bluuebunny/crossref_metadata_2025_split huggingface dataset:
EARLY SPORT SPECIALIZATION IN YOUNG FEMALE FIGURE SKATERS
Authors: Sugimoto D , Lambrinakos-Raymond K , Kobelski GP , Geminiani ET , Stracciolini A , Meehan WP 
Published: April 2020

BACKGROUND: Understanding the association between sport specialization in young athletes and injury continues to be an important goal of sports medicine specialists. However, studies focused on females were scarce. Additionally, studies dedicated to sport specialization in the performing artistic athletes, including figure skaters are deficient at this time. Purpose: 1) To investigate the prevalence of sport specialization in a cohort of female figure skaters, and 2) to determine if low back injury is more common in specialized female figure skaters compared to female figure skaters who are not classified as specialized. METHODS: Cross-sectional survey study design was used. Questionnaire data was collected from three major figure skating clubs in the Greater Boston area. Female figure skaters (age range: 5 to 22 years) were asked the following questions based on established sport specialization criteria: 1) Do you solely perform figure skating?, 2) Did you quit other sports to focus on figure skating?, and 3) Do you participate in figure skating more than 8 months/year? Status of specialization was defined as a “yes” answer to all 3 questions while “no” to any of the 3 questions was labeled as non-specialized. All participants were asked about a history of low back injuries, including muscular spine pain, stress fracture (spondylolysis/spondylolisthesis), disc protrusion/herniated disc, sciatica, and spinal cord injury. Descriptive statistics and chi-square analyses were performed, with p ≤ 0.05 as the critical statistical value. RESULTS: A total of 132 female figure skaters (mean age: 14.0±4.0 years) were analyzed. Approximately, 85% (112/132) of female figure skaters solely participated in figure skating and 54% (71/132) quit other sports to focus on figure skating. Almost all of the female figure skaters (99%) (131/132) engaged in figure skating lessons/practices > 8 months/year. About 62% (82/132) of figure skaters were classified as specialized, and 38% (50/132) were classified as non-specialized. There were no significant difference in low back injury history between the specialized female figure skaters (25.6%, 21/82) and non-specialized female figure skaters (24.0%, 12/52, p=0.836). CONCLUSION/SIGNIFICANCE: The majority of female figure skaters in this cohort were classified specialized, and almost all female figure skaters participated in figure skating more than 8 months of the year. Although no association with low back injury was found based on status of specialization, more research is needed including effects of training volume on injury risk in female figure skaters.
PHYSICAL LITERACY IN ELEMENTARY PHYSICAL EDUCATION: A SURVEY OF FUNDAMENTAL MOVEMENT SKILL PRACTICE PATTERNS
Authors: Butler Lauren S. , Gupta Apeksha , DeVerna Amie , Moore James G. , Latz Kevin , Davelaar Cassidy Foley , Sugimoto Dai ,   PRiSM Injury Prevention Research Interest Group
Published: April 2020

Background: Pediatric physical inactivity is a major public health concern. According to the 2017 State of Play report, only 24% of youth meet the recommended physical activity (PA) dosage. Previous studies identified fundamental movement skill (FMS) proficiency as a predictor of physical literacy and PA. Mastery of FMS requires direct instruction and practice; however, it is unknown how well FMS are implemented in physical education (PE). Hypothesis/Purpose: To describe FMS practice patterns in the elementary PE curriculum. We had two hypotheses: 1) Fewer PE teachers provide comprehensive FMS instruction in later curriculum (grades 4-6) compared to early curriculum (grades 1-3) and 2) Fewer PE teachers teach FMS with direct instruction methods in later curriculum compared to early curriculum. Methods: A cross sectional survey design was used. PE teachers (grades 1-6) were recruited via electronic mail from various U.S. regions from January 2018 to March 2019. An electronic questionnaire was developed to ask about timing of FMS teaching and method of instruction. Additional questions were asked about methods used to evaluate FMS proficiency, including use of a standardized assessment of gross motor development, referrals and remediation recommended for children who appeared to be falling behind, and perceived barriers to FMS instruction. Chi-square tests (p<0.05) were employed. Results: We collected 87 responses with approximately 9% from West, 42% from Midwest, and 49% from South regions. Among all responses, 54% of PE teachers taught all FMS and 40% taught all FMS with direct instruction. Approximately, 66 % taught all FMS for grades 1-3 compared to 42% for grades 4-6 (p<0.0001). Regarding instruction methods, 47% of teachers for grades 1-3 utilized direct instruction to teach all FMS compared to 27% for grades 4-6 (p=0.0007). Only 3.7% of teachers used a standardized assessment of gross motor development to evaluate FMS proficiency. For children who appeared to be falling behind, 6.7% of teachers reported accepting the child’s “best effort” in participation. Only 7.3% reported referring to an exercise program and no PE teacher sought a healthcare referral. Time was reported as the greatest barrier to improving a child’s FMS competency in 52.4% of responses. Conclusion: Results suggests that fewer PE teachers teach all FMS in late elementary PE curriculum compared to early curriculum. Additionally, fewer teachers utilize direct instruction methods to teach skills in late elementary curriculum. With time reported as the greatest barrier, a more efficient screening tool to evaluate FMS competency may be needed.
A NECK STRENGTH TRAINING PROTOCOL IN HIGH SCHOOL FOOTBALL PLAYERS FOR CONCUSSION RISK REDUCTION
Authors: Rotto Torsten , Kraus Emily , Fredericson Michael 
Published: April 2020

