bluuebunny/crossref_metadata_2025_split huggingface dataset:
TRENDS IN US HIGH SCHOOL AND CLUB CHEER PRACTICE CONCUSSION REPORTING FROM 2012-2017
Authors: Burkhart Scott O. 
Published: April 2020

Background: Sport-related concussion (SRC) is one of the leading injuries among the 3.24 to 4.03 million athletes participating in cheerleading from 2012-2017. The purpose of this study was to provide a descriptive epidemiology of SRC in the school and club cheerleading practice setting from the 2012 to 2017 calendar years. Methods: Female cheerleading athletes, ages 12 to 18 participating in school or club cheer from 2012 to 2017 were included in the current study. Injury and exposure data from school and club cheerleading practices from the Rank One Health Injury Surveillance Database (ROH ISD) were analyzed. SRC counts, percentages, rates per 10,000 athletic exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Any RR or IPR with a 95% CI not containing 1.0 were considered statistically significant. Results: From 2012-2017, 951 SRCs were recorded from a sample of 51,812 females participating in school cheerleading and 12,643 females participating in club cheerleading. Cheerleading SRCs accounted for 0.40% of all injuries in sports from 2012-2017. The total SRC rate in school cheerleading was 6.02/10,000 AEs (95% CI = 5.87, 6.17). The total SRC rate in club cheerleading was 11.98/10,000 AEs (95% CI = 11.74, 12.22). The SRC rate was higher in club practices than in school practices (RR = 1.99; 95% CI = 1.89, 2.09). More SRCs occurred at school cheerleading practices (65.62%) than club practices (34.48%). The proportion of SRCs from falls onto hardwood surfaces was higher in club cheerleading practices than school cheerleading practices (IPR = 1.69; 95% CI = 1.61, 1.77) while the proportion of falls onto padded surfaces was higher in school cheerleading practices than club cheerleading practices (IPR = 2.26; 95% CI = 2.18, 2.34). Conclusions: The findings from this study provide the largest SRC incidence rates for school and club cheerleading practices to date and reveal evidence of differences in the club and school practice settings. Club cheerleading practice SRCs occurred at a higher rate than school cheerleading practice SRCs and appear to be significantly reduced by practicing on padded surfaces. These findings should be considered when educating cheerleading coaches, parents, and athletes regrading concussion injury risks as well as identifying potential areas of injury prevention. Further research is warranted to identify potential causes for injury trends observed in the current study.
MOVEMENT VARIABILITY IN PRE-TEEN AND TEENAGE ATHLETES DURING SPORTS RELATED TASKS
Authors: Edison Bianca , O’Callahan Bridget , Mueske Nicole M. , Conrad-Forrest Adriana , Katzel Mia J. , Zaslow Tracy , Wren Tishya A. L. 
Published: April 2020

Background: Movement variability may affect injury assessment and may change as athletes mature. Hypothesis/Purpose: We hypothesized that pre-teen athletes would exhibit greater variability than teenage athletes when performing drop jump, heel touch, and single leg hop motions. Methods: 55 uninjured pediatric athletes were divided into pre-teen (age 7-12 years; n=29; 11 female) and teenage (age 13-15 years; n=26; 13 female) groups of similar size. All participants performed 2-3 repetitions per side of three sports related tasks: drop jump (41 cm), heel touch (single-leg squat from 15 cm or 23 cm step, depending on whether subject height <155 cm), and single leg hop for distance. 3D kinematics were recorded using motion capture during the loading phase of each task. To assess intra-individual variability, we examined the standard deviation (SD) and range (maximum-minimum) of key metrics among the multiple repetitions of each task performed by each participant. Variability was compared between age groups using 2-sided t-tests. Results: In the drop jump and heel touch, the younger group was more variable than the older group (Figure 1.1 left). The median within-subject SD of repeat measurements varied from 1-6° in the sagittal plane, 1-3° in the frontal plane, and 1-4° in the transverse plane over both groups (Table 1.2), while the within-subject range of measurements varied from 2-11° in the sagittal, 2-5° in the frontal, and 2-7° in the transverse planes (Table 1.3). Representing a worst-case scenario, the 95th percentile for range of measurements was >15° for many sagittal plane variables and >10° for many frontal and transverse plane variables in the younger group. In the singl- leg hop, the older group was much more variable than the younger group in the sagittal plane, particularly at the trunk, pelvis, and ankle (Figure 1.1 right). The younger group was still more variable than the older group at the trunk and pelvis in the transverse plane. Median within-subject variability ranged from 2-9° for SD and 3-17° for range of repeat measurements. Conclusion: There was substantial within-subject variability in performing sports related tasks for pediatric athletes of all ages. Variability was generally lower for older athletes, but was particularly high in the older group for sagittal plane trunk and pelvis motion during single-leg hop landing, which may reflect the need to adjust for less constrained positioning of a larger proximal mass. The high variability in performing sports tasks suggests that multiple trials should be analyzed for a more complete and representative evaluation. [Figure: see text][Table: see text][Table: see text]
DUAL-TASK BALANCE CONTROL IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION
Authors: Zaslow Tracy , Burton Camille , Mueske Nicole M. , Conrad-Forrest Adriana , Edison Bianca , Wren Tishya A. L. 
