bluuebunny/crossref_metadata_2025_split huggingface dataset:
CAN NEAR POINT CONVERGENCE IN PEDIATRIC CONCUSSION PATIENTS PREDICT STUDENTS’ SUCCESSFUL RETURN TO LEARNING?
Authors: Koschmeder Katelyn , Mortazavi Mohammed , Rierio Hector , Handmaker Hirsch ,   CACTIS Foundation
Published: April 2020

Purpose: The purpose of this study was to identify whether abnormal near point convergence (NPC) could be used as a clinical predictor of a 10-18 year old student’s ability to successfully return to learning (RTL). Methods and Study Design: This was a retrospective chart review of 122 students who initially visited a sports medicine clinic between 11/22/17 to 02/27/19 due to a concussion. A total of 268 visits were analyzed. RTL is graded in color zones, with red = no school, orange = half time or less, yellow = half time or more, green = full time with accommodations, and blue = full clearance. No patients were reported in the red zone in our cohort due to its severity. Patients with learning disabilities or oculomotor deficits were excluded. Results: Of the patients who met the inclusion criteria, we found a statistically significant difference in average NPC between the blue and orange zones (p<0.001) using a pooled proportions test. Average NPC was 7.03cm for blue, 8.84cm for green, 12.67cm for yellow, and 14.40cm for orange representing a positive linear correlation with an R2 of 0.975. Whereas 81% of patients in the blue zone had a normal NPC (<9cm), this was true for only 31% of patients in the orange zone. There was a 43% increase in average NPC from yellow to green zone. Yellow was the most frequent color zone with 56.7% of all visits in this zone. Conclusions: NPC appears to have a strong correlation with academic tolerance and can be predictive of RTL zones. Significance: Currently, little research has been done on clinical predictors of RTL. This data supports the use of oculomotor testing, such as NPC, which can easily be completed at office visits, as predictive tools that may indicate which patients presenting with concussion need increased academic accommodations. [Figure: see text]
ARTHROSCOPIC SHOULDER STABILIZATION IN HIGH SCHOOL FOOTBALL PLAYERS: RECURRENT INSTABILITY WITH RETURN TO CONTACT SPORT
Authors: Stambaugh Jessica , Edmonds Eric , Pennock Andrew 
Published: April 2020

Background: The etiology of recurrent shoulder instability after arthroscopic surgery in the high school American football population remains unknown. Purpose/Hypothesis: To determine the risk of recurrent instability after shoulder arthroscopy upon return to competitive football. The hypothesis was that the rate of recurrence would be greater in high school players with more years of eligibility remaining (YER), suggesting greater likelihood of return to football after surgery. Methods: Consecutive male high school football players with at least one year of eligibility remaining who sustained traumatic in-season shoulder instability episode(s) and underwent arthroscopic labral stabilization by two Orthopaedic Sports surgeons at Rady Children’s Hospital San Diego between 2012 and 2017 were identified. 64 subjects aged 14-17 met inclusion criteria of which 45 were able to be contacted and included in analyses. Average follow up period was 4.06 years. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistics were conducted using chi square analysis to compare recurrence of instability with return to sport. Results: Surgery itself was career ending in 50% of cases due to reported fear of recurrent football-related injury. The hypothesis that career longevity in terms of years of eligibility remaining (YER) affects return to game play in this young active population remains unclear although preliminary results suggest positive exponential correlation. Comparative analysis demonstrates a statistically significant difference between rate of recurrence in high school football players that return to contact sports vs transition to non-contact activity after arthroscopic shoulder stabilization. Interestingly, football players who concurrently played baseball during high school demonstrated decreased risk of postoperative instability episodes. Conclusion: Risk of recurrent instability after shoulder arthroscopy is increased in high school football players who return to competitive contact sports whereas transition to non-contact and/or recreational activity likely confers protective effect. High school football players who play baseball may derive functional benefit from cross training. [Figure: see text]
EPIDEMIOLOGY OF PEDIATRIC CARTILAGE RESTORATION PROCEDURES IN THE UNITED STATES: INSURANCE AND GEOGRAPHY PLAY A ROLE
Authors: Hall Tyler B. , Hyman Max J. , Patel Neeraj M. 
Published: April 2020