Background: Increased neck strength may be a protective factor for reducing concussions in youth athletes. However, little research exists regarding validated neck strength training methods among this demographic. Purpose: To determine whether a 7-week neck strength training period is sufficient to achieve significant gains in neck strength and size amongst high school football players. Additionally, to assess if increased neck strength influences concussion outcomes. Methods: This study enrolled 54 male high school football players, ages 14-17, in a 7-week strength training protocol in which neck exercises were incorporated into preseason strength and conditioning workouts (figure 1). Pre- and post-neck strength was assessed in four directions: forward flexion (FF), extension (EXT), right lateral flexion (RLF) and left lateral flexion (LLF). Strength was measured as maximal isometric head pressure applied into a pre-inflated sphygmomanometer cuff (figure 2). Concussion totals from the subsequent 2018 season were compared with totals from the 2017 and 2016 seasons per data obtained from the team’s athletic trainer. Results: Fifty athletes in total were analyzed; 4/54 athletes did not complete final testing due to scheduling conflicts. A two sample t-test of neck circumferences revealed a statistically significant increase of 0.37 cm from pre- to post-neck strength training (p=0.0025, figure 3). Single sample strength t-test analysis (corrected for cuff pre-inflation) demonstrated a statistically significant post-test strength increase of 19.8% (FF), 11.0% (EX), 18.8% (RLF), and 18.0% (LLF) (p<0.001, figure 3). The team suffered 4 concussions in the 2018 season, 2 of which were sustained by athletes who did not participate in preseason neck training, compared to 12 concussions in 2017 and 7 concussions in 2016 (figure 3). Conclusion This study demonstrates that increases in neck size and strength can be achieved amongst high school athletes using easily implemented training methods during a 7-week preseason training period. The additional observation of reduced concussion outcomes is not conclusive, though these initial results are promising. Additional research is needed to investigate the potential of neck strengthening in modifying concussion risk. Funding provided by the Stanford Medical Scholars Fellowship Program [Figure: see text][Figure: see text][Figure: see text]
AMBULATORY SURGERY TRENDS IN PEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: WHERE’S IT HAPPENING AND HOW MUCH CAN WE SAVE?
Authors: Meza Blake C. , Ganley Theodore J. , Adams Alexander J. , Sankar Wudbhav N. , Flynn John M. , Shah Apurva S. 
Published: April 2020

