of the defect filled on follow-up imaging. Return to sport rates among patients who participated in a sport preoperatively was 100%.

Conclusion:

Restoration of patellofemoral chondral defects in young patients with particulated juvenile allograft can be performed with satisfactory short-term efficacy, excellent postoperative MRI appearance, and very high rates of return to sport.

Tables/Figures:

[Figure: see text]
THREE-DIMENSIONAL PREDICTORS OF FAI DISEASE PROGRESSION IN THE CONTRALATERAL HIP
Authors: Fowler Lucas M. , Clohisy John C. , Abu-Amer Wahid , Garrido Cecilia Pascual , Nepple Jeffrey J.
Published: July 2021

Background:

Bony morphologies contributing to femoroacetabular impingement (FAI) are relatively common in the general population, but drivers of symptom development are not well understood.

Hypothesis/Purpose:

The purpose of this study was to determine the role of three-dimensional bony morphology in symptom development in the contralateral hip in patients undergoing ipsilateral surgical treatment for FAI.

Methods:

The study included a prospective cohort of 161 consecutive patients (101 females, 60 males) who presented for ipsilateral FAI surgical treatment from 2013-2018. The average age was 29.1 years. Minimum follow-up was 1 year (mean, 2.3 years; range, 1-6 years). Low-dose CT scans were obtained prior to surgical treatment. Three-dimensional hip analysis of the contralateral hip was performed relative to normative data and allowed measurements of 15 key parameters. Prior to surgery and at routine follow-up, patients completed standardized questionnaires that included pain in the contralateral hip. Univariate and multivariate analyses were performed to identify independent predictors.

Results:

There were 133 patients (83%) with follow-up. Significant levels of pain in the contralateral hip were reported in 25 (18.8%) patients at presentation and 50 (35.3%) patients at follow-up. Twenty-six (19.5%) patients progressed to surgery at an average of 1.12 years. Significant predictors of symptom development were alpha angle >55° at 1:00 (p=0.037), femoral version <0° or > 20° (p=0.027), and decreased central acetabular version at 3:00 (p=0.048). Significant predictors of surgery were age <30 years (p=0.023) and alpha angle >55° at 1:00 (p=0.005).

Conclusion:

We found that roughly 1 in 5 patients undergoing surgical treatment for ipsilateral FAI experienced pain in the contralateral hip at presentation, over one third reported pain at follow-up, and 1 in 5 progressed to surgery. Higher alpha angle, abnormal femoral version, and decreased acetabular version were correlated with symptom development, while higher alpha angle and age under 30 were associated with progression to surgery.
LOOSE BODY VERSUS TROCHLEAR BIOPSY MATRIX-INDUCED AUTOLOGOUS CHONDROCYTE IMPLANTATION (MACI) MOCART SCORES AND IKDC REPORTED OUTCOMES IN PEDIATRIC PATIENTS
Authors: Hill Z , Delman C , Vandervoort W , Shelton TJ , Haus BM
Published: July 2021

Background:

Third generation autologous chondrocyte implantation (ACI) has traditionally used biopsies from non-weightbearing sites within the knee for culture and growth. Given the potential risk of functional deficits from this procedure, other donor sites are being investigated. A recent study showed no difference in the viability of the MACI implant using biopsies from the standard intercondylar region compared to biopsies from the osteochondral loose body. However, clinical outcomes using these two different donor sites remains unknown. The purpose of this study was to asses differences in clinical outcomes as measured by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART 2.0) and International Knee Documentation Committee (IKDC) scores at a minimum of 2 years post-implantation in patients who underwent a MACI procedure in the knee using cartilage grown from either the intercondylar notch or the osteochondral loose bodies.

Methods:

A retrospective study was performed on all ACI procedures from 2014 to 2017 at a single institution. Patients were split into two groups: one group having their cartilage derived from a standard intercondylar biopsy while the other group had their cartilage derived from osteochondral loose bodies. At a minimum 1-year post-implantation, MRIs of the implantation site were performed and three individual orthopaedic surgeons used the MOCART 2.0 knee score to assess the cartilage. Interclass correlation coefficients (ICC) were calculated between the 2 groups. IKDC scores were determined at a minimum 2 years after implantation. Differences between outcomes were compared using a Wilcoxon rank-sum test.