Published: April 2020

Background: Previous research has identified deficient dual-task balance control at the time of return to play (RTP) and possible worsening after RTP in older adolescents/young adults with concussion. These findings have not been investigated in younger patients with concussion. Hypothesis/Purpose: We hypothesized that concussed adolescents would have slower walking speed and increased medial-lateral (ML) center of mass (COM) movement, which would normalize by the time of RTP but worsen after resuming activity. Methods: 13 adolescent concussion patients (7 male; age 10-17 years) were prospectively evaluated at their initial visit (IV) (mean 18, range 4-43 days post-concussion), at RTP clearance (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days post-RTP) along with 11 controls (3 male) seen for similarly timed visits. Standing balance was assessed using range and root mean squared (RMS) COM motion in the anterior-posterior (AP) and ML directions during standing on both legs with eyes open while performing quiet standing, dual-task audio Stroop, side-to-side head turns, and side-to-side thumb tracking tasks. Dynamic balance was assessed using walking speed and COM ML range and velocity during walking alone and with side-to-side head turns and verbal fluency (reciting words starting with “F”) dual tasks. Patients were compared against controls using t-tests, and changes over time were evaluated using linear mixed-effects regression. Results: During standing, patients had higher COM ML RMS than controls at IV during head turns and higher COM AP range during thumb tracking. COM ML motion decreased from IV to RTP (head turns range -6.5mm, p=0.058; head turns RMS -16.8mm, p=0.002; thumb range 9.2mm, p=0.012) and increased from RTP to 1 month follow-up (head turns RMS +10.0mm, p=0.040; Stroop RMS +8.4mm, p=0.086). Patients walked slower than controls at IV during all tasks, and COM ML range was higher in patients vs. controls during verbal fluency at IV and RTP. Walking speed increased from IV to RTP during verbal fluency (+7.8cm/s, p=0.044), from RTP to post-RTP in single task walking (+6.1cm/s, p=0.041), and at each successive visit during head turns (+6.0cm/s and +6.5cm/s, p<0.07). COM ML range also decreased in patients from IV to RTP with verbal fluency (-14.7mm, p=0.011) and from RTP to post-RTP in single task walking ( 4.0mm, p=0.061). Conclusion: Adolescent concussion patients had deficits in static and dynamic balance control at initial presentation. This tended to improve by RTP and only worsened post-RTP for dual-task ML control during standing, suggesting that current conservative treatment protocols are appropriate.
HEALTH DISPARITIES IN ADHERENCE WITH PRESCRIBED REHABILITATION FOLLOWING SURGICAL TREATMENT OF KNEE INJURIES IN PEDIATRIC PATIENTS
Authors: Metz Allan K. , Hart-Johnson Tami , Blackwood R. Alexander , Crawford Eileen A. 
