bluuebunny/crossref_metadata_2025_split huggingface dataset:
DEFINING TROCHLEAR DYSPLASIA VIA THE LATERAL TROCHLEAR INCLINATION ANGLE
Authors: Cheng Christopher , Hedgecock Jon , Solomito Matthew , Joseph Sheeba , Pace J. Lee 
Published: April 2020

Background: Trochlear dysplasia (TD) is the principle anatomic risk factor for patellar instability (PI). The lateral trochlear inclination (LTI) is a quantitative measure of trochlear morphology on axial magnetic resonance imaging (MRI). Threshold values for patients at risk for PI via LTI measurement have ranged from 11o to 17o. Our group recently described a new technique for characterizing LTI by referencing the fully-formed posterior femoral condyles. This novel measurement technique revealed that the historically-used method was comparable in reliability but significantly underestimated TD. Purpose: The purpose of this study was to define, with high specificity, a LTI value cutoff value consistent with patellar instability using the new LTI measurement technique. Methods: MRI scans of 95 patients aged 9 to 18 years treated for PI at our tertiary referral center were compared with a control cohort of 98 age- and gender- matched patients with knee imaging but no clinical evidence of PI. LTI was measured as the angle formed between a line subtended from the cartilaginous surface of the lateral trochlea at its most proximal extent and a line parallel to the fully-formed posterior condyles. Receiver operator characteristic (ROC) curve analysis was conducted to establish a cutoff value with optimal specificity and sensitivity. Results: Average LTI was significantly lower in the study group (5.9±10.4o) than control (18.9±5.8o) (p<0.001). Area under the ROC curve was 0.86. A proposed 8.9o LTI threshold angle achieves good discrimination between the two groups, with specificity of 0.904 and sensitivity of 0.684. Conclusion: Re-examination of previously described threshold values using ROC curve analysis of LTI measured in reference to the posterior condyles found 8.9o as the optimal threshold value to achieve good discrimination between patients with and without PI. The novel technique has previously been established to have excellent intra- and inter-observer reliability and produced significantly lower LTI values than the historically-used technique. Taken in concert, this new cutoff is valuable to improve future clinical decision making in regards to risk stratification, treatment algorithms and research purposes.
HOW DO LEARNING DISORDERS IMPACT CLINICAL MEASURES FOLLOWING CONCUSSION?
Authors: Zynda Aaron J. , Stokes Mathew A. , Chung Jane S. , Cullum C. Munro , Miller Shane M. 
Published: April 2020

Background: There is limited evidence examining the impact of learning disorders on testing and screening scores used in evaluation following concussion in adolescents. Purpose: To examine differences in clinical measures between adolescents with a history of dyslexia or ADD/ADHD and those without a history of learning disorder (LD) following concussion. Methods: Data were collected from participants enrolled in the North Texas Concussion Network Prospective Registry (ConTex). Participants ages 10-18 who had been diagnosed with a concussion sustained within 30 days of enrollment were included. Participants were separated into three groups based on self-reported prior diagnosis: dyslexia, ADD/ADHD, and no history of LD. Clinical measures from initial presentation were examined, including ImPACT®, King-Devick (KD), SCAT-5 symptom log, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7) scale. Independent t-test analysis was performed to compare scores between groups. Results: A total of 993 participants were included; 68 with dyslexia, 141 with ADD/ADHD, and 784 with no history of LD. There was no difference in age, sex, time since injury, or history of concussion between the dyslexia group and no LD group. In the ADD/ADHD group, there were significantly more male participants (64.5% and 50.3% respectively, p=0.002). Participants with a history of dyslexia had a significant increase in KD time (63.7 sec vs 56.5 sec, p=0.019). Additionally, ImPACT® testing showed a decrease in visual motor speed (28.87 vs 32.99, p= 0.010). Total symptom score was higher in this group as well (36.22 vs 28.27, p=0.013). In those with a history of ADD/ADHD, multiple domains were found to be significantly different on ImPACT® testing including visual motor speed (30.05), reaction time (0.75), and cognitive efficiency (0.23) when compared to those with no LD (32.99, 0.71, and 0.27 respectively, p=0.004, 0.047, 0.027). KD time was also significantly higher in this group (62.1 sec vs 56.5 sec, p=0.008), as was the total symptom score (32.99 vs 28.27, p=0.043). PHQ-8 and GAD-7 were both significantly higher in the group with ADD/ADHD (5.79 and 5.06 respectively, p=0.001) than those with no LD (4.32 and 3.56, p=0.001). Conclusion: Differences were seen in participants with a history of dyslexia and ADD/ADHD on clinical concussion measures, including ImPACT® and KD testing, SCAT-5 symptom log, and screenings for depression and anxiety. A better understanding of the unique profiles seen in these patients will aid providers in their evaluation and assist as they counsel families regarding their child’s injury.