Results:

The intraclass coefficient between examiners for the MOCART scoring was excellent at 0.94. With regards to the MOCART score, the loose body group had a statistically insignificant 15-point lower median score at 65 (IQR 61-83) compared to the intercondylar group at 80 (IQR 60-89) (p=0.46). With regards to the IKDC, the loose body group had a statistically insignificant 1-point higher median score at 85 (IQR 69-96) compared to the intercondylar group at 84 (IQR 53-99) (p=0.79).

Conclusions:

This study demonstrates no difference in MOCART and patient reported outcomes in patients who had MACI from cartilage derived from either a standard intercondylar biopsy or an osteochondral loose body. Surgeons should be aware that using cartilage derived from osteochondral loose bodies is a viable option for MACI as it eliminates donor site morbidity and has comparable MOCART and functional outcomes at 2 years post-implantation compared to the standard intercondylar biopsy.

Level of evidence:

Level III
NEURAL ACTIVITY PROFILES ASSOCIATED WITH ACL INJURY-RISK MECHANICS IN ECOLOGICAL SPORT SPECIFIC VIRTUAL REALITY
Authors: Grooms Dustin R. , Diekfuss Jed A. , Slutsky-Ganesh Alexis B. , Criss Cody R. , Anand Manish , DiCesare Christopher A. , Kiefer Adam W. , Riley Michael A. , Thomas Staci , Kitchen Katie , Riehm Christopher , Bonnette Scott , Gadd Brooke , Foss Kim D. Barber , Myer Gregory D.
Published: July 2021

Background:

Anterior cruciate ligament (ACL) injury is secondary to a multifactorial etiology encompassing anatomical, biological, mechanical, and neurological factors. The nature of the injury being primarily due to non-contact mechanics further implicates neural control as a key injury-risk factor, though it has received considerably less study.

Purpose:

To determine the contribution of neural activity to injury-risk mechanics in ecological sport-specific VR landing scenarios.

Methods:

Ten female high-school soccer players (15.5±0.85 years; 165.0±6.09 cm; 59.1±11.84 kg) completed a neuroimaging session to capture neural activity during a bilateral leg press and a 3D biomechanics session performing a header within a VR soccer scenario. The bilateral leg press involved four 30 s blocks of repeated bilateral leg presses paced to a metronome beat of 1.2 Hz with 30 s rest between blocks. The VR soccer scenario simulated a corner-kick, requiring the participant to jump and head a virtual soccer ball into a virtual goal (Figure 1A-E). Initial contact and peak knee flexion and abduction angles were extracted during the landing from the header as injury-risk variables of interest and were correlated with neural activity.

Results:

Evidenced in Table 1 and Figure 1 (bottom row), increased initial contact abduction, increased peak abduction, and decreased peak flexion were associated with increased sensory, visual-spatial, and cerebellar activity (r2= 0.42-0.57, p corrected < .05, z max > 3.1, table & figure 1). Decreased initial contact flexion was associated with increased frontal cortex activity (r2= 0.68, p corrected < .05, z max > 3.1).

Conclusion:

Reduced neural efficiency (increased activation) of key regions that integrate proprioceptive, visual-spatial, and neurocognitive activity for motor control may influence injury-risk mechanics in sport. The regions found to increase in activity in relation to higher injury-risk mechanics are typically activated to assist with spatial navigation, environmental interaction, and precise motor control. The requirement for athletes to increase their activity for more basic knee motor control may result in fewer neural resources available to maintain knee joint alignment, allocate environmental attention, and handle increased motor coordination demands. These data indicate that strategies to enhance efficiency of visual-spatial and cognitive-motor control during high demand sporting activities is warranted to improve ACL injury-risk reduction.

[Figure: see text][Table: see text]
VESTIBULAR TESTING IN CHILDREN WITH DIZZINESS AND BALANCE CONCERNS AFTER CONCUSSION: LABORATORY AND CLINICAL RESULTS
Authors: Karl Michael S , Darvin Arielle , O’Reilly Robert C , Beam Megan , Dillon Karen
Published: July 2021

Background:

Dizziness is the second most common symptom in people who sustain a concussion and there are few reports on vestibular laboratory findings in the concussed pediatric population. Studies to date have shown conflicting findings regarding incidence of peripheral vestibular disorders. Hypothesis/Purpose: The purpose of this study is to report vestibular laboratory and clinical examination findings in concussed youth referred to a multidisciplinary vestibular clinic.

