bluuebunny/crossref_metadata_2025_split huggingface dataset:
PATIENT REPORT OUTCOME MEASURE USE FOR CONCUSSION AMONG HIGH SCHOOL ATHLETIC TRAINERS
Authors: McLeod Tamara Valovich , Hattrup Nicholas , Root Hayley J. 
Published: April 2020

Background: Recent recommendations suggest incorporating patient-report outcome measures (PROMs) into concussion assessment batteries. Utilizing PROMs provides information on the patient’s perspective and how the concussion may influence the patient’s health status. Past studies evaluating PROM use among athletic trainers (ATs) found varying practices and barriers to implementation. However, there is limited data on use of PROMs in managing concussion among adolescent patients. Hypothesis/Purpose: To describe the use of PROMs as part of concussion assessment and treatment practices of ATs working in middle and high school settings. Methods: An online survey regarding concussion treatment perceptions and practices was distributed to a convenience sample of 5000 ATs through the NATA Survey Research Program. The survey included personal and institutional demographics, healthcare provider access and referral practices, perceptions of concussion treatment, clinical practice characteristics of concussion treatment and PROM use. The survey was pilot tested and validated in a sample of ATs prior to distribution. Analysis of the PROM section was conducted using descriptive statistics (percentages, frequencies) for this study. Results: The survey was accessed by 304 ATs (6.1% access rate) and completed by 153 ATs (58.3% completion rate). Of those, 27.2% (n=57) were employed in the middle school or high school setting and were analyzed for this study. Just over half of respondents had <10 years of experience (52.7%, n=30). Only 35.1% (n=20) of ATs reported they use PROMs as part of their clinical management of concussion. Of those who use PROMs, 75% (n=15) indicated that they use them always or almost always. The most commonly used generic PROMs were the Short Form 12 or 36 (25%, n=5) and Patient Reported Outcomes Measurement Information System (25%, n=5) and the most common specific PROMs were the Headache Impact Test (45%, n=9) and Dizziness Handicap Inventory (15%, n=3). Figure 1 shows the level of self-reported confidence of those utilizing PROMs. Barriers for PROM use included it being too time consuming (24.6%, n=14/57), lacking a support structure (15.8%, n=9/57), and not familiar with PROMs (14%, n=8/57). Close to one-fourth (22.8%, n=13/57) of respondents would be willing to use PROMs, but lacked time. Conclusion: While the use of PROMs is recommended in the evaluation and treatment of adolescent athletes, just over one-third of ATs providing care to these patients, use PROMs. Educational efforts for ATs should look to increase their familiarity and confidence when using PROMs for concussion while suggesting strategies to incorporate PROMs into practice. [Figure: see text]
DESCRIPTIVE STUDY OF INJURIES IN MIDDLE SCHOOL CROSS COUNTRY RUNNERS
Authors: Wu Alexander , Ackerman Kate , Barrack Michelle , Tenforde Adam 
Published: April 2020

Background: High school athletes participating in cross-country sports are at increased risk of overuse injuries. Little is known in younger athletes including those participating in running during middle school regarding prevalence of injuries or related risk factors. The objective of this study was to assess the frequency of sports-related injuries in middle school cross-country runners. Methods: This was a retrospective online survey study of middle school cross-country runners. Middle school cross-country coaches from middle school teams in the Boston area sent letters of invitation via email to the parents of their athletes to participate in an optional, anonymous online survey administered in REDCap. Participants received a $5 gift card for their time. The online survey included demographic information, weight, height, training variables, daily dietary patterns, and injury history. We conducted univariate and bivariate analyses while stratifying for sex. Results: A total of 101 subjects completed the survey, 47% (n=48) were female. Mean age was 12.5 years [SD 0.94], and 24% (n=24) were in sixth grade, 39% (n=39) in seventh grade, and 38 % (n=38) in 8th grade. The mean BMI for girls was 17.9 kg/m2 and for boys 18.24 kg/m2. The