bluuebunny/crossref_metadata_2025_split huggingface dataset:
ARE SPORTS INJURIES THE MOST COMMON CAUSE OF MOREL-LAVALLEE LESIONS IN THE PEDIATRIC POPULATION?
Authors: Kushare Indranil , Ghanta Ramesh Babu , Wunderlich Nicole A. 
Published: July 2021

Background: Traumatic internal degloving injury i.e. Morel-Lavallée lesion (MLL) develops as a result of blunt trauma with tangential shear forces. In the pediatric population, these have been described only as small case reports till date. Purpose: To describe the largest case series of lower extremity Morel-Lavallée lesion (MLL) in the pediatric population, to determine its etiology (especially its relationship to sports), treatment and outcomes. Methods: Retrospective study of patients <18 years presenting to a tertiary children’s hospital with MLL between 2013-2019. Demographics, clinical data, imaging features, treatment and outcomes data was collected. Descriptive statistical analysis was conducted. Results: 38 patients (21 males, 17 females) having MLL with mean age 14.6 years were classified into 2 groups- hip/thigh MLL (9 patients) and lower leg MLL (29) (Table 1.1). Most common cause of lower leg MLL was sports injury (79%). Most commonly implicated sports in MLL were football and baseball(24% each). Associated injuries were seen in 9 (23%) patients. Radiographs done in 58% of patients showed no bony abnormalities. Imaging modality of choice was MRI for lower leg MLLs (72%) and US for hip/thigh MLL (67%)(Fig.1.2). MLL size was larger for hip/thigh MLL (168 cm3) as compared to leg MLL (38.6 cm3). 25 (65.8%) of MLLs were treated with conservative management,12 (31.5%) with minimally invasive methods and 1(2.6%) needed surgical management. 2/9 (22.2%) of the associated injuries required operative management. 2/38 (5%) patients were given prophylactic antibiotics. 72.4% Lower leg MLLs were treated with conservative management while intervention was needed more in hip/thigh MLLs (55.6%). Patients returned to activities at 14.3 weeks for hip/thigh MLL;9.1 weeks for lower leg MLL. 24 patients with adequate documentation demonstrated lower extremity functional score (LEFS) and pain level of 74/80 (92.5%) and 0.7/10 respectively at mean 12.5 months follow-up. Leg cellulitis was seen as a complication in one patient. Conclusion: The largest case series on MLL exclusively in the pediatric population suggests that they are more common in knee/leg region region and usually caused by sports injuries which is notably different as compared to adult population. Most pediatric injuries are treated conservatively, especially sports related MLLs. Although return to activities takes longer for hip/thigh injuries, majority of patients regain satisfactory functionality post-injury. [Table: see text][Figure: see text]
NEURAXIAL ANESTHESIA FOR HIP ARTHROSCOPY IS ASSOCIATED WITH DECREASED IMMEDIATE POSTOPERATIVE PAIN SCORES AND OPIOID REQUIREMENTS COMPARED TO GENERAL ANESTHESIA
Authors: Turner Elizabeth H. G. , Whalen Christopher J. , Beilfuss Matthew A. , Hetzel Scott J. , Schroeder Kristopher M. , Spiker Andrea M. 