Background: A number of surgical options are available for sizeable articular cartilage lesions of the knee. These include osteochondral autograft (OAU) or allograft (OAL) transfer, or autologous chondrocyte implantation (ACI). In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another, which may lead to variation in preferred practice. Hypothesis/Purpose: The purpose of this study is to analyze the epidemiology of children and adolescents undergoing OAU, OAL, and ACI in the United States, with attention to variation along the lines of demographic and geographic factors. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing OAU, OAL, and ACI between 2012 and 2018. Demographic information was collected for each subject. United States Census guidelines were used to categorize hospitals geographically into regions. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 809 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (48.6%) underwent OAL, 339 (41.9%) underwent OAU, and 77 (9.5%) underwent ACI. The most common diagnosis at the time of surgery was osteochondritis dissecans in 360 patients (44.5%) followed by an associated cruciate ligament injury in 126 (15.6%) and patellar instability in 98 (12.1%). After adjusting for confounders in a multivariate model, ACI was more 3.4 times more likely to be performed in patients with private insurance than those that were publicly insured (95% CI 1.5-7.5, p=0.002). Furthermore, a patient in this Northeast was 29.3 times more likely to undergo ACI than in the West (95% CI 4.0-217.4, p=0.001). OAU was performed most frequently in the West and Midwest (52.4% and 51.8% of the time, respectively; p<0.001). Univariate analysis also revealed differences along the lines of race, but these findings did not maintain statistical significance in multivariate analysis. Conclusion: In the United States, there is substantial variation in the procedures performed for cartilage restoration in children and adolescents. Though ACI is the least commonly selected operation overall, it is significantly more likely to be performed on patients with private insurance and those in the Northeast. OAU is the most commonly performed procedure in the West and Midwest.
THE RELATIONSHIP BETWEEN PATELLAR MORPHOLOGY AND LATERAL PATELLAR INSTABILITY
Authors: Andelman SM. , Hedgecock J. , Solomito M. , Kostyun R. , Pace JL. 
Published: April 2020

Background: Lateral patellar instability (LPI) is a substantial cause of morbidity in the pediatric population. Previously identified risk factors for LPI include trochlear dysplasia, a lateralized tibial tubercle, genu valgum, femoral anteversion, and external tibial torsion. Less is known regarding the relationship between patellar morphology and LPI. Purpose: The goal of this study is to determine whether there exists a relationship between patellar morphology and LPI. Methods: Magnetic resonance imaging (MRI) evaluation was performed for patients under 18 years of age with LPI and compared to a control group of MRIs of patients with anterior cruciate ligament (ACL) rupture. Using T2 axial MRI images, the lateral and medial facet angle of both the bone and cartilage of the patella was measured at three locations: the most proximal and distal aspects of the patella where the cartilage of the facets could be identified and the widest point of the patella. The width of the patella at each point was also recorded, resulting in 15 total data points per subject (5 at each of the three locations on the patella). Results were analyzed and compared between the instability group and the control group to determine any relationship between facet angle and LPI. Results: 196 MRIs were reviewed, 97 in the instability group and 96 in the control group. The LPI group was noted to have a less steep angle at the proximal medial patellar facet of both the bone (LPI 27.2° ± 9.3° ; control 32.7° ± 8.8°, p < 0.001) and cartilage (LPI 26.5° ± 8.8°, control 32.7° ± 8.4°, p < 0.001) as well as a less steep angle of the cartilage at the distal lateral facet (LPI 23.4° ± 7.2°, control 25.6° ± 6.6°, p = 0.033). No other differences were noted for the remaining 12 data points. Conclusion: The are very few differences in patellar morphology between patients with and without LPI. Patients were LPI have a less steep angle of the bone of the proximal medial facet, the cartilage of the proximal medial facet, and the cartilage of the distal lateral facet when compared to a control group. [Figure: see text]
OUTCOMES OF ARTHROSCOPIC LOOSE BODY MANAGEMENT IN PATELLA INSTABILITY: MEDIAL PATELLOFEMORAL LIGAMENT NEGLECT OR REPAIR VERSUS RECONSTRUCTION
Authors: Johnson Kristina P. , Carroll Alyssa N. , Pennock Andrew T. 
Published: April 2020

Background: Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. Hypothesis/Purpose: To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children. Methods: Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables. Results: 64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up. Conclusion: Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.
THE CHALLENGES OF TREATING FEMALE SOCCER PLAYERS WITH ACL INJURIES: IS THERE A BEST GRAFT CHOICE?
Authors: Britt Elise , Ouillette Ryan J. , Johnson Kristina P. , Edmonds Eric W. , Chambers Henry G. , Bastrom Tracey P. , Pennock Andrew T. 
Published: April 2020