Background: Benefits of ambulatory surgery include more efficient operations, lower cost, and patient preference. The national frequency of anterior cruciate ligament (ACL) reconstruction in children has increased three-fold compared other pediatric orthopaedic procedures, a trend that is likely attributable to an increased rate of ACL tears associated with year-round training and competition in young athletes. Hypothesis/Purpose: The goal of this study was to utilize the Pediatric Health Information System (PHIS) to analyze the national trends towards ambulatory surgery for ACL reconstruction procedures and quantify the cost savings associated with the trend. Methods: The PHIS database was queried using Common Procedural Terminology (CPT) and International Classification of Disease (ICD-9 and 10) codes for ACL reconstruction from 2009-2017. Patient information including gender, age at surgery, region (Northeast, South, Midwest, West) and hospital cost data for each procedure was collected. Cases were classified as ambulatory or non-ambulatory (inpatient or observation). Annual rates of ambulatory surgery were calculated for each procedure regionally for hospitals with cases included in each year of the query. The Consumer Price Index (CPI) was used to adjust procedural costs for inflation. Ambulatory and non-ambulatory costs were analyzed with the Wilcoxon Signed-Rank test. Trends in rates of ambulatory surgery were compared using joinpoint regression and annual percent change (APC). Results: A total of 21,582 cases of ACL Reconstruction were identified from 33 different children’s hospitals from 2009-2017. More than half (50.3%) of the patients were female, and the average age at surgery was 15.4 years (± 2.1 years). The overall rate of ambulatory pediatric ACL reconstructions across the United States increased by 14.7% (APC 1.6%, 95% C.I. 0.8-2.4, p<0.01) from 2009 to 2017. Overall, this trend was most significant in the West (APC 2.0%, 95% C.I. 1.2-2.7, p<0.01), however in more recent years (2012-2017), there has been a similar significant increase in ambulatory pediatric ACL reconstruction in the South (APC 3.0%, 95% C.I. 1.7-4.3, p<0.01). The mean difference in median procedural cost between ambulatory and non-ambulatory ACL reconstructions was $3,145 ($13,866 vs. $10,721, p<0.01). This corresponds to national annual savings of 4.1% associated with the shift towards ambulatory surgery. Conclusions: From 2009-2017, there was a national trend towards performing pediatric ACL reconstruction in the ambulatory setting, which was accompanied by an annual 4.1% procedural cost savings. The feasibility of ambulatory surgery for other common pediatric orthopaedic surgeries should be explored in order to reduce healthcare costs. [Figure: see text]
A COMPARISON OF THE MARX ACTIVITY RATING SCALE AND THE HOSPITAL FOR SPECIAL SURGERY PEDIATRIC FUNCTIONAL ACTIVITY BRIEF SCALE
Authors: Marom Niv , Xiang William , Heath Madison R. , Boyle Caroline , Fabricant Peter D. , Marx Robert G. 
Published: April 2020

Background: The Marx Activity Rating Scale (MARS) and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) are both validated activity scales. While the MARS examines greatest physical activity level within the last year, the HSS Pedi-FABS assesses the greatest level of physical activity within the last month. Purpose: To determine whether the different time frames used in MARS and HSS Pedi-FABS affect scores on common items in both scales, and if so, to determine whether age or injury status affect this difference. Methods: The MARS and 4 analogous items on the HSS Pedi-FABS were administered sequentially in random order to patients being evaluated at two sports surgeons’ clinic for knee injuries in addition to their healthy companions in order to enroll an uninjured comparison group. Responses to each question were scored from 0-4 for a maximum overall score of 16. Participant demographics were also recorded. Paired and independent sample t-tests were used to determine mean differences between the two scales and between healthy and injured adults and children, respectively. Results: The final cohort included 88 participants of which 47% were children (ages 10-17) and 51% had a knee injury. All participants except for healthy adults scored significantly lower on the HSS Pedi-FABS than the MARS (p < 0.05, Table 1). On the HSS Pedi-FABS activity scale, healthy participants scored significantly higher than injured participants (p<0.01), but there were no significant differences based on age, Figure 1A. Conversely, on the MARS scale, children scored higher than adults (p≤0.001), but there were no significant differences based on injury, Figure 1B. Conclusion: Physical activity level is significantly different when evaluated by either MARS or its analogue portion of HSS Pedi-FABS. Because the only difference between the scales is the timeframe, the lower scores on the Pedi-FABS than the MARS are likely due to seasonal changes in activity which are not captured in the MARS. Because the Pedi-FABS analyzes a shorter window, it is more likely to capture acute changes in physical activity due to a recent injury than the MARS scale while the MARS scale is better suited for examining general physical activity unaffected by seasonality. Understating the differences between these scales can guide clinicians in using them appropriately when evaluating patient activity level. Tables: [Table: see text] Figures: [Figure: see text]
LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES
Authors: DeVries Clarabelle , Nepple Jeffrey J , Fowler Lucas , Akers Sean , Pashos Gail , Harris Michael , Clohisy John C 
Published: April 2020

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.
THE EFFECT OF A BODY CHECKING RULE CHANGE ON HEAD IMPACT BIOMECHANICS IN BANTAM ICE HOCKEY ATHLETES
Authors: Combs Patricia R. , Ford Cassie B. , Teel Elizabeth F. , Wasserman Erin B. , Cools Michael J. , Mihalik Jason P. 
Published: April 2020