Methods:

A retrospective chart review was performed for all patients (n=474) seen from August 2017 to March 2020 for a single comprehensive examination in a multidisciplinary pediatric vestibular specialty clinic. Data was extracted from the charts of patients (n=64) with a history of concussion referred because of chronic dizziness and/or imbalance. Each patient was examined by a neurotologist, physical therapist, and audiologist with specialized training in vestibular disorders. Vestibular laboratory testing performed by audiologists included video nystagmography (VNG) evaluation of oculomotor function and BPPV, rotational chair, video head impulse test (vHIT), vestibular evoked myogenic potentials (VEMPs), post-headshake nystagmus, and caloric irrigation. Physical therapy clinical examination included dynamic visual acuity testing (DVA), vestibular/oculomotor screening (VOMS), and sensory organization test (SOT). Not all tests were performed on every patient secondary to factors such as insurance coverage, patient tolerance, and young age.

Results:

1 or more components of VOMS was abnormal in 30 of 53 patients examined. DVA was completed on 40 patients, 23 of which were reported as abnormal. SOT was completed on 46 patients, 18 of which demonstrated below normal composite equilibrium scores. Laboratory findings were as follows: VEMPs (n=50) were normal in all but 1 patient, vHIT (n=59), caloric irrigation (n=26), post-headshake nystagmus (n=49), and positional testing (n=55) were normal on all patients tested. Rotational chair (n=60) was performed at 4 different frequencies and revealed low gain in 3 patients.

Conclusion:

Vestibular laboratory examination was normal in nearly all subjects tested. These results suggest that in concussed youth with chronic dizziness and/or imbalance, laboratory vestibular test outcomes indicative of peripheral dysfunction are rare, which contradicts previous research in this population. In contrast, clinical vestibular assessment was abnormal in more than 50% of subjects examined which suggests that clinicians should use caution interpreting clinical examination findings for diagnosing peripheral vestibular dysfunction. Abnormal clinical examination findings may be indicative of central vestibular conditions such as space and motion intolerance and PPPD in chronically dizzy pediatric patients after concussion.

Tables/Figures:

[Table: see text][Table: see text]
Marginalization Through Curricularization of Language Teaching: Creating and Exposing Deficits in an Adult Language and Literacy Program
Authors: Sosnowski Jim
Published: July 2021

Research supports the premise that adult language and literacy instruction should build on prior linguistic knowledge and the lived experiences of the students. Despite these widely held tenets, classroom practices often do not reflect these ideals, instead providing learning opportunities that are decontextualized and isolated from the students’ lives. Drawing on 18 months of qualitative data and based on principles of participatory action research, this ethnographic case study of a peer-taught, prison-based, adult language and literacy program, situated in a state-run, medium security prison in the Midwest of the United States, focuses on the role language ideologies played in shaping classroom practices and the marginalization of both students and instructors. This study found that language ideologies contributed to a curricularized approach to language and literacy instruction focused on teaching discrete linguistic features and lexical items. This curricularization of language positioned students as linguistically deficient and shaped deficit perspectives of the students in the classroom. Additionally, the curricularized approach in conjunction with racialized understandings of “native speakerism” marginalized instructors through influencing who was perceived as a viable language model in the classroom. These findings emphasize the need to move away from reified understandings of language and build on the situated ways students use language. Additionally, moving toward a curriculum focused on situated language practices provides opportunities for students and instructors to critically examine issues of power and privilege related to language.
Radiographic Outcomes, Union Rates, and Complications Associated With Plantar Implant Positioning for Midfoot Arthrodesis
Authors: Fraser Tyler W. , Miles Daniel T. , Huang Neal , Davis Franklin B. , Dunlap Burton D. , Doty Jesse F.
Published: July 2021

Background:

Midfoot arthrodesis has long been successfully included in the treatment paradigm for a variety of pathologic foot conditions. A concern with midfoot arthrodesis is the rate of nonunion, which historically has been reported between 5% and 10%. Plantar plating has also been noted to be more biomechanically stable when compared to traditional dorsal plating in previous studies. Practical advantages of plantar plating include less dorsal skin irritation and the ability to correct flatfoot deformity from the same medial incision. The purpose of this study is to report the arthrodesis rate, the success of deformity correction, and the complications associated with plantar-based implant placement for arthrodesis of the medial column.