Relationships Between Sport Specialization and Running-Related Injury Among Competitive High School Cross-Country Runners
Authors: Rauh Mitchell J. , Tutino Alexandra K. , Post Eric G. , Prescher Kelly , Rosenthal Michael D. 
Published: April 2020

BACKGROUND: During the past few decades, the number of participants in high school cross-country has increased. Simultaneously with its popularity has been an increased incidence of running-related injury (RRI). Limited risk factors have been examined in their relationship to RRI in this population. Of these, few studies have reported on the prevalence of sport specialization and its association with RRI among competitive high school cross-country runners. PURPOSE: The purpose of this study was to assess the prevalence of sport specialization and examine its risk association with RRI in competitive high school cross-country runners. METHODS: We prospectively followed 93 runners (35 females, 15.7±1.1y) who competed in the 2018 interscholastic cross-country season in Southern California. At baseline, all runners were injury-free and completed the study questionnaire, which included questions on whether cross-country was their primary sport, the number of months/year spent running-related training, and if they quit another sport(s) to focus on cross-country/track distance running during the past year. High (all 3 factors), moderate (2 of 3 factors) and low (0 or 1 factors) sport specialization was then determined using a widely-utilized scale. Injury occurrence data for all runners was recorded throughout the cross-country season using a standardized injury reporting system. Odds Ratio (OR) estimates and 95% confidence intervals (CIs) were used to determine the association between sport specialization and likelihood of RRI. RESULTS: Of the 93 runners, 15 (16.1%) met criteria for high sport specialization, 49 (52.7%) were classified as moderately specialized, and 29 (31.2%) runners were classified as low sport specializers. The prevalence of high sport specialization was similar between female (17.1%) and male (15.5%) runners (p=0.38). Twenty-six runners (28%) experienced a time loss RRI, with a higher percentage among female runners (37.1%) than males (22.4%) (p=0.16). Although the incidence of injury was greater among high sport specializers (40.0%) than low sport specializers (24.1%), the likelihood of RRI was not statistically significant (OR=2.10, 95% CI: 0.6-8.0; p=0.28). Similar risk associations between high sport specialization and RRI were found between female and male runners. CONCLUSIONS: Based on the existing classification method for sport specialization, these findings indicated that high sports specialization was not common among competitive high school cross-country runners in this study sample. As the incidence of RRI was almost twice as great among high sport specializers, studies assessing larger populations of high school cross-country runners are needed to better evaluate this relationship.
ISOKINETIC PERFORMANCE AND LIMB ASYMMETRY DIFFERENCES BETWEEN ADOLESCENT MALES AND FEMALES FOLLOWING QUADRICEPS TENDON – PATELLAR BONE AUTOGRAFT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Gagliardi Alexia G. , Howell David R. , Kanai Susan K. , Rhodes Jason T. , Tagawa Alex , Albright Jay C. 