Published: July 2021

Background: Hip arthroscopy is most commonly performed utilizing general anesthesia. Studies in hip and knee arthroplasty have shown an association between neuraxial anesthesia and lower rates of perioperative adverse events, lower post-operative pain scores, and lower dosing of postoperative systemic analgesics when compared to general anesthesia. A direct comparison between neuraxial and general anesthesia in hip arthroscopy has not previously been investigated. Hypothesis/Purpose: We sought to identify the immediate post-operative differences in opioid use, pain scores, and post-anesthesia care unit (PACU) length of stay (LOS) after hip arthroscopy related to the type of anesthesia used for the surgical procedure. Methods: Patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with labral tears by a single surgeon at an academic center between October 2017 and July 2019 were retrospectively reviewed. The primary outcome was PACU opioid administration, measured by morphine equivalents (MEQ). Secondary parameters included total LOS, post-incision LOS, PACU LOS and PACU arrival/discharge pain scores. Analyses conducted were t-tests, Wilcoxon rank sum tests, or chi-square tests. Results: A total of 129 patients met inclusion criteria for this study; 54 males and 75 females, with an average age of 28 (±10.1) years. 52 (40.3%) had general anesthesia and 77 (59.7%) had neuraxial anesthesia, including spinal, epidural, and combined spinal-epidural anesthesia which were intermixed throughout the study period. Intraoperative and PACU opioid administration demonstrated a significant difference in medians. Neuraxial methods required a lower MEQ in both the operating room (30.0 vs 53.9, p = 0.001) and PACU (18.2 vs 31.2, p = 0.002). Neuraxial anesthesia had lower median PACU arrival and discharge pain scores (0.0 vs. 5.0, p = 0.001, 3.0 vs. 4.0, p = 0.013). There was no statistically significant difference in post-incision LOS, or traction time. General anesthesia was associated with a longer PACU phase 1 time (1.0 vs. 1.3 hrs, p = 0.005). No major adverse events such as death, disability, or prolonged hospitalization occurred in either group. Conclusion: Neuraxial anesthesia use in routine hip arthroscopy was associated with lower immediate postoperative pain scores, lower intraoperative and immediate postoperative opioid requirements, and may be associated with shorter anesthesia recovery time without any major adverse events when compared to general anesthesia. Tables [Table: see text][Table: see text]
PHYSICAL THERAPISTS’ PERCEPTIONS OF ADOLESCENT IDIOPATHIC SCOLIOSIS TREATMENT
Authors: Davelaar Foley , Sugimoto D 
Published: July 2021

Background: Few studies have demonstrated the benefit of physical therapy in the treatment of adolescent idiopathic scoliosis (AIS), alone or in conjunction with bracing or surgery. To our knowledge, there is no consensus in pediatric physical therapists who treat AIS patients. Purpose: To identify the optimal physical therapy practices for AIS including; weekly frequency, session length, treatment duration, clinical interventions, therapeutic goal-setting, and outcome measures from pediatric physical therapists’ perspectives. Methods: A 40-question validated survey, The Analysis of the Schroth Method in Adjunct to Physical Therapy Services for Treatment of AIS, was distributed to pediatric physical therapists across the country via the Academy of Pediatric Physical Therapy electronic newsletter and via dissemination by the Injury Prevention Research Interest Group from Pediatric Research in Sport Medicine. REDCap was used to collect and organize responses. The responses were analyzed by a descriptive statistics using percentages (%). Results: Sixty-five responses were obtained. The majority of physical therapists, 78.5%, were Doctors of Physical Therapy (DPT), treating 1-5 AIS patients a week (69.2%), and 18.8% had Schroth certification. Preferred treatment frequency was twice a week (41.5%) for a duration of 60 minutes (53.8%), over the course of 3-5 months (44.6%). The top three common clinical interventions were; core and trunk stability enhancement (90.8%), abdominal strengthening (83.1%) and postural correction (80.0%). The three most common therapeutic goal-setting parameters were activity based (78.5%), quality of life measure based (56.9%), and therapy participation based (50.8%). Additionally, for outcome measures, patient reported outcome was the most common objective measurement (78.5%), followed by pain (63.1%), manual muscle testing (46.2%), range of motion (44.6%), cobb angle (27.7%), scoliometer readings (26.2%) and Adam’s forward bend test (10.8%). Therapists