bluuebunny/crossref_metadata_2025_split huggingface dataset:
PITCH COUNTS IN YOUTH BASEBALL PLAYERS: A COMPARISON TO PITCH SMART GUIDELINES
Authors: Greiner Justin J. , Baer Geoffrey S. , McGuine Timothy A. 
Published: April 2020

Background: Overthrowing injuries in youth baseball players have been linked with pitching behaviors such as as high pitch counts, inadequate rest, and participating in throwing activities throughout the year. Pitch Smart guidelines were developed as an initiative between Major League Baseball and USA Baseball to provide recommendations for youth baseball athletes to help decrease the risk of injuries from overthrowing. Purpose: The purpose of this study was to perform a quantitative analysis of pitch counts in youth baseball players and evaluate compliance with Pitch Smart guidelines. Methods: Local youth baseball teams competing in nine and under (9U) to fourteen and under (14U) age brackets were recruited to track pitches during the summer baseball season. A tablet with a pitch counting application was used to record pitches for each pitcher of the study team and their opponents. Days of rest between games was calculated for the study teams only and not opponents. Pitch counts and days of rest for each pitcher were compared to the recommended Pitch Smart guidelines. Continued prospective collection of data is ongoing through the 2019 summer. Results: Interim review of 23 youth baseball teams using a tablet allowed analysis of 181 pitchers of the 23 study teams using tablets and 285 pitchers of 98 opponent teams. Violation of Pitch Smart guidelines occurred in 14 (60.9%) study teams and 29 (16.0%) pitchers. Of these violations, 27 (93%) pitchers had insufficient rest between games while 2 (7%) pitchers exceeded daily maximum pitches. Further, 8 (35%) teams had more than one player violate guidelines. Pitch smart daily maximum pitch counts were violated in 2 of 98 (2.0%) opponent teams and 2 of 285 (0.7%) of opponent pitchers Conclusion: A total of 61% of youth baseball teams and 16% of pitchers in this study violated Pitch Smart guidelines at interim analysis. The vast majority of guideline violations were due to inadequate rest between games. The high rate of Pitch Smart violations suggests that further education of coaches, parents, and athletes regarding these guidelines, with emphasis on rest recommendations, is necessary to prevent overthrowing injuries in youth baseball players. [Table: see text]
FEAR AVOIDANCE BELIEFS RELATED TO PROLONGED RECOVERY FROM PEDIATRIC SPORTS CONCUSSIONS
Authors: Arnold Jennifer , Santana Jonathan 
Published: April 2020

Background: Individuals experiencing persistent pain or discomfort may develop avoidance behaviors and fear. Fear avoidance behaviors have been found to be predictive of chronic disability in adults with neck and low back pain. These behaviors were found to be predictive of symptom severity and disability in adults with mild traumatic brain injury. To our knowledge there has been no research examining this correlation in the pediatric population. Hypothesis/Purpose: To evaluate whether pediatric patients who had prolonged recovery from a concussion presented with greater fear avoidance behaviors, as measured by the Fear of Pain Questionnaire (FoPQ). Methods: Patients, ages 8 to 17 years old, diagnosed with a concussion and presenting within 2 weeks of the initial injury to sports medicine clinic were included in this study. Individuals were excluded if the mechanism of injury was a motor vehicle accident or assault. Participants who consented were administered a FoPQ at their initial visit. The FoPQ, which has been validated in the pediatric population, contains 24 questions rated on a 5 point Likert scale. Patient’s length of recovery, vestibular ocular motor screen (VOMS) score, and post-concussion symptoms scale score (PCSS) were also recorded. Results: From September 2018-May 2019, a total of 82 patients consented for the study. Out of the total number, 44 were female and 38 were male, with an average age of 14 years ( SD = 2.2). Patients who had prolonged recovery (> 28 days) had similar FoPQ scores ( M = 30.06, SD = 16.6) to those with normal recovery ( M = 31.35 SD = 19.1). No significant correlation was found between days to recovery and FoPQ score, r(67) = .05 , p = .668. Patients found to have a positive VOMS (79% of patients) at initial visit took longer to recover by 24.96 days, t(61.65) = -4.26, p < .001 when compared to those with a negative screen. A positive VOMS screen did not correlate with higher fear avoidance score t(21.71) = -.61, p = .550. PCSS severity positively correlated to days to recovery r(67) = .26, p = .037. Conclusion: Based on preliminary study results we found no correlation between fear avoidance beliefs and time to recover from sports concussions in a pediatric population. Our data did support previous findings that PCSS severity scores and positive VOMS were predictive of prolonged recovery from a concussion. We will continue to collect data in line with our a priori power analysis (n=200).