Introduction: While Anterior Cruciate Ligament (ACL) injuries are common in female soccer players, the optimal graft option is currently unclear. Purpose: The purpose of this study was to compare outcomes of female soccer players undergoing an ACL reconstruction with either hamstring tendon autograft versus bone-patellar tendon-bone (BTB) autograft. Methods: A retrospective review of all skeletally mature adolescent female soccer players who underwent a primary ACL reconstruction with either hamstring tendon or BTB autograft between 2013 and 2016 was performed. Patients who had a multi-ligamentous reconstruction, a prior ACL injury, or had follow-up less than 2 years were excluded. Demographic, injury, and surgical variables were documented. Outcome measures included the Lysholm, Single Assessment Numerical Evaluation (SANE), Tegner activity, visual analog pain, and satisfaction scores. Ability to return soccer as well as their pre-injury level of play and any reason that they could not return was documented. Results: Ninety-three female soccer players met the inclusion criteria of which 76% (41 BTB and 30 hamstring) were available for a minimum 2 year follow-up or had a documented graft failure prior to this time. The mean age of the cohort was 15.4±1.3 years. The BTB group had a Body Mass Index (BMI) that was significantly lower than the hamstring group (23±3 vs 25±4; p=0.02). There were no other differences in demographic, injury, or surgical variables between groups. Patient reported outcomes demonstrated that most patients did well with a mean Lysholm, SANE, Satisfaction, and pain scores of 92, 88, 8.9, and 1.1 respectively with no differences between groups. The BTB autograft group did achieve a significantly higher Tegner score (6.0 vs 4.3; p=0.004). Although not reaching significance, the BTB group had a greater percentage return to pre-injury level of play (44% vs 30%; p=0.31), or return to any level of soccer play (71% vs 53%; p=0.21 and. Of the patients that returned to soccer, 30% sustained another ACL injury (retear or contralateral tear) with no differences identified based on graft selection. Conclusion: Adolescent female soccer players undergoing an ACL reconstruction have relatively high satisfaction and outcome scores independent of autograft choice. Patients and families, however, need to be counseled that less than half of patients will return to their pre-injury level of sport and if an athlete attempts to return there is a high risk of further ACL injury.
CLASSIFICATION OF ACL TEARS IN THE PEDIATRIC AND ADOLESCENT POPULATION
Authors: Kushare I , Beran M , Klingele K , Ettia E , Elabd A , Inneh I , McKay S 
Published: April 2020

Background: There have been previous imaging classification schemes in the literature that described ACL tears in adults and pediatric patients. More recent publications have described the epidemiology, injury mechanisms, and repair versus reconstruction techniques. None have proposed an arthroscopic classification for pediatric patients. Purpose: To describe our experience with a novel arthroscopic classification using 4 patterns of ACL tears depending on the type of tear and the tissue quality. Methods: An IRB approved prospective with 2 parts to this study: Part 1: Single center prospective case series using descriptive statistics of intraoperative findings. We included children ≤18 years old with an ACL tear who underwent surgery within 8 weeks of injury. Those with associated ligamentous injuries or revision surgery were excluded. We proposed a 4-stage classification as follows: I. Avulsion off femur II. <10% tear from femoral end III. Midsubstance tear IV. Single bundle tear. Part 2: Four fellowship-trained surgeons from two tertiary children’s hospitals classified ACL injury based on intraoperative video of 33 randomly selected surgeries. 2 rounds of classification were performed. Inter and intra-observer reliability studies were calculated using Kappa statistics. Results: 120 patients (73 males and 47 females) with mean age of 16 (9-20) years and mean BMI 26 (16-51) were included in this study. 59 patients (49%) had left sided injury while 61 (51%) had right sided injury. 29 (24%) patients reported contact injury while 91 (76%) reported non-contact. Isolated ACL injury was recorded in 49 patients only (41%) while concomitant injuries were recorded in 71 patients (59%). The most common associated injury was the lateral meniscus tear (33%), followed by lateral and medial meniscus tear (13.4%). According to our classification, 23 (19.2%) patients were type I, 15 (12.5%) were type II, 65 (54.2%) were type III, and 17 (14.2%) were type IV. The intra-rater reliability was excellent for 2 reviewers, good for 1 and marginal for another. The overall inter rater reliability for all 4 reviewers was marginal for both readings (k=0.35, 95% CI: 0.23-0.44; k=0.26, 95%CI: 0.16-0.35 respectively). Conclusion: With renewed interest in ACL repairs and techniques, a classification system for ACL tears can guide a proper surgical plan. Our classification system provides a step to achieve this goal. It showed overall good intra-observer reliability, with marginal inter-observer reliability.
Can EOS imaging substitute traditional AP pelvis radiographs? A Comparative study
Authors: Powell Jenna , Gibly Romie , Faulk Wade , Mayer Stephanie Watson , O’Donnell Courtney Michelle 
Published: April 2020