often monitored progress with completed surveys by patients. However, patients’ ability to return to activity was the most common marker of improvement (72.3%). Patient’s scoliosis was often being treated in another manner aside from PT (46.2%), and many patients had medical conditions in addition to scoliosis (52.3%). Conclusion: According to our data, pediatric physical therapists believe that patients with AIS can benefit from physical therapy treatments addressing core and trunk stability, abdominal strengthening, and postural correction. Ideal treatment sessions would occur twice a week for 60 minutes over a period of 3-5 months. Objective measurements can be monitored to ensure improvements in quality of life, pain, strength, range of motion and curvature of the patient’s spine. Acknowledgements The Injury Prevention Research Interest Group from Pediatric Research in Sports Medicine and Suzanne M. McCahan, PhD
COMMUNITY IMPACT FOR CLINICALLY INTEGRATED ATC PROGRAM IN A SPORTSMEDICINE PRACTICE
Authors: Grambo Laura , Rivero Samantha , Harbacheck Katie , Boyd Christine , Keefer Shaun , Klein Eric , Vuong Brian , Ford-Hemann Carolyn , Larson Scott , D’Alpe Cameron , Frick Steve , Shea Kevin 
Published: July 2021

Background: Health Systems routinely make investments in clinically driven outreach programs to build for future community needs, improve health outcomes, and serve their community mission. Many community sports programs have limited access to sports medicine care, including access to athletic trainers. Hypothesis/Purpose: The primary purpose of this study was to evaluate the impact of a clinically integrated Certified Athletic Trainer (ATC) Community Sports Outreach Program, by evaluating the outreach into the community, sports clubs, schools, covered events. Methods: The ATC Community Outreach Program monitored key metrics over a 3 and 1/2-year period. Metrics included the partnerships developed with local clubs and schools, number of athletes covered in each organization, games covered and hours spent supporting organizations. Categories were divided into fiscal years (FY) running from September to August. Fiscal Year 2016 was calculated from January – August, as it was the first year of the program. The percentage of growth of the amount of games covered was calculated from the adjacent FY. Results: Over the first 3 and 1/2 years (FY2016-FY2019), the number clubs, schools, programs covered grew from 10, 19, 25, to 31 from FY2016 - FY2019. Number of athletes from 7,363, 12,552, 15,104, to 19,794 from FY2016 - FY2019. The number of community outreach events grew from 6, 11, 57, to 190 from FY2016 - FY2019 (Table/Figure 1.1). The percentage of growth of games covered grew from 183%, 518% to 333% between FY2016 and FY2019. Discussion/Conclusion: Building, maintaining a sports medicine practice is a complex undertaking, and represents a significant investment for the health system and community. In many communities, access to sports medicine care for athletes is very limited. A clinically integrated ATC program can generate a significant impact on the community by building relationships with local sports clubs/schools and improving sports medicine care access to young athletes. Tables/Figures: [Table: see text][Figure: see text]
LIMITED INTER-RATER RELIABILITY IN ANTEROLATERAL LIGAMENT DETECTION IN PEDIATRIC KNEE MRIS
Authors: Williams Brendan A. , Mehta Nishank , Ganley Theodore J. , Lawrence J. Todd , Kim Sung H. , Nguyen Jie C. 
Published: July 2021

Background: Despite the rapidly expanding anterolateral ligament (ALL) literature base, little has focused on the reliability of its detection on MRI. This is especially important in the pediatric population where the scarcity of pediatric cadaveric specimens hinders the accurate estimation of its prevalence. Purpose: The purpose of this study was to assess the visibility of ALL on common MRI pulse sequences and to calculate the inter-rater reliability among multiple expert readers in a cohort of normal pediatric knee MRIs. Methods: A series of 3T pediatric knee MRIs obtained from 8/2018-4/2019 were reviewed to identify patients without significant knee pathology. Knee laterality, age, gender, and regional physeal status were also recorded. One orthopedic surgeon, 1 pediatric musculoskeletal (MSK) radiologist, and 1 adult MSK radiologist, independently reviewed each MRI pulse sequence (T1-weighted, PD-weighted, and PD-weighted fat-suppressed images) separately, to determine the presence or absence of the 3 parts of the ALL (femoral, tibial, and meniscal proper). Inter-rater reliability was calculated using Fleiss’ Kappa (K). Results: Inclusion criteria