self-reported race/ethnicity was white in 72% (n=72), Asian in 22% (n=22), Latino in 5% (n=5), and black in 1% (n=1). Mean weekly mileage during the cross-country season was 15.2 miles [SD 7.6]. Of female subjects, 17% (n=8) reported that they were diagnosed with a bone stress injury (BSI) due to running, compared to 2% (n=1) of male subjects, p=0.009. The injured bones in females included the tibia (n=1), fibula (n=1), navicular (n=1) and metatarsal bones (n=6). The injured bone in the male was a sacral fracture. Compared to those without injury, runners with BSIs did not have observed differences in calcium or vitamin D intake; no differences were observed related to ball sport or other forms of strengthening exercises. A total of 63 non-fracture injuries occurred from running, with females (18%) more likely to have sprained ankles than males (6%, p=0.47). Conclusions/Significance: Running-related injuries are relatively common in middle school cross-country runners. In middle school, female runners are more likely to sustain running related BSIs than male runners. Efforts to prevent overuse stress injuries in middle school runners should be considered. [Table: see text]
GRAFT CHOICE FOR ACL RECONSTRUCTION IN YOUNG ACTIVE PATIENTS – USE OF QUADRICEPS TENDON AUTOGRAFT INCREASED LIKELIHOOD OF MEETING RETURN TO PLAY CRITERIA AT 6 MONTHS POST SURGERY
Authors: Gregory Bonnie , Magill John , Meyers Heather , Pietrosimone Laura , Le Daniel , Reinke Emily , Riboh Jonathan 
Published: April 2020

Background: ACL graft tears and contralateral injuries are problematic in pediatric sports medicine, with a combined incidence of 25-35%. Recent publications have highlighted a high failure rate with hamstring autografts in young patients, while others have suggested lower failure rates with quadriceps autografts. However, little is known about the possible reasons for this difference. Hypothesis: We hypothesized that the use of quadriceps soft tissue autografts would lessen post-operative neuromuscular deficits compared to other autografts, and therefore, young athletes would achieve objective return to sport (RTS) criteria more rapidly. Methods: A retrospective review of consecutive patients who underwent ACL reconstruction by a single surgeon and completed a comprehensive series of physical performance tests (PPTs) at 6 months post-surgery was conducted. A chart review of demographic and surgical data was completed. Patients performed nine common PPTs; limb symmetry index (LSI) was established and LSI> 90% was used as the cut-off for passing each individual test. Athletes met RTS criteria if they achieved LSI>90% on at least 8 of 9 tests. Multivariate linear and logistic regressions were performed to assess the effect of age (dichotomous; pediatric (<16 years) versus skeletally mature), gender, graft type, concomitant meniscal surgery, and time post-op, on the number of tests an individual could pass and the likelihood of passing the battery of PPTs, respectively. Results: The cohort of 68 young, active patients (mean age= 18.9 years +/- 7.5; 56% pediatric; 46% female; graft type: 63% BTB, 16% hamstring, 15% quadriceps, 6% ITB) were tested at a mean 6.7 months +/- 1.9. Overall, 35% of patients “passed” the battery of PPTs. Upon logistic regression, age and concomitant meniscal surgery were poor predictors of “passing.” In contrast, use of quadriceps was a strong predictor of passing (OR 14.1, 95% CI 2.4-83, p=0.003, compared to BTB). Upon linear regression, use of quadriceps was again a strong predictor of the number of individual PPTs passed (b=1.8, 95% CI 0.33-3.3, p=0.02, compared to BTB). No other demographic variables predicted “passing” or number of individual PPTs passed. Conclusion: Young, active patients undergoing ACL reconstruction with quadriceps autograft are 14 times more likely to meet RTS criteria at 6 months post-op than similar patients with BTB, hamstring or ITB autograft. This may provide valuable insight into the decreased failure rates suggested with the quadriceps autograft. Additionally, this study confirms the majority of these high-risk, young athletes do not meet RTS criteria at 6 months post-operatively.
OPEN OSTEOCHONDRAL AUTOGRAFT TRANSFER RESULTS IN MORE FREQUENT REOPERATION THAN OPEN ALLOGRAFT TRANSFER IN THE PEDIATRIC KNEE
Authors: Hall Tyler B. , Hyman Max J. , Patel Neeraj M. 