Published: April 2020

Background: Rehabilitation is paramount to recovery following surgery for ligamentous and meniscal knee injuries, but there exists little research regarding adherence with rehabilitation in pediatric populations, especially how this relates to health disparities in this population. Hypothesis/Purpose: Our study aimed to evaluate the effect of patient socioeconomic/demographic factors on adherence with physical therapy appointments following surgical repair or reconstruction of knee injuries. This information would be used to raise awareness of health disparities and potentially develop a set of predictors for a higher risk of non-adherence with prescribed rehabilitation. Methods: This study was a retrospective chart review of patients under the age of 18 who underwent physical therapy at the authors’ institution following initial surgical repair or reconstruction of a knee injury (ACL, MCL, LCL, PCL, meniscus, patellar tendon, and tibial eminence injuries included). Surgeries from 1 January 2015 to 31 December 2016 were considered, with physical therapy being considered for dates extending to 1 January 2018. Rate of adherence with physical therapy, reasons for lack of attendance, and socioeconomic/demographic variables were gathered. Data was evaluated utilizing bivariate and separate hierarchical linear regression analyses. Results: Our study population was comprised of 108 individuals with a mean age of 15.15 ± 2.04 years and a mean compliance rate with physical therapy of 80.2 ± 11.8%. Bivariate analysis revealed Hispanic/Latino patients were more likely to cancel/no show (18 ± 22.82) than non-Hispanic/Latino patients (7.55 ± 6.88, p = 0.010). Logistic regression revealed patients were significantly less likely to attend 85% of rehabilitation visits if in single-parent households ( p = 0.024). The interaction of insurance type and residence stability (maintaining a single residence during treatment) found patients with public insurance and stable housing were less likely to reach the 85% compliance threshold (Table 1). At trend level, linear regression revealed an inverse relationship with distance and physical therapy attendance ( p = 0.082), in addition to linear regression showing unstable residence ( p = 0.052) and public insurance ( p = 0.067) as significant at trend level of patients not reaching 85% compliance. Conclusion: Our study revealed single-parent households and Hispanic/Latino patients were significantly correlated with lower rehabilitation adherence, in addition to trends showing distance to physical therapy, unstable housing, and public insurance correlated with lower compliance. Our work highlights potential predictors of rehabilitation noncompliance and allows for targeted efforts to increase adherence in patients with these factors. [Table: see text]
TROCHLEAR MORPHOLOGY DEVELOPMENT: STUDY OF NORMAL PEDIATRIC KNEE MRIS
Authors: Trivellas Myra , Kelley Ben , West Nicole , Jackson Nicholas , Beck Jennifer 
Published: April 2020

Introduction: Trochlear dysplasia is a known risk factor for patellar dislocations yet normal trochlea development is not well described. This study will define the articular cartilage and subchondral trochlear morphology development in pediatric patients using MRI evaluation. Methods: Retrospective knee MRI review including patients aged 3-16 years with non-patellofemoral related diagnoses. ICD-9/ICD-10 codes identified eligible study patients. Measurements of the trochlea were made based on previously established methods using the axial MRI image just distal to the physis at the deepest portion of the trochlear groove. Three linear (Lateral Trochlear Height (LTH), Medial Trochlear Height (MTH), Central Trochlear Height (CTH)) and three angular (Sulcus Angle (SA), Lateral Trochlear Slope (LTS), Medial Trochlear Slope (MTS)) were made at the Articular Cartilage (AC) and Subchondral Bone (SCB) (Figure 1). Twelve measurements were made independently by two study authors. Interrater reliability was assessed. Trochlea measurements were summarized across age quartiles: 1st (age 5.1 - 8.3y), 2nd (8.3 - 11.5y), 3rd (11.5 - 14.3y), 4th (14.3 - 16.9y). Associations between age and trochlea measures were assessed using linear regression with Huber-White adjusted standard errors. Results: 246 knee MRIs from 230 patients were included in this study. 