Methods:

A retrospective review was undertaken of all consecutive patients between 2012 and 2019 that underwent midfoot arthrodesis with plantar-positioned implants. Radiographic outcomes and complications are reported on 62 patients who underwent midfoot arthrodesis as part of a correction for hallux valgus deformity, flatfoot deformity, degenerative arthritis, Lisfranc injury, or Charcot neuroarthropathy correction.

Results:

Statistically significant improvement was seen in the lateral talus–first metatarsal angle (Meary angle) and medial arch sag angle for patients treated for flatfoot deformity correction. In patients treated for hallux valgus deformity, there was a reduction in the intermetatarsal angle from 15.4 to 6.8 degrees. The overall nonunion rate was 6.45% in all patients. The rate of nonunion was higher at the NC joint compared to the TMT joint and with compression claw plates. One symptomatic nonunion required revision surgery (1.7%). There were no nonunions when excluding neuroarthropathy patients and smokers. The odds ratio (OR) for nonunion in patients with neuroarthropathy was 6.05 ( P < .05), and in active smokers the OR was 2.33 ( P < .05).

Conclusion:

Plates placed on the plantar bone surface for midfoot arthrodesis achieved and maintained deformity correction with rare instances of symptomatic hardware for a variety of orthopedic conditions. An overall clinical and radiographic union rate of 94% was achieved. The radiographic union rate improved to 100% when excluding both neuroarthropathy patients and smokers. The incidence of nonunion was higher in smokers, neuroarthropathy patients, naviculocuneiform joint fusions, use of compression claw plates, and when attempting to fuse multiple joints. Incisional healing complications were rarely seen other than in active smokers.

Level of Evidence:

Level IV, case series.
Artificial intelligence in inflammatory bowel disease endoscopy: current landscape and the road ahead
Authors: Sundaram Suneha , Choden Tenzin , Mattar Mark C. , Desai Sanjal , Desai Madhav
Published: July 2021

Inflammatory bowel disease is a complex chronic inflammatory disorder with challenges in diagnosis, choosing appropriate therapy, determining individual responsiveness, and prediction of future disease course to guide appropriate management. Artificial intelligence has been examined in the field of inflammatory bowel disease endoscopy with promising data in different domains of inflammatory bowel disease, including diagnosis, assessment of mucosal activity, and prediction of recurrence and complications. Artificial intelligence use during endoscopy could be a step toward precision medicine in inflammatory bowel disease care pathways. We reviewed available data on use of artificial intelligence for diagnosis of inflammatory bowel disease, grading of severity, prediction of recurrence, and dysplasia detection. We examined the potential role of artificial intelligence enhanced endoscopy in various aspects of inflammatory bowel disease care and future perspectives in this review.
Measuring pulmonary function in COPD using quantitative chest computed tomography analysis
Authors: Bakker Jens T. , Klooster Karin , Vliegenthart Rozemarijn , Slebos Dirk-Jan
Published: July 2021

COPD is diagnosed and evaluated by pulmonary function testing (PFT). Chest computed tomography (CT) primarily serves a descriptive role for diagnosis and severity evaluation. CT densitometry-based emphysema quantification and lobar fissure integrity assessment are most commonly used, mainly for lung volume reduction purposes and scientific efforts.

A shift towards a more quantitative role for CT to assess pulmonary function is a logical next step, since more, currently underutilised, information is present in CT images. For instance, lung volumes such as residual volume and total lung capacity can be extracted from CT; these are strongly correlated to lung volumes measured by PFT.

This review assesses the current evidence for use of quantitative CT as a proxy for PFT in COPD and discusses challenges in the movement towards CT as a more quantitative modality in COPD diagnosis and evaluation. To better understand the relevance of the traditional PFT measurements and the role CT might play in the replacement of these parameters, COPD pathology and traditional PFT measurements are discussed.
Evaluating the association of social needs assessment data with cardiometabolic health status in a federally qualified community health center patient population
Authors: Drake Connor , Lian Tyler , Trogdon Justin G. , Edelman David , Eisenson Howard , Weinberger Morris , Reiter Kristin , Shea Christopher M.
Published: July 2021

Background

Health systems are increasingly using standardized social needs screening and response protocols including the Protocol for Responding to and Assessing Patients’ Risks, Assets, and Experiences (PRAPARE) to improve population health and equity; despite established relationships between the social determinants of health and health outcomes, little is known about the associations between standardized social needs assessment information and patients’ clinical condition.