Published: April 2020

Background: Osteochondral autograft (OAU) and allograft (OAL) transfer are surgical options for sizeable articular cartilage lesions in the knee. In the pediatric population, there is little data on the patients undergoing these procedures or evidence to support one technique over another. Specifically, the rate of reoperation in these young patients is unknown. Hypothesis/Purpose: The purpose of this study is to compare the rate of reoperation in children and adolescents undergoing OAU or OAL of the knee in a nationally representative population. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing open or arthroscopic OAU and OAL between 2012 and 2018. Demographic information was collected for each subject as well as data regarding subsequent reoperations, readmissions, and returns to the emergency department. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 732 subjects with a mean age of 15.4±2.4 years were included in the analysis. Of these, 393 (53.7%) initially underwent OAL (273 open, 120 arthroscopic) and 339 (46.3%) underwent OAU (137 open, 202 arthroscopic). The overall reoperation rate was 144/732 (19.7%) at a median of 198 days (range 17-1604 days) after the index operation. This rate was similar between OAL and OAU. In 18 subjects (2.5%), OAU, OAL, or autologous chondrocyte implantation (ACI) was performed at the time of revision surgery. When analyzing only open procedures, 25.5% of open OAU patients underwent a repeat procedure compared to 16.5% of open OAL patients (p=0.03). After adjusting for other factors in a multivariate model, those who initially underwent open OAU had 1.7 times higher odds of requiring a future reoperation than an open OAL patient (95% CI 1.1-2.8, p=0.04). There was no difference in the rate of repeat surgery among arthroscopic procedures or when comparing open to arthroscopic operations. Conclusion: While 19.7% of children and adolescents undergoing OAU or OAL eventually require repeat surgery, the rate at which revision OAU, OAL, or ACI is performed is 2.5%. Patients undergoing open OAU have 1.7 times higher odds of ultimately requiring a reoperation than those undergoing open OAL, even when adjusting for confounding factors.
LATERAL FEMORAL CONDYLE OSTEOCHONDRITIS DISSECANS: DOES WEIGHTBEARING ZONE LOCATION PREDICT HEALING?
Authors: Huang Sharon G. , Zhou Liang , Wagner K. John , Gee Shawn , Wilson Philip L. , Ellis Henry B. 
Published: April 2020

Background: Osteochondritis dissecans (OCD) is a focal, idiopathic alteration of subchondral bone with potential for instability and disruption of adjacent articular cartilage that may result in premature (early secondary) osteoarthritis. Purpose: The purpose of this study was to evaluate differences in clinical, radiographic, and treatment outcomes in weightbearing (WB) versus non-weightbearing (NWB) lateral femoral condyle (LFC) OCDs. Methods: An IRB-approved retrospective review of 62 patients with LFC OCD lesions, 26 of which were weightbearing and 36 non-weightbearing (defined as Cahill and Berg sagittal zones B and C, respectively), treated at a single institution between 2004 and 2019 was performed. All participants were 18 years of age or younger at the time of diagnosis. Demographic and clinical characteristics, radiographic features, treatment modalities, and outcomes were evaluated. Continuous variables were analyzed using a Mann-Whitney test and a Kruskal-Wallis test when comparing across various groups. A Chi-square test was used to compare categorical variables. Results: The study cohort consisted of 40 (64.5%) male and 22 (35.5%) female participants, with an average age at diagnosis of 12.86 ± 2.74 years, and an average follow-up of 24 months. WB and NWB LFC OCDs had no differences in symptom chronicity or the presence of mechanical symptoms. NWB lesions were more likely to present with distinct ossification of the progeny bone segment (70.0% vs. 25.0%; p = 0.044) and were deeper lesions (MRI sagittal depth 7.11 vs. 5.96; p = 0.046). Across a variety of treatment modalities, NWB lesions were significantly more likely than WB lesions to demonstrate full radiographic healing at final follow-up (52.8% vs. 24.0%; p = 0.033). There was no difference in the likelihood of initial non-operative versus operative treatment selection or in the outcomes of non-operative treatment between the two lesion types. Additionally, OCDs in either zone were equally likely to be pain-free at final follow-up. Conclusion: Lateral femoral condylar OCD lesions in weightbearing and non-weightbearing zones have similar clinical presentation. However, lesions in non-weightbearing zones demonstrate improved radiographic healing at final follow-up. These data may aid in clinical decision-making and counseling during treatment of children and adolescents presenting with lateral femoral condylar OCD. [Figure: see text]
ASSOCIATION BETWEEN SADNESS AND SYMPTOM SEVERITY IN PEDIATRIC AND ADOLESCENT PATIENTS WITH HIP PAIN
Authors: Wagner K. John , Tigabu Kirubel , Sabatino Meagan J. , Richard Heather M. , Podeszwa David A. , Sucato Daniel J. , Ellis Henry B. 