ADOLESCENT POSTERIOR-SUPERIOR GLENOID LABRAL PATHOLOGY: DOES INVOLVEMENT OF THE BICEPS ANCHOR MAKE A DIFFERENCE?
Authors: Hansen Cody H. , Asturias Alicia M. , Pennock Andrew T. , Edmonds Eric W. 
Published: April 2020

Background: Adolescent athletes are at risk to sustain an injury to the posterior and superior labrum of the glenoid. Limited information is available regarding the outcomes of surgical intervention in this specific age cohort. Purpose: To compare those patients with pure posterior pathology and those with involvement of the biceps anchor (superior labrum anterior-posterior tears - SLAP) to determine risks for failure in the surgical management. Methods: A retrospective review was performed on all patients under the age of 19 years over an eight year period to identify those treated for superior and posterior labral pathology, followed by chart review, radiographic review and arthroscopic findings. Demographics and other variables were recorded, including: etiology (traumatic versus atraumatic), activity/sports (overhead versus non-overhead), involvement of the biceps anchor – crossing the 12 o’clock position (Posterior vs SLAP), associated pathologies, outcome scores (SANE – Self Assessment Numerical Evaluation versus PASS – Pediatric Adolescent Shoulder Score), and complications. Results: 48 patients (30 males, 18 females) with a mean age at surgery of 16.5 years (range 13.5 to 19) were identified that met criteria with a mean follow-up of 4.1 years (range 1.3 to 6.9). Nineteen subjects had SLAP tears, and 29 subjects had posterior tears. All but 2 regularly participated in sports at the time of their injury; of the athletes, 26 (56.5%) played an overhead sport and 20 (43.5%) played a non-overhead sport. The etiology of the injury was traumatic in 25 cases (52.1%), and atraumatic in 23 cases (47.9%). Outcome scores were not significantly different between etiology or type of sports played; but, the mean PASS score in the SLAP group was 88.7, compared to 76.2 in the posterior group (p=0.005) at final assessment. Only 1 SLAP patient failed management (5.3%) compared to 5 patients in the posterior only cohort (17.2%). Conclusion: SLAP tears have better outcomes and lower failure rates than posterior only tears in the adolescent population. Posterior-superior labral tears can occur in all sport types with multiple etiologies, but the only factor that appears to play a role in ultimate outcome is whether or not the tear crosses under the biceps anchor to the anterior side.