were met for 75 patient knees with a mean age of 12.7±3.42y (3-19) and a greater proportion of females (57.3%). The distribution of regional physeal status was: Open-48.0%, Closing-29.3%, and Closed-22.7%. Inter-rater reliability was slight to fair (K: 0.141-0.340) for visualizing any specific ALL component on a unique MRI sequence (Table 1). For visualizing a specific attachment on any MRI sequence, there was slight to moderate agreement (K: 0.018-0.411). Visualizing any ALL attachment on any MRI sequence also yielded slight agreement (K: 0.190). Inter-rater reliability between specialities (i.e. Ortho vs. MSK Radiology) did not differ substantially from group findings. No single study sequence demonstrated enhanced reliability for all ALL components. Conclusion: The reliability of ALL detection on MRI across multiple clinicians was slight to moderate for all components in this cohort of normal 3T pediatric knee MRIs. No single sequence was consistently better for ALL detection agreement. This is in contrast with previous work showing substantial agreement among raters and describing PD-weighted imaging as preferable for viewing the ALL. Experience in musculoskeletal imaging did not confer improved agreement. Establishing diagnostic reliability should be a prerequisite for use of an imaging finding in the research or clinical setting. Existing literature drawing conclusions from ALL findings on MRI may need to be interpreted with caution if reliability testing is not described. [Table: see text]
CONCOMITANT MENISCECTOMY RESULTS IN REDUCED RETURN TO SPORT COMPARED TO MENISCUS REPAIR IN PRIMARY PEDIATRIC ACL RECONSTRUCTION
Authors: Williams Brendan A. , Wright Maggie L. , Bram Joshua T. , Maguire Kathleen J. , Patel Neeraj M. , Ganley Theodore J. 
Published: July 2021

Background: Meniscus repair has demonstrated favorable outcomes when performed with ACL reconstruction (ACLR). However, literature comparing meniscal tear patterns, treatments, and outcomes among pediatric patients remains limited. Purpose: The aim of this study is to evaluate the impact of surgical technique on patient outcomes, in primary pediatric ACLR with associated meniscal pathology. We secondarily examined patient factors and tear characteristics on these outcomes. Methods: This is a retrospective cohort study from 2014-2016 of pediatric ACL reconstruction patients who underwent concurrent surgical management of a meniscus tear. Predictors included patient demographics, injury mechanism, meniscal tear characteristics and surgical treatments. Clinical outcomes including return to sport (RTS), meniscus or ACL graft re-tear, and return to surgery were assessed via patient cross-sectional survey. Criteria for RTS were based on standardized postoperative rehabilitation protocols. Univariate and multivariate analyses were used to examine the relationship between studied predictors with the likelihood of RTS and other outcomes. Results: Inclusion criteria were met by 123 patients with an average follow-up time of 2.5 ± 0.7 years. RTS was achieved by 80.8% of patients while 17.1% of patients had a subsequent knee surgery within the studied timeframe. Univariate analysis of factors associated with successful RTS are shown in Table 1. While patients failing to RTS were shown to have delayed surgical intervention in univariate testing, multivariate analysis identified that patients who underwent meniscectomy were less likely to RTS than those who underwent meniscal repair (OR=2.690, 95% CI 1.044-6.930, p=0.040). Patients with an initial contact mechanism of injury were also demonstrated to be more likely to return to the OR for any reason (OR=13.443, CI 1.736-104.108, p=0.013) in multivariate modeling. Conclusion: In one of the few large cohorts of pediatric ACL reconstructions with concomitant meniscus surgery, this study adds to our understanding of a potentially modifiable factor (meniscus repair) in the surgical treatment of ACL injury with concaminant meniscus tear. Although no differences were seen in rates of meniscus or graft re-tear when comparing treatments, patients who underwent meniscal repair were more likely to return to sport than patients treated with meniscectomy. While these findings may reflect the quality of the torn meniscal tissue and severity of injury, it further emphasizes the importance of meniscal preservation not just for long term joint quality, but also for short term function in active pediatric patients. [Table: see text]
SPORTS SPECIALIZED YOUTH ATHLETES EXHIBIT LOWER RISK QUALITY OF MOTION THAN NON-SPECIALIZED ADOLESCENTS
Authors: Heath Madison R. , Janosky Joseph , Pegno Angelo , Schachne Jonathan M. , Fabricant Peter D. 