Published: April 2020

Background: Accurate measurement of limb strength asymmetry differences between sexes may be important to consider when determining readiness to return to sport among adolescents following ACL reconstruction. Hypothesis/Purpose: The purpose was to compare isokinetic performance between females and males after ACL reconstruction but before return to sport clearance on isokinetic measures of limb strength asymmetry and flexor/extensor strength ratio. We hypothesized there would be no difference in limb strength asymmetry or flexor/extensor strength ratio between sexes measured by isokinetic testing. Methods: We retrospectively collected demographic, surgical, and injury information on patients aged 10 – 18 years at time of surgery. Patients completed isokinetic testing within 5-10 months after primary quadriceps tendon ACL reconstruction, and before return to sport clearance. Isokinetic testing assessed maximum torque at three speeds, 60, 180, and 300 degrees per second, through a limited range of knee extension and flexion. Maximum torque percent deficit of the involved leg compared to the uninvolved leg and flexor/extensor strength ratios were calculated. We compared peak torque extensor deficits and flexor deficits (the % difference between operative and non-operative sides) and flexor/extensor ratios at the three isokinetic test speeds within sexes and between sexes. Results: 80 subjects were tested during the study period, of which 44 subjects met inclusion criteria (female: n=29, 66%). Injury characteristics and time since surgery were similar between sexes (Table 1). Greater extensor deficits among males and females were observed at 60 degrees/s compared to 180 degree/s (p=0.003) and 300 degree/s (p<0.001), and at 180 degrees/s compared to 300 degrees/s (p=0.001) (Figure 1). Females demonstrated significantly greater peak torque flexor deficits at 300 degrees/s, compared to males (p=0.04, Figure 2). Within males, greater flexor deficits were observed at 60 degrees/s compared to 180 degrees/s (p<0.001) and 300 degrees/s (p=0.001) (Figure 2). Within females, greater flexor deficits were observed at 60 degrees/s compared to 180 degrees/s (p=0.02, Figure 2). There were no significant interactions or main effects of sex or speed for either the operative or the non-operative limb peak torque flexor/extensor ratio. Conclusion: The results demonstrate greater peak torque flexor deficits among females compared to males at the fastest testing speed in our protocol. Currently, our results indicate variability both within and between sex isokinetic performance at different speeds and suggest that isokinetic testing at slower speeds may be most effective in determining strength deficits between limbs. Tables and Figures: [Table: see text][Figure: see text][Figure: see text]
THE EFFECTIVENESS OF ONLINE ACL INJURY PREVENTION EDUCATION FOR SPORTS COACHES
Authors: Russomano James , Ologhobo Titilayo , Janosky Joseph J. , Goldsmith Sandra , Marx Robert G. , Kinderknecht James , Robbins Laura 
Published: April 2020

Background: The efficacy of ACL injury prevention programs (IPP) have been well-defined by sports medicine researchers over the past decade, but the adoption and implementation of effective ACL IPP is noticeably deficient in real-world situations. One barrier to the widespread implementation of ACL IPP by sports coaches is the limited understanding of how to effectively deliver these programs to young athletes. The ability to effectively identify and correct high-risk movements during the performance of neuromuscular training and athletic activities has been reported as a key factor in the effectiveness of an ACL IPP. Educational opportunities to train sports coaches to effectively deliver ACL IPP programs are not common, but those that do exist are often delivered in live settings. Live educational workshops are resource-intensive and limit the number of participants that can be trained over time. Educational workshops offered online can deliver information efficiently to large numbers of individuals but have not yet demonstrated education outcomes that are equivalent to live education events. Hypothesis/Purpose: The purpose of this study is to investigate the association between participation in an online educational workshop for coaches and knowledge of how to effectively employ an ACL IPP with young athletes. We hypothesize that participation in an online educational workshop is associated with increased knowledge of how to effectively employ an ACL IPP with young athletes and high levels of program satisfaction. Methods: An online educational workshop was developed to teach sports coaches how to effectively employ an ACL IPP program with young athletes. Coaches from throughout the United States were recruited to access the workshop through a computer-based learning management system. A series of instructional videos were used to deliver educational content to participants. Pre- and post-workshop surveys were utilized to determine program effectiveness and participant satisfaction. Results: 468 coaches (77% male) participated in the pilot phase of the program. Nearly two-thirds of all participants demonstrated an increase in knowledge immediately post-intervention. Mean knowledge scores increased by 33% (56.5 to 74.9, p < 0.001). 89% of participants rated the workshop favorably and 90% of participants reported that they would recommend the workshop to other coaches. Conclusion: Results indicate that an online workshop for sports coaches improved the knowledge needed to effectively deliver an ACL IPP to young athletes. These findings support the continued evaluation of computer-based learning management systems to deliver online ACL IPP workshops to sports coaches. [Table: see text][Table: see text][Table: see text]
ENERGY BALANCE AND VITAL SIGNS IN PEDIATRIC PATIENTS
Authors: Young Julie A. , Napolitano Jessica , Rauh Mitchell J. , Nichols Jeanne , Fischer Anastasia N. 