PREVALENCE OF OVER THE COUNTER PAIN MEDICATION USE AMONG HIGH SCHOOL VOLLEYBALL PLAYERS
Authors: Lang Pamela , McGuine Timothy , Mack Lianna , Biese Kevin , Bell David , Watson Andrew , Brooks M. Alison , Post Eric , Kliethermes Stephanie 
Published: April 2020

Background: Volleyball’s popularity among middle and high school girls continues to rise with many athletes playing the sport year-round. While up to 40% of high school basketball players consume analgesics frequently to manage sport related pain, there is limited evidence regarding the prevalence of over the counter (OTC) pain medicine use among high school volleyball players. Hypothesis/Purpose: Identify the prevalence of OTC pain medicine use in high school volleyball players and assess its association with prior injury and sports specialization level. Methods: Female volleyball players from 78 high schools were recruited to enroll in this prospective cohort study during the fall 2018 volleyball season. Baseline data were collected on demographic and volleyball characteristics including volume and type of volleyball participation, sport-related injuries over the previous twelve months, and level of sport specialization. The frequency of OTC pain medication use for pain management not related to menstrual cramps over the previous seven days was also collected. Participants were asked to describe their OTC pain medicine use during practice, matches, or conditioning and the location of pain they were treating. Results: In total, 2,073 female athletes (Age: 15.6 ± 1.1, BMI: 22.4 ± 3.5, Grade: 9-12) enrolled in the study. Sixty-nine percent (n=1425) reported no OTC pain medication use over the past seven days, 16.0% (n=332) reported seldom (one day/week) OTC medication use, 12.6% (n=261) reported sometimes (2-3 days/week) using OTC medications, and 2.7% (n=55) reported frequent (4-5 days/week) OTC medication use. In the same time period, 24.8% (n=513) used OTC medications during practice, 16.0% (n=331) during matches, and 21.4% (n=443) during conditioning. Across practice, matches, and conditioning OTC medications were most frequently used to control headaches (7-13%) and knee pain (4-6%). Highly specialized volleyball players were more likely to frequently use OTC medications (4.5%) compared to low (1.97%) and moderately specialized (2.5%) athletes (p=0.001). Of those reporting no OTC medications use, 16.7% (n=238) had an injury in the last year compared 36.4% (n=20) of athletes who frequently used OTC medications also reporting an injury in the last year (p<0.001). Conclusion: Almost one third of female high school volleyball athletes reported using OTC pain medications in the past week. Those with a history of injury and highly specialized athletes were more likely to use OTC medications. Coaches, athletic trainers, and healthcare providers should be aware of trends in the use of OTC medications among volleyball athletes as its popularity continues to rise.
FEMORAL TUNNEL FIXATION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN THE GROWING PATIENT IS SAFE FOR FUTURE GROWTH
Authors: Gross Bruno , Sabatino Meagan J. , Brenner Madison , Wyatt Charles W. , Wilson Philip , Ellis Henry 
Published: April 2020

Background: Medial patellofemoral ligament (MPFL) reconstruction has been shown to be a successful treatment for patients with recurrent patellar instability and is increasingly used to treat skeletally immature patients. Purpose: The purpose of this study is to compare radiographic parameters prior to and following an MPFL reconstruction with femoral tunnel fixation in the skeletally immature patient to investigate potential effects on the physis and future growth. Methods: Skeletally immature patients undergoing isolated MPFL reconstruction were retrospectively reviewed. Fixation of proximal MPFL was performed as a femoral socket using Schottle’s point with the entry approximately 5 mm distal to the physis (Figure 1). Patients with open growth plates and 1-year post-operative standing alignments were included. Radiographic measures of patellar tilt, patellar height, patellar subluxation, and trochlear dysplasia were compared pre-operatively and post-operatively on the operative limb. Pre- and post-operative coronal alignment and limb length measurements were compared between the operative and non-operative limbs. Results: Nineteen skeletally immature patients with an average age of 11.6 years (range 5-15) underwent isolated MPFL reconstruction. The average follow-up time was 24 months. No significant differences were found between the change in femur (0.49 mm, p=0.526) or total limb length (1.08 mm, p=0.241) when comparing the operative to the non-operative limb, with an average of 47 mm of growth in the operative limb seen during the time period. There was no significant difference in the change in LDFA between operative and non-operative limb as well as symmetric changes noted in the mechanical axis. The change in patellar tilt on the operative limb was found to be significant (12.78°, p=0.030), and the change in patellar height by Caton-Deschamps approached significance (0.08mm, p= 0.077). No significant difference was found with trochlear dysplasia measures. Conclusion: The present study suggests MPFL reconstruction with femoral tunnel fixation is safe and does not result in growth disturbance in skeletally immature patients. [Figure: see text]
RETURN TO PLAY ASSESSMENTS: RATES OF NEUROMUSCULAR ASYMMETRIES IN HEALTHY ADOLESCENT ATHLETES
Authors: Jenkins Paul , Minaie Arya , Bauerlein Jaime , Piskulic David , Kirn Tim , Merklein Meghan , Nepple Jeffrey J. 