Published: July 2021

Background: Quality of motion and neuromuscular balance are noted predictors of acute injury risk. Early sports specialization and extremely high activity levels have been linked to high risk of injury, especially overuse injury. Purpose: The purpose of this study is to investigate for any relationships between quality of physical movement, quantity of physical activity, and degree of sports specialization in a healthy cohort of children and adolescents. Methods: Healthy children between the ages 10 and 18 completed the HSS Pedi-FABS to assess quantity of physical activity and the Jayanthi scale to assess degree of sports specialization. Quality of motion was assessed using motion analysis sensors (DorsaVi, Kew, Australia) during 5 repetitions of 4 different jumping and squatting motions (Table 1). For each repetition, one point was given for low risk of injury anterior or medial/lateral motion, for a maximum score of 2 per leg. Quality of motion scores were summed for a maximum score of 100 per participant. Specialization level was dichotomized as high specialization with a Jayanthi scale score of 2 or 3 and low specialization with a score of 1 or 2. Independent samples t-tests were used to compare high vs. low specialization participants on physical activity quantity and overall quality of motion. A Pearson correlation was used to determine the relationship between quantity of physical activity and quality of motion. Results: Final analyses included 147 participants (72% male) with a mean age of 13.4 ± 2.2 years. For the entire cohort, the mean Pedi-FABS score was 22.9 ± 6.8, the mean quality score was 25.5 ± 13.5 and 73% were highly specialized. Participants that were highly specialized displayed low risk motion more frequently than participants with low sport specialization (27.6 ± 14.0 vs 19.8 ± 10.1, p < 0.01; Table 2). Highly specialized participants had significantly higher activity levels (24.6 ± 5.9 vs 18.1 ± 6.9, p < 0.001). Additionally, quality of motion was moderately correlated with physical activity level (r = 0.349, p < 0.001). Conclusion: Overall quality of motion as in jump-landing tasks in healthy children was better in highly specialized participants. Taken together with existing literature, although early specialization may put young athletes at risk for overuse injuries, highly sports specialized youth athletes may be at lower risk for acute injury. Future research should explore associations between sports specialization, physical activity, save movement patterns, and athletic injuries. [Table: see text][Table: see text]
INITIAL CLINICAL PRESENTATION OF PEDIATRIC PATIENTS WITH PSYCHOLOGICAL DISORDERS FOLLOWING CONCUSSION
Authors: Worrall Hannah M. , Miller Shane M. , Cullum C. Munro , Chung Jane S. 
Published: July 2021

Background: There is limited evidence regarding the impact of pre-existing psychological disorders on the initial clinical presentation in pediatric patients following concussion. Hypothesis/Purpose: To examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorder (PD) following a concussion. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015 and March 2020. Participants aged 5-18 years diagnosed with a concussion were included. Demographic variables and a range of clinical measures from initial presentation were reviewed, including SCAT-5 Symptom Log, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into four groups based on self-reported prior diagnosis: depression, anxiety, depression+anxiety, and no PD. Results: A total of 1770 participants were included: 50 with depression, 82 with anxiety, 84 with both, and 1554 with no history of PD. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or between the anxiety and no PD group. A significant difference was found between the depression+anxiety group and no PD group in the following variables: age (15.11±1.8 vs 13.68±2.61 years, p<0.001), prior concussion history (40.5% vs 23.9%, p=0.001), and time to presentation (31.47±25.82 vs 19.85±26.33 days, p=0.01). Additionally, there were more females in the depression+anxiety group than the no PD group (71.4% vs 47.8%, p<0.001). The depression, anxiety, and depression+anxiety groups had significantly higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p<0.001). A significant difference in SCAT-5 symptom severity scores between the depression, anxiety, and depression+anxiety groups compared to the no PD group was found. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The depression+anxiety group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. Table 1.1 summarizes these significant findings. Conclusion: Differences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, SCAT-5 symptom severity scores, and common screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding these differences at initial presentation may urge providers to engage multidisciplinary teams early in facilitating patient recovery. Tables/Figures: [Table: see text]