INTRODUCTION: Young patients followed for hip disorders often require serial imaging and incur significant radiation to the abdomen and pelvis. The EOS imaging system offers a low-radiation alternative. However, consistency with radiographic parameters from conventional radiographs (CR) have not been studied. We evaluated the reliability and validity of EOS imaging in comparison to CR in evaluating acetabular morphology. METHODS: 48 hips (27 patients, 66.67% female, 14.4 ± 3.6 years old), indicated for open hip preservation procedure between 2015-2017, which had both EOS imaging and AP pelvis CR taken pre-operatively were examined. Both symptomatic and contralateral hips were measured, excluding hips with prior osteotomies. Three orthopaedic surgeons measured Tonnis angle, lateral center edge angle (LCEA), acetabular depth ratio (ADR), and extrusion index (EI) in both imaging modalities. Images were measured twice, two weeks apart. Reliability was assessed using intraclass correlation coefficients (ICC). Bland-Altman analysis was used to evaluate test-retest agreement and inter-modality agreement. RESULTS: Test-retest reliability was excellent for all raters on all tests (ICC range 0.8047 to 0.9714). Inter-rater reliability was also excellent for all measures on both modalities (ICC range 0.8593 to 0.9547). ICC values were consistent across EOS and CR. By Bland-Altman analysis, test-retest agreement was high, with no statistically significant mean differences in any test or modality (p > 0.6) except LCEA measured on EOS images (p = 0.02), which was 1.16° lower. Tonnis angle (p < 0.005) and ADR (p < 0.001) were statistically different from EOS to CR. Bias was also not uni-directional across tests: LCEA and ADR were, on average, higher on CR while Tonnis angle and EI were, on average, higher on EOS images. Reliability between the EOS and CR images was excellent for all raters on all tests (ICC range 0.8402 to 0.9458). DISCUSSION AND CONCLUSION: LCEA, ADR, EI, and Tonnis angle have consistently high test-retest reliability, test-retest agreement, and inter-observer reliability in both EOS imaging and CR to evaluate acetabular morphology. Inter-modality disagreement was observed between EOS and CR, but the difference was small and likely not clinically significant. When establishing acetabular morphology, these results suggest that EOS may provide an opportunity to minimize radiation exposure for patients followed long-term for hip pathology while maintaining the accuracy of diagnostic measures. [Table: see text][Table: see text]
RELIABILITY OF A NOVEL KOCHER CLASSIFICATION FOR OSTEOCHONDRITIS DISSECANS
Authors: Mathew Stephen T. , Lins Laura A. , Miller Patricia , Kocher Mininder S. 
Published: April 2020

Background: Current radiographic classification systems for osteochondritis dissecans (OCD) of the knee utilize different characteristics of lesions to rate the stability and severity of disease. Classification systems such as Hefti and Nelson are widely used as the current standards for radiographic imaging and arthroscopic evaluation is the gold standard to assess stability. The purpose of this study was to compare the reliability of this new method with that of older, more established methods, as the first step in establishing its validity and clinical utility. Methods: One hundred twenty-four standardized knee MRIs of established patients with knee OCD were pre-selected to capture the spectrum of lesion types both regarding progression and location of the lesion. Each of the MRIs were classified independently by 2 readers into the Kocher, Hefti, and Nelson classification systems and a random sample was re-reviewed by one rater 6 weeks after initial review. The inter-rater and intra-rater agreement was evaluated by estimating Krippendorff’s alpha. Results: 108 knees were classified by the Kocher, Hefti, and Nelson classification systems, as 16 of the studies had an absence of the appropriate imaging sequences necessary. There were no differences in agreement across classification systems. Krippedorf’s alpha for interrater agreement was 0.51 (CI 0.33-0.66) for the Hefti classification, 0.50 (0.34-0.64) for the Nelson classification, and 0.49 (0.32-0.65) for the Kocher classification. The intrarater agreement was 0.88 (0.75-0.97) for the Hefti classification, 0.94 (0.86-0.99) for the Nelson classification and 0.98 (0.94-1.00) for the Kocher classification system. Conclusions: The novel Kocher classification for knee OCD had almost perfect intrarater agreement and moderate interrater agreement, consistent with well-established classification systems. This new classification system would be simpler with only three categories, whereas the Hefti (five) and Nelson (four) sysems had more. This simpler classification system could be widely applicable because the results could more accurately drive clinical treatment decision making for clinicians.