Published: April 2020

Background: Patient-reported outcome measures (PROMs) are used by hip surgeons to assess treatment outcomes. Purpose: The purpose of this study was to evaluate patient-reported sadness and its association with perceived pain, symptoms, and clinical disease severity in patients with hip pain. Methods: A review of prospectively collected PROMs from patients presenting with hip pain was performed. PROMs were completed at baseline, one year, and two years post-treatment. Those who reported feeling ‘downhearted and blue’ sometimes, often, or always on a baseline SF-12 (SAD) were compared to those who did not (NOT SAD). A subset of patients diagnosed with femoroacetabular impingement (FAI) was analyzed to assess radiographic and intraoperative disease severity between the groups. Radiographic measures consisted of baseline alpha angle and lateral center edge angle. Intraoperative disease severity of the femoral head, labrum, acetabulum, and capsule was determined by an orthopaedic surgeon using a standardized 1-3 ranking system. A Mann-Whitney Test was used to compare groups. Results: Of 378 participants, the mean age was 15.3 (range 7-19) and 64.6% were female. Sixty-four participants (16.9%), of which 78.1% were female (p=0.013 compared to male) reported feeling SAD at baseline. SAD participants scored worse on the HOOS at baseline (55.8 vs. 66.1, p<0.001), with significantly lower scores on every subscale (Table 1). Additionally, SAD participants demonstrated worse perceived outcomes one year post-treatment. While not significant, SAD participants also demonstrated a trend towards lower HOOS scores two years post-treatment (Table 1). Of 121 participants diagnosed with FAI (mean age 15.8; 72.7% female), SAD participants reported worse quality of life (29.1 vs. 44.5, p<0.001), pain (52.2 vs. 60.1, p=0.049), physical function (59.7 vs. 68.8, p=0.028), and scored lower overall on the HOOS at baseline (53.8 vs. 62.0, p=0.023). However, SAD participants did not demonstrate worse radiographic or intraoperative disease severity (Table 2). One year post-treatment, SAD participants reported worse pain on the HOOS (68.0 vs. 87.6, p=0.033). There were no significant differences between the SAD and NOT SAD groups at two years post-treatment, but lower scores were noted (Table 1). Conclusion: The question of feeling ‘downhearted or blue,’ perhaps a symptom of underlying depression, may be associated with patient reported symptom severity at baseline and one year post-treatment. However, no differences were found in radiographic or intraoperative disease severity of hip impingement between the SAD and NOT SAD groups, indicating that symptoms of underlying depression may be a risk factor for poor treatment outcomes. [Table: see text][Table: see text]
OSTEOCHONDRAL LESIONS OF THE TALUS: FACTORS PREDICTIVE OF CARTILAGE INTEGRITY
Authors: Perkins Crystal A , Erickson John , Braithwaite Kiery , Busch Michael T , Willimon S. Clifton 
Published: April 2020

Background: The integrity of articular cartilage in patients with osteochondral lesions of the talus (OLTs) guides treatment. The ability to predict cartilage integrity in OLTs, as previously published for OCD of the knee1, would be beneficial. The purpose of this study is to evaluate the association of radiographic and MRI findings and articular cartilage integrity at the time of ankle arthroscopy for OLTs. Methods: A single-institution retrospective review identified patients 19 years of age and younger with operative treatment of OLTs from 2010 – 2017. Demographics and intra-operative findings at the time of ankle arthroscopy were identified by chart review. Radiographs were assessed for physeal status, OLT location, and Berndt and Hardy grade. MRIs were reviewed for OLT size and location, modified Kramer grade, and cartilage status. Results: 53 patients with 54 OLTs and a mean age of 13.6 years (range 7 – 19 years) were included. OLTs were located in the posteromedial talus in 39 patients (72%). Physeal status was closed/closing in 32 patients (59%) and open in 22 patients (41%). On MRI, the cartilage was predicted to be disrupted in 40 patients (74%) and intact in 14 patients (26%). At the time of ankle arthroscopy, the cartilage was found to be disrupted in 38 OLTs (70%) and intact in 