113 patients (51%) were female while 117 (49%) were male. 116 MRIs (47%) were of the Left knee and 130 (53%) were Right knee. Average patient age was 11.4±3.4 years. Interrater agreement was high (ICC values >0.7). Mean values for measurements are presented by age quartiles (Table 1). LTH, MTH, and CTH showed linear increase with age (range 2 to 2.6 mm per year, p<0.001). SA, LTS, MTS measured at the AC showed no change with age (p>0.05) however LTS and MTS measured at SCB showed significant increases with age (0.6 and 0.9 degrees per year, p<0.001) while SA showed a decrease with age (-1.4 degrees per year, p<0.001). There were no significant differences found in the age associations by laterality, left vs right. There were no gender differences in the age associations for SA, LTS, MTS (p>0.05) however for MTH, LTH, and CTH, males were found to have a significantly greater growth rate (p<0.001). Conclusions: This study found an increase in articular cartilage and subchondral bone MTH, LTH, and CTH over time as well as an increase in subchondral bone LTS, MTS, and SA. However, no significant change in articular cartilage LTS, MTS, or SA was found. This normative data indicates that articular cartilage angles determine final trochlear morphology. [Table: see text][Figure: see text]
High School Student-Athletes’ Awareness of Concussion Education May Differ by Age
Authors: Kostyun Regina , Wang David , Solomito Matthew 
Published: April 2020

Background: A tremendous amount of resources and education have been directed towards those involved in high school athletics to help recognize the signs and symptoms of a concussion and ensure removal from play of potentially concussed athletes. Concussion education policies have been broadly implemented across the country; however, the success of these educational methods at encouraging adolescents to disclose their symptoms has yet to be determined. Purpose: The purpose of this study was to (1) identify how many student-athletes recognized they had been provided concussion education and (2) document disclosure and non-disclosure patterns. Methods: An anonymous survey was distributed to student-athletes at four Connecticut high schools. The survey contained demographic questions (sex, age, primary sport, and prior history of concussion) along with a question asking if the individual had received formal concussion education. The survey then asked in which of six provided situations the athlete would disclose their symptoms and which of eight provided reasons would prevent the athlete from disclosing their symptoms. Respondents were grouped by education status (received or not) and the difference in response frequency was evaluated using Chi-Square tests. Results: A total of 872 athletes (average age 15.8±1.3 years, 410 Males, 462 Females) completed the survey (61.2% response rate). A total of 583 (66.9%) athletes reported having received concussion education. Athletes who reported that they had not received concussion education were significantly younger than athletes that reported that they had received concussion education (p=<0.001). Both the education and non-education groups identified an important game as the least likely situation to disclose symptoms, and practice as the most likely situation. The most common reason for non-disclosure was “Don’t want to miss game” in the education group and “Don’t think I have a concussion” in the non-education group. Significant differences in response rates between groups were found for ‘Don’t think I have a concussion’ (p=0.038) and ‘Others played with concussions’ (p=0.005). Conclusion: Current educational efforts may not be successfully educating younger student-athletes about the importance of recognizing and reporting concussion symptoms. Within our small cohort of Connecticut high schools, approximately 1/3 of individuals reported not receiving education, and more than half of student-athletes report that they would not disclose concussion symptoms during important games despite receiving education. Further work is required to re-evaluate the efficacy of current educational programs available to high school athletes, focusing on non-disclosure reasons reported by varying ages of student-athletes. [Table: see text]
Presence and Perceptions of Menstrual Dysfunction Among High School Female Athletes
Authors: Armento Aubrey , VanBaak Karin , Sweeney Emily A. , Wilson Julie C. , Howell David R. 