Methods

In this cross-sectional study, we examined the relationship between social needs screening assessment data and measures of cardiometabolic clinical health from electronic health records data using two modelling approaches: a backward stepwise logistic regression and a least absolute selection and shrinkage operation (LASSO) logistic regression. Primary outcomes were dichotomized cardiometabolic measures related to obesity, hypertension, and atherosclerotic cardiovascular disease (ASCVD) 10-year risk. Nested models were built to evaluate the utility of social needs assessment data from PRAPARE for risk prediction, stratification, and population health management.

Results

Social needs related to lack of housing, unemployment, stress, access to medicine or health care, and inability to afford phone service were consistently associated with cardiometabolic risk across models. Model fit, as measured by the c-statistic, was poor for predicting obesity (logistic = 0.586; LASSO = 0.587), moderate for stage 1 hypertension (logistic = 0.703; LASSO = 0.688), and high for borderline ASCVD risk (logistic = 0.954; LASSO = 0.950).

Conclusions

Associations between social needs assessment data and clinical outcomes vary by cardiometabolic condition. Social needs assessment data may be useful for prospectively identifying patients at heightened cardiometabolic risk; however, there are limits to the utility of social needs data for improving predictive performance.
Genomic surveillance of antimicrobial resistant bacterial colonisation and infection in intensive care patients
Authors: Wyres Kelly L. , Hawkey Jane , Mirčeta Mirianne , Judd Louise M. , Wick Ryan R. , Gorrie Claire L. , Pratt Nigel F. , Garlick Jill S. , Watson Kerrie M. , Pilcher David V. , McGloughlin Steve A. , Abbott Iain J. , Macesic Nenad , Spelman Denis W. , Jenney Adam W. J. , Holt Kathryn E.
Published: July 2021

Background

Third-generation cephalosporin-resistant Gram-negatives (3GCR-GN) and vancomycin-resistant enterococci (VRE) are common causes of multi-drug resistant healthcare-associated infections, for which gut colonisation is considered a prerequisite. However, there remains a key knowledge gap about colonisation and infection dynamics in high-risk settings such as the intensive care unit (ICU), thus hampering infection prevention efforts.

Methods

We performed a three-month prospective genomic survey of infecting and gut-colonising 3GCR-GN and VRE among patients admitted to an Australian ICU. Bacteria were isolated from rectal swabs (n = 287 and n = 103 patients ≤2 and > 2 days from admission, respectively) and diagnostic clinical specimens between Dec 2013 and March 2014. Isolates were subjected to Illumina whole-genome sequencing (n = 127 3GCR-GN, n = 41 VRE). Multi-locus sequence types (STs) and antimicrobial resistance determinants were identified from de novo assemblies. Twenty-three isolates were selected for sequencing on the Oxford Nanopore MinION device to generate completed reference genomes (one for each ST isolated from ≥2 patients). Single nucleotide variants (SNVs) were identified by read mapping and variant calling against these references.

Results

Among 287 patients screened on admission, 17.4 and 8.4% were colonised by 3GCR-GN and VRE, respectively. Escherichia coli was the most common species (n = 36 episodes, 58.1%) and the most common cause of 3GCR-GN infection. Only two VRE infections were identified. The rate of infection among patients colonised with E. coli was low, but higher than those who were not colonised on admission (n = 2/33, 6% vs n = 4/254, 2%, respectively, p = 0.3). While few patients were colonised with 3GCR- Klebsiella pneumoniae or Pseudomonas aeruginosa on admission (n = 4), all such patients developed infections with the colonising strain. Genomic analyses revealed 10 putative nosocomial transmission clusters (≤20 SNVs for 3GCR-GN, ≤3 SNVs for VRE): four VRE, six 3GCR-GN, with epidemiologically linked clusters accounting for 21 and 6% of episodes, respectively (OR 4.3, p = 0.02).

Conclusions

3GCR-E. coli and VRE were the most common gut colonisers. E. coli was the most common cause of 3GCR-GN infection, but other 3GCR-GN species showed greater risk for infection in colonised patients. Larger studies are warranted to elucidate the relative risks of different colonisers and guide the use of screening in ICU infection control.