16 OLTs (30%). Table 1 lists variables predictive of cartilage integrity. [Table: see text] MRI classification of cartilage integrity was 95% sensitive and 75% specific for arthroscopic integrity, with 11% misclassification. In the 16 patients less than 13 years, MRI perfectly predicted arthroscopic cartilage integrity. In patients with open physes, MRI sensitivity was 92% and specificity 100%. In patients with closing/closed physes, MRI sensitivity was 89% and specificity 50%. Receiver operator curve characteristics of a model to predict arthroscopic cartilage integrity combining MRI cartilage integrity, physeal status, and radiographic grade has an AUC of 0.955. Conclusions: Physeal status, radiographic grade, MRI grade, and cartilage integrity on MRI are independent predictors of cartilage integrity at the time of ankle arthroscopy for patients with OLTs. Overall, MRI has 95% sensitivity and 75% specificity for cartilage integrity at the time of arthroscopy, which improves to near 100% sensitivity and specificity in patients with open physes. A model combining MRI cartilage integrity, physeal status, and radiographic grade has the highest predictability of intra-operative cartilage integrity. SIegaSll E, Faust JR, Herzog MM, Marshall KW, Willimon SC, Busch MT. Age predicts disruption of the articular surface of femoral condyles in knee OCD: can we reduce usage of arthroscopy and MRI? J Pediatr Orthop 2018;38:176-180.
ACADEMIC CONCERNS, REQUESTED AND RECEIVED SUPPORT AMONG ADOLESCENTS IN THE FOUR WEEKS FOLLOWING CONCUSSION: A PILOT STUDY
Authors: Snedden Traci , Post Eric , Schmidt Christian , Brooks Alison 
Published: April 2020

Background: Even short-term cognitive challenges place adolescents at risk for successful achievement of academic success and attainment of career goals. Studies that have examined subjects receiving follow-up at a concussion or other specialty clinic have noted cognitive issues that cause learning problems upon return to the classroom. However, a gap exists specific to the types of academic concerns and needs for academic support using a prospective longitudinal design in a general sample. Purpose: The purpose of this pilot study was to describe the scope of academic concerns, requested and received academic support over time among adolescents in the four weeks following a concussion injury. Methods: Prospective longitudinal pilot study. Adolescents, aged 13-18 years, and their parent/legal guardian were enrolled within 7 days of concussion injury using a community-based design. Academic effects, requested and received support were assessed by electronic completion of the Concussion Learning Assessment and School Survey (CLASS) of both adolescent and their parent/legal guardian at 4 time points across 28 days, each one week apart. Results: Overall, 37 adolescents (51.4% female, mean age: 16.4±1.4 years) and their parent/legal guardian, provided sufficient data for analysis. A decrease in the frequency of academic concerns over time was noted across the 4 weeks following injury with 37.8% (n=14) reporting challenges in one or more of their classes in the first week after their concussion, compared to 10.8% (n=4) at 28 days. A decrease in requested supports was also noted, with 48.6% (n=18) requesting some form of academic support in the first week compared to 13.5% (n=5) at 28 days. Most commonly requested supports across all time points included extra time to complete work, reduced homework, reduced or waived makeup work, and a shortened school day. Received academic support was also greatest in the first week following concussion (40.5%, n=15) and declined to 16.2% (n=6) at 28 days. Grades were reported as worse since their concussion across all time points with 18.9% reporting this concern at 14 and 21 days. Conclusion: High rates of academic concerns and requested supports were reported in the first week following concussion. In addition, a consistent proportion of students reported a worsening of grades and continued to report academic concerns and needs for academic support four weeks after they sustained a concussion. These pilot findings support the need for greater attention to the academic effects of concussion and related support needs in the classroom for all students. [Table: see text][Table: see text]