Background: Body checking is the most common injury mechanism in ice hockey. Rule changes have sought to mitigate body checking exposure among youth players. In 2011, USA Hockey changed the legal body checking age from Pee Wee (11/12-year-olds) to Bantam (13/14-year-olds). Interestingly, Bantam players with checking experience during Pee Wee had a lower concussion risk relative to Bantam players without checking experience in a sample of Canadian youth hockey players. Understanding the head impact biomechanics underlying these findings could further elucidate the consequences of this rule change. Purpose: To determine the association between Pee Wee checking exposure and head impact biomechanics in a cohort of Bantam players. Methods: We prospectively collected data on Bantam ice hockey players during the 2006/07-2009/10 seasons and the 2012-2013 season. The 2006/07-2009/10 cohort (n= 61, age=13.9±0.5 years, height=168.2±8.7 cm, mass=59.9±10.4 kg) was allowed to body check (BC) as a Pee Wee player. The 2012-2013 cohort (n=15, age=13.3±0.4 years, height=167.5±7.4 cm, mass=57.5±8.6 kg) was not permitted to body check (NBC) as a Pee Wee player. Over the course of each season, head impacts were measured using in-helmet accelerometers. Only head impacts with linear acceleration ≥10 g were included in our analysis. Main outcome measures were mean linear acceleration (g) and rotational acceleration (rad/s2). Levene’s tests assessed equality of variance between groups. We employed mixed effects models to assess group differences in mean linear and rotational acceleration between BC and NBC groups. Results: The BC and NBC groups did not differ in height (t74=0.28, p=0.78) or mass (t74=0.84, p=0.40). When assessing group differences in head impact biomechanics, the NBC experienced significantly greater linear acceleration (F1,74=4.36, p=0.04) and greater rotational acceleration (F1,74=21.2, p<0.001) relative to the BC group. On average, the NBC group experienced 23.1 ± 0.87 g linear acceleration and 1993.5 ± 68.4 rad/s2 rotational acceleration compared to the BC group, which experienced 21.2 ± 0.30 g linear acceleration and 1615.9 ± 45.2 rad/s2 rotational acceleration. Conclusions: Bantam ice hockey players without body checking experience during their Pee Wee years experienced greater average linear and rotational acceleration relative to players with Pee Wee body checking experience. While removing body checking from Pee Wee ice hockey may reduce short-term injury risk, these athletes may demonstrate more high-risk head impact biomechanics when legally allowed to body check. Future research should continue to examine the influence of policy changes on head impact biomechanics and injury risk in youth ice hockey. [Figure: see text]
MAGNETIC RESONANCE QUANTIFICATION OF MENISCUS VASCULARITY IN PEDIATRIC VERSUS ADULT KNEES
Authors: Lin Kenneth M. , Gadinsky Naomi E. , Klinger Craig E. , Dyke Jonathan P. , Rodeo Scott A. , Green Daniel W. , Fabricant Peter D. , Helfet David L. , Shea Kevin G. , Lazaro Lionel E. 
Published: April 2020

Background: Despite advances in surgical techniques, implant technology, and biological augmentation, one innate limitation to meniscus healing is lack of vascularity. Ability to quantify meniscal vascularity has been limited with previous techniques, and minimal data exists describing differential vascular zones in the skeletally immature meniscus. Purpose/Hypothesis: The objective of this study is to use quantitative contrast-enhanced magnetic resonance imaging (MRI) to compare meniscal vascularity in pediatric cadaveric specimens to adults. We hypothesize that the developing meniscus has greater and more uniform vascularity throughout all zones. Methods: We utilized 10 fresh-frozen human cadaveric knees (5 immature knees, age 0-6 months; 5 mature knees, age 34-67 years). Gadolinium-enhanced MRI was performed using a previously established vascularity quantification protocol. Regions of interest corresponding to peripheral and central zones of the meniscus were identified on pre-contrast coronal images, and signal enhancement (normalized against background tissue) was compared between pre-and post-contrast images (Figure 1). Results: Quantitative MRI demonstrated increased perfusion in the peripheral zones compared to the central zones (2.3:1 in immature knees and 3:1 in mature knees) in the medial and lateral menisci separately, and both menisci aggregated. Overall, the medial and lateral menisci had similar levels of perfusion in all specimens (45.9% ± 8.3% medial vs. 54.1% ± 8.3% lateral in immature knees; 50.5% ± 11.3% medial vs. 49.5% ± 11.3% lateral in mature knees). Immature specimens demonstrated greater overall normalized meniscal signal uptake, with the 0-month specimen demonstrating the greatest proportional signal enhancement. Conclusion: While blood flow to peripheral zones is greater than to central zones in both immature and adult menisci, younger menisci receive proportionally greater overall blood flow compared to adults, including greater blood flow to the inner zone, challenging the conventional wisdom of the central zone being avascular. As younger patients become increasingly active in sports, thorough understanding of the immature meniscus is required. Greater overall vascularity, including centrally, to the developing meniscus suggests improved healing potential following injury, and further encourages meniscal preservation when possible. [Figure: see text][Figure: see text]