Published: April 2020

Background: Return to play (RTP) assessments after ACL reconstruction attempt to identify patients with residual deficits that haven’t regained their preinjury function, in hopes of decreasing the high rate of reinjury in this population. However, the utility of common RTP assessments, including hop testing and Biodex isokinetic strength, remains to be better understood. In the adolescent population, RTP assessments commonly rely upon those used in adults with limited evidence. The purpose of the current study was to establish the performance of young healthy athletes on common RTP assessments. Methods: A prospective cohort study of 47 healthy athletes aged 12 to 16 years was performed. All athletes performed hop testing (4 components - single, triple, crossover and timed) and Biodex isokinetic strength (6 components - quadriceps and hamstring; 60, 180, 300 degrees/second). The results were compared to the contralateral leg with a deficit defined as greater than 10% less relative to the contralateral leg. Patient demographics including age, sex, BMI, and sport played, as well as the dominant and nondominant leg were recorded. Analysis was performed relative to a single extremity (total 94) to simulate the evaluation in the setting of ACL return to play. Results: A total of 17 males and 30 females were included, with 27 being 12-13 yo and 20 being 14-16 yo. Overall, at least one deficit was present in 61.7% of extremities. This was significantly more common in non-dominant (76.6%) than dominant (46.8%) extremities (p<0.001). Biodex isokinetic strength deficits were present in 55.3% of extremities, while hop testing deficits were present in 24.5% of extremities. A total of 17 extremities had deficits in both Biodex and hop testing, while 35 had isolated biodex deficits and 6 had isolated hop testing deficits. Biodex deficits were present for quadriceps strength in 18.1%, 7.4%, and 17.0% at 60, 180, and 300 degrees respectively, while deficits in hamstring strength were present in 27.7%, 11.7%, and 17.0% at 60, 180, and 300 degrees respectively. Hop testing deficits were present in 7.4% of single hop, 9.6% of triple hop, 9.6% of crossover hop, and 6.4% of timed hop testing. Conclusions: The current study demonstrates that asymmetries in strength and hop testing are common in adolescent healthy athletes. These deficits are more common for Biodex isokinetic strength testing than functional hop testing. Deficits are more likely to occur in the nondominant extremity.
CHALLENGES IN SMALL KNEE ARTHROSCOPY: A QUALITATIVE AND QUANTITATIVE PEDIATRIC CADAVERIC EXPERIENCE
Authors: Ellis Henry , Edmonds Eric , Yen Yi-Meng , Wilson Philip , Tran Emily , Cannamela Peter , Shea Kevin 
Published: April 2020

Background: Arthroscopy may be utilized for treatment of septic arthritis of the pediatric knee, with success reported in ages from 3 months to 12 years. There is limited data on the ability to arthroscopically assess articular structures and ensure adequate evaluation without arthrotomy. Hypothesis/Purpose: The purpose of this study is: (1) utilize arthroscopy in small cadaveric knees to improve qualitative and quantitative knowledge of pediatric articular structures and (2) to obtain pilot data for common procedures performed in pediatric patients Methods: Five small pediatric cadaveric specimens (1-4 years) underwent arthroscopy (2.7 mm Stryker arthroscope). Medial and lateral compartments were assessed for meniscus size/mobility/height, compartmental joint space, ACL insertion, patellar chondral height and length, and position of the medial patellofemoral ligament were recorded. Utilizing standard anterior medial and lateral portals, the ability to visualize the structures of the posteromedial and posterolateral compartments was recorded. Procedures pertinent to immature ACL reconstruction and meniscal repair (unstable discoid) were critically evaluated to provide source data for future work. Results: Prior to arthroscopy, all specimens underwent volume-assessed knee insufflation (average 11.4 cc normal saline). Arthroscopic