Published: April 2020

Background: Previous studies have reported a high prevalence of menstrual dysfunction (MD) among adolescent female athletes. Little is known about the characteristics of adolescent athletes with MD, as well as their awareness of MD. Purpose: Our primary study purpose was to determine the prevalence and characteristics of female athletes who believe that MD is a normal response to high training demands. The secondary purpose was to explore the relationship between MD and patient-reported quality of life. Methods: We conducted a cross-sectional study of adolescent athletes undergoing pre-participation evaluation. Participants completed health history, family affluence, and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires. Those who reported menarche within the past year were excluded. We categorized participants into groups based on their response to, “Do you think it is normal to lose your period during high levels of athletic training?” (yes/no). We compared groups using Mann-Whitney U and Fisher’s exact tests. We also grouped patients into MD (yes/no) if they exhibited one or more of the following: 1) age of menarche >15 years; 2) ≤9 periods in the last year; or 3) a period of three consecutive months without a menstrual cycle. We constructed a series of linear multivariable regression models assessing the effect of MD on PROMIS outcomes adjusting for age and BMI. Results: 44% (n=40/90) answered that period loss was a normal response to a high level of training, and this group had lower body mass index (BMI), were less likely to report being worried about current weight, and had a higher family affluence level than those who answered period loss was not a normal response to training (Table 1). The overall prevalence of MD was 28% and was not significantly different between those who did and did not answer that period loss was a normal response to training (Table 1). Those with MD reported higher fatigue and pain interference scores than those without MD (Table 2). After adjusting for age and BMI, MD was significantly associated with higher levels of anxiety, fatigue, and pain interference (Table 3). Conclusion: Nearly half of our sample of adolescent female athletes perceive MD as a normal response to high training demands. Females with MD reported higher levels of anxiety and fatigue than those without MD. Understanding adolescent perceptions of MD and the characteristics of those with MD can guide future educational interventions aimed at high risk athletes for the female athlete triad. [Table: see text][Table: see text][Table: see text]
WHAT ARE THE PREDICTORS OF POOR PATIENT-REPORTED OUTCOMES FOLLOWING SHOULDER INSTABILITY SURGERY?
Authors: Bayomy Ahmad F. , Briskin Isaac , Grobaty Lauren E. , Sosic Elizabeth , Strnad Greg J. , Farrow Lutul D. , Rosneck James T. , McCoy Brett W. , Schickendantz Mark S. , Miniaci Anthony , Jones Morgan H. , Spindler Kurt P. , Saluan Paul M. 
Published: April 2020

Background: Prospectively-collected patient-reported outcomes (PROs) following shoulder instability surgery are limited. Attention has been drawn to standardizing these outcome measures in the adolescent literature. Hypothesis/Purpose: The purpose of this study was to evaluate which factors predict unfavorable PROs following shoulder instability surgery, including a “No” response to the Patient Acceptable Symptom State (PASS) question. We hypothesized that poor outcomes are associated with adolescent males, bone loss, larger labral tears, and articular cartilage injury. Methods: A cohort of patients age 13 years and older undergoing shoulder instability surgery were prospectively enrolled in point-of-care data collection at a single institution across 12 surgeons from 2015-2017. Demographics, ASES and SANE responses, and surgical findings were obtained at baseline. ASES, SANE, and PASS responses as well as revision surgery were queried at least one year post-operatively. Patients with isolated posterior labral tears and prior ipsilateral shoulder surgery were excluded. Regression analyses were performed. Results: A total 268 patients met inclusion criteria of which 201 completed follow-up responses (75%). Non-responders had a greater BMI, smaller proportion of glenoid bone loss, fewer Hill-Sachs lesions, and lower baseline ASES scores by 7.5 points (p < 0.05). Responders’ mean age was 25.5 years and 23% were female. Revision surgery occurred in 2.5% of these patients, and 81% responded “Yes” to PASS. A “Yes” response correlated to mean 31-point improvement in ASES and 34-point improvement in SANE scores. On univariate analysis, “No” responders were more likely to have a smoking history, a larger proportion of glenoid bone loss, and revision surgery (p < 0.05). However, on multivariate analysis, only combined labral tears (anterior/inferior plus superior or posterior tears) and injured capsules were associated with greater odds of responding “No” to PASS and with lower ASES and SANE scores (p ≤ 0.05) (Table 1). Age, sex, Hill-Sachs lesions, and grade III/IV articular cartilage injuries were not associated with variation in any PROs. Conclusion: In this prospective cohort, patients largely approve of their symptom state at one year or greater following shoulder instability surgery. A PASS “Yes” response occurred in 81% of patients and correlated to a clinically and statistically significant improvement in ASES and SANE scores. Combined labral tears and injured capsules were negative prognosticators across PROs, whereas age, sex, and Hill-Sachs lesions were not. Table: [Table: see text]