Published: April 2020

BACKGROUND: Prior studies have shown that vital signs such as heart rate, blood pressure and body temperature are depressed in patients with an eating disorder who have experienced a negative energy balance for a significant amount of time. More recently, a negative energy balance has been the focus of Relative Energy Deficiency in Sport (RED-S), which links energy availability to the health of multiple body systems in adults in as little as 5 days with a negative energy balance. High rates of disordered eating patterns have been reported in high school athletes. As adolescents grow, the consequences of a negative energy balance can be significant and potentially irreversible. Thus, vital signs may help clinicians quickly evaluate a patient’s energy status or highlight them for further evaluation. PURPOSE: The purpose of this study was to examine energy balance and vital signs in a cohort of adolescents who were seen by a sports dietitian to gain weight or optimize sports performance. METHODS: We evaluated 240 subjects, 83% female, average age 15.0±2.3 years. Heart rate and blood pressure were measured with a dynamometer in a seated position. Body temperature was measured orally. Height and weight were recorded. BMI was then calculated and evaluated by percentile. Energy intake was assessed using a 3-day food recall log. Energy expenditure was calculated using Harris Benedict Equation and combined with estimated exercise energy expenditure. Energy balance was estimated as energy intake minus energy expenditure. RESULTS: Average age was 15.03±2.71. 85% were female. 30% were below the 15th percentile for BMI. There were no differences in BMI percentiles between males and females (p=0.99). The average heart rate was 71.62±13.4 bpm and 19% were below the 10th percentile for heart rate. Average systolic blood pressure was 110±11 mm Hg and average diastolic blood pressure was 62±7 mmHg. Average temperature was 98.1±.4 degrees F. 88%were in a negative energy balance with an average energy deficit of 552±511 calories. There were no statistically significant differences in energy balance between males and females (p=0.08). CONCLUSIONS: A disproportional number of children with low BMI and heart rate percentiles was observed, which may indicate a long-standing energy deficiency. We also found a high proportion of adolescents who experienced a standalone negative energy balance itself or vital signs consistent with a negative energy balance. Additional studies are needed to study the relationships between energy deficit magnitude and duration in adolescents and children.
OUTCOME OF SURGICAL TREATMENT IN PATIENTS WITH BORDERLINE ACETABULAR DYSPLASIA: A COMPARATIVE ANALYSIS OF HIP ARTHROSCOPY AND PERIACETABULAR OSTEOTOMY
Authors: Nepple Jeffrey J , Schwabe Maria , Graesser Elizabeth , Pascual-Garrido Cecilia , Clohisy John C 
Published: April 2020

Background: Optimal treatments of patients with borderline hip dysplasia, defined as LCEA 20°-25°, is controversial. These patients can have symptomatic impingement and/or instability. The optimal treatment of either hip arthroscopy (HA) alone or periacetabular osteotomy (PAO) (with/without hip arthroscopy) has not been established. Purpose: The purpose of this study was to evaluate surgical outcomes of patients with borderline hip dysplasia at a minimum of 2-year follow-up. Methods: A longitudinal cohort was utilized to identify patients with borderline acetabular dysplasia defined via prospective radiographic measurements. Demographics and radiographic measurements were recorded. Patient evaluation, diagnosis and treatment decisions (PAO v HA) were made by one treating surgeon. Outcome were assessed at baseline and a minimum 2 years postoperative. Descriptive and comparative statistics were performed. Failure was defined as reoperation, or failure to reach mHHS MCID (8 points) or PASS (mHHS <74). Results: Total of 113 hips were included at 4.7 years postoperatively (range 2.0-11.2 years). Overall, 76% were female and 42% of hips had PAO (65% combined with hip arthroscopy), while 58% had isolated hip arthroscopy (HA). For PAO group, mHHS improved from 57.9 to 82.8 postoperatively, compared to 62.6 to 84.0 for the HA group. Similarly, HOOS pain (PAO 48.2 to 79.1, HA 61.2 to 82.0) and HOOS Sports (PAO 36.5 to 73.0, HA 47.8 to 74.4) demonstrated similar improvements. Comparing the PAO and HA groups, the change in PRO was significantly greater for the PAO group for HOOS Pain (10.5 ±23.2, p=0.02) and HOOS ADL (9.4 ±20.5, p=0.04) which was primarily due to a lower baseline score (similar final score). No significant difference was detected for other PROs. Reoperations in the PAO group were 2% (1 hip arthroscopy) and 6% for hip arthroscopy group (3 hip arthroscopies, 1 PAO). The failure rate was 17% for PAO and 15% for HA (p=0.86). Discussion: Surgical outcomes at minimum of 2 years in patients with borderline hip dysplasia in selected patients undergoing PAO or hip arthroscopy were good. Significant differences in patient characteristics and radiographic parameters were present between hips indicated for PAO vs. HA emphasizing the need for careful diagnosis and treatment decision-making.
HIP ARTHROSCOPY VS. PHYSICAL THERAPY IN PATIENTS WITH FEMOROACETABULAR IMPINGEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Schwabe Maria , Cheng Abby L , Pascual-Garrido Cecilia , Harris-Hayes Marcie , Harris Michael , Hunt Devyani , Prather Heidi , Clohisy John C , Nepple Jeffrey J 
Published: April 2020

Introduction: Both physical therapy (PT) and surgery appear to have some efficacy in treating femoroacetabular impingement (FAI). Only recently have high-level evidence studies compared these two options, though results of these randomized controlled trials (RCTs) are contradictory. The purpose of this study was to perform a systematic review and meta-analysis of RCTs comparing PT and surgery in patients with FAI. Methods: A systematic review was performed to identify randomized trials comparing FAI and PT. Data was extracted for demographics, study design, patient reported outcomes (PROs), and study quality/bias. In total, 819 abstracts were reviewed, with three RCTs identified (Griffin 2018, Mansell 2018, and Palmer 2019). All three RCTs reported iHOT-33, while two studies reported HOS ADL and Sport (Mansell 2019 and Palmer 2019). In a random effects meta-analysis, between-group differences in post-intervention scores were assessed using intention-to-treat analysis in each study. Results: All 3 RCTs reported PROs improvement from baseline to follow-up for both PT and surgery. The meta-analysis demonstrated greater improved iHOT-33 outcomes with surgery compared to PT with a mean relative difference of 11.3 (95% CI 1.86-20.73, p=0.014). The meta-analysis for HOS ADL and Sports (two RCTs) similarly demonstrated higher scores with surgery with a mean difference of 3.9 (95% CI -9.6-17.3, p=0.571) and 6.2 (95% CI -6.8-19.2, p=0.347), respectively, though without statistical significance. The quality of two RCTs was assessed as good with minimal bias (Griffin and Palmer). In the third RCT, an extremely high crossover rate may affect its validity (Mansell 2018, 70% crossover from PT to surgery). For instance, HOS ADL outcome based on treatment received, adjusting for Mansell’s crossover rate, favored surgery with a larger mean difference of 12.0 (95% CI 7.5-16.5, p<0.001) (compared to intention-to-treat difference of 3.9). Discussion: In patients with FAI, combined results of three RCTs demonstrate superior outcomes of surgery compared to PT. However, PT can result in improvements in some patients and does not appear to compromise surgical outcomes. Provided that the studies adjusted for certain patient characteristics, further research needs to identify patient characteristics that predict success of non-operative and operative treatment of FAI in specific patient subgroups. [Figure: see text]