visualization of the menisco-capsular attachment was possible posteromedially in 4/6, and posterolaterally in 5/6 knees. Qualitative arthroscopic relationships were similar to adult references; including patellar-trochlear articulation and lateral meniscal positional relationship to the ACL insertion (see Figure 1). The ACL center was within 2 mm of the posterior aspect of the anterior horn of the lateral meniscus in all specimens. The average height of the medial compartment space under valgus load was 1.5 mm (1 – 2 mm), and lateral space under varus was 2.2 mm (2-3 mm); further emphasizing the need for small joint instruments. The width of the medial and lateral menisci are noted in Table 1. All-inside meniscal devices designed for skeletally mature specimens should be used with caution (Figure 1). Traditionally described inside-out technique for immature ACL reconstruction with an iliotibial band demonstrated significant proximity of the passing device to the neurovascular bundle (Figure 1). Conclusion: The entirety of the small knee is assessable via standard diagnostic arthroscopy, when a 2.7mm arthroscope is utilized. These findings suggest that intra-articular pathology can be reliably identified utilizing this surgical technique. However, the ability to work on the infant meniscus and cartilage with standard arthroscopic instruments is likely limited given the constraints of joint height. [Table: see text][Figure: see text]
CLOSED REDUCTION IN THE TREATMENT OF DISPLACED TIBIAL SPINE FRACTURES: REVISITING A LOST ART
Authors: Ellis Henry , Adkins Morgan , Elliott Marilyn , Huang Sharon G. , Wyatt Charles W. , Wilson Philip 
Published: April 2020

Background: There is renewed interest in optimal treatment, and development of algorithmic care for pediatric tibial spine fractures. While recent publications have most often investigated operative treatment, closed reduction of selected tibial spine fractures may result in good outcomes without invasive surgical procedures. Purpose: To evaluate an institutional series of displaced tibial spine factures treated with closed reduction for factors associated with treatment success. Methods: An IRB-approved, retrospective review of consecutive pediatric patients treated by a tertiary pediatric orthopedic group for displaced tibial spine fractures with closed reduction (2000 - 2017) was performed (Figure 1). Those with inadequate imaging or follow up were excluded. Demographics, injury data, exam findings, and reduction variables were recorded. Radiographic measures of fracture displacement pre and post-reduction, and at union were noted. Statistical comparison of variables associated with definitive closed reduction vs conversion to operative treatment was performed. Results: Of the 35 patients (mean age= 10.9 years [6-16 years]; 24 males) who underwent closed reduction of a tibial spine fracture, 19 (54.2%) had Type II Meyers and McKeever fractures, with the remainder Type III. Mean time to treatment was 6 days (2 hrs-46 days). Hemarthrosis aspiration with anesthetic injection was performed in 20 (57.1%) patients and 9 (25.7%) had general anesthesia or procedural sedation. Short-duration immobilization (typically 3 weeks) of long-leg casting (32, 91.4%) or bracing was utilized. The average reduction (Δ) in superior displacement of the tibial spine fragment was 4.6mm (0-16.4 mm) with 12 fractures improving > 5 mm following reduction maneuver. Eight patients (22.8%) failed closed reduction and were converted to operative fixation to treat residual displacement. Although no differences where noted in demographics, injury mechanism, classification (II vs III), or type of reduction; failures of closed reduction were noted to have more superior displacement (12.93 vs. 8.17 mm; p=0.023). Conclusion: Closed reduction of both Type II and Type III tibial spine fractures can result in acceptable reduction in in pediatric patients. Further prospective study of closed reduction of tibial spine fractures in selected patients presenting early, without critical meniscal pathology is warranted. [Figure: see text]