bluuebunny/crossref_metadata_2025_split huggingface dataset:
POST-CONCUSSION PHYSICAL THERAPY REFERALS
Authors: Burkhart Scott , Price August , Caze Todd J. , Knell Gregory , Ellis Christine , Abt John 
Published: July 2021

Background: Treating a concussion is complex, requiring a multi-disciplinary patient-centered approach for optimal outcomes. Physical therapy (PT) is a treatment utilized to facilitate concussion recovery, however little is known about those patients referred to PT. Purpose/Hypothesis: The purpose of this study was to report the demographics and other outcome measures of patients referred to PT from an attached specialty concussion clinic. Methods: Retrospective data were extracted from medical records for patients who were referred for physical therapy (PT) from its specialty concussion clinic. Patients included in this study were aged 8-18, diagnosed with a concussion, and referred to PT. Demographic data (age, gender, ethnicity, race) were patient reported. Other patient outcome measures (total injury recovery in days, total number of PT visits, total days between the first and last PT visit, positive VOMS score (symptom increase of 2 from baseline on any symptom and/or convergence on any trial >6cm). Statistical analyses included summary statistics and were reported appropriately as proportions, medians (interquartile range [IQR]), and means (± standard deviation [SD]). Results: Of the 88 patients referred to PT, the mean (± SD) age was 14.31 (± 2.58), 27.3% were children (8-12 years), 72.7% were adolescents (13-18 years), 65.9% were female, 87.5% were white race, 6.8% were black race, and 12.5% were Hispanic in ethnicity. A total of 84.1% patients had a positive VOMS, 9.1% had a negative VOMS, and 6.8% had an invalid VOMS. On average, patients were seen for 4 (± 2.60) total visits, spanning across an average of 18 (± 14.83) days between initial and last PT visits, with the median recovery between date of injury and medical clearance being 48 days (SD=175). Conclusions: This is the first study to provide preliminary demographics of post-concussive PT patients referred from its specialty concussion clinic. These results will be useful in establishing future protocols for future studies to examine the effect of early PT intervention on pediatric concussion recovery.
CLASSIFYING ISCHIAL TUBEROSITY AVULSION FRACTURES BY OSSIFICATION STAGE AND TENDON ATTACHMENT
Authors: Mitchell Brendon C. , Bomar JD , Wenger Dennis , Pennock Andrew T. 
Published: July 2021

Background: Currently, there is no classification system for ischial tuberosity avulsion fractures. Hypothesis/Purpose: To provide a new classification system for ischial tuberosity fractures based on the ossification pattern of the apophysis. Methods: We performed a retrospective records review of patients diagnosed with ischial tuberosity avulsion fractures at our institution from 2008 to 2018. Skeletal maturity (Modified Oxford score [MOS], Risser score), fracture type, size, and displacement were recorded based on initial injury radiographs. We reviewed a large series of pelvic CT and MRI scans from patients aged 10-19 years old to assess the ossification pattern and tendinous attachments of the ischial tuberosity. Pelvic CT review demonstrated a reproducible 5-stage pattern of ossification spanning the age of 13-19 years for males and 12-17 years for females (Figure 1). Review of available CTs and MRIs indicated that the semimembranosus attaches at the most lateral ossification center, followed by the conjoint tendon and adductor magnus as one moves medially (Figures 1). We created a classification system based on location of the ischial tuberosity avulsion fracture: Type 1 (lateral – semimembranosus and conjoint tendons) or Type 2 (complete – semimembranosus, conjoint, and adductor magnus tendons). An A or B descriptor was then added to distinguish minimally displaced (<1 cm) and displaced (≥1 cm) fractures, respectively (Figure 2). Results: We identified 45 ischial tuberosity fractures. Mean age was 14.4 years (range, 10.3–18). Males accounted for 82% of the cohort. Type 1 fractures accounted for 47% of cases and 53% were classified as Type 2. Type 1 fractures were associated with younger age chronological age (p=0.001), lower MOS (p=0.002), lower Risser score (p=0.002), less displacement (p=0.001), and smaller size (p<0.001), when compared with Type 2 fractures (Table 1). Of the 45 patients, 18 had >6 month follow-up with 56% going on to non-union. Non-union was associated with greater displacement (p=0.016) and size (p=0.027). When comparing union rates by fracture location, 33% of Type 1 fractures progressed to non-union, while 78% percent of Type 2 suffered a non-union; however, this difference did not reach statistical significance (p=0.153) (Table 2). Conclusion: In younger patients (ages 13-15 years), the lateral ossification centers of the ischial tuberosity, at which the hamstrings attach, are at risk for isolated avulsion injury. However, in older patients (16-18 years), coalescence of the hamstring and adductor magnus ossification centers predispose patients to a combined avulsion injury consisting of a larger fragment and with greater displacement. [Figure: see text][Figure: see text][Table: see text][Table: see text]
Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period
Authors: Verhofste Bram P , Hedequist Daniel J , Birch Craig M , Rademacher Emily S , Glotzbecker Michael P , Proctor Mark R , Yen Yi-Meng 
Published: July 2021

Background: Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes. Hypothesis/Purpose: The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports. Methods: We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI). Results: Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003). Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity. Conclusion: The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability. [Figure: see text][Table: see text][Table: see text]
Epidemiologic Study of the Discoid Meniscus: Investigating Demographic-Based Predictors in Large-Scale Claims Database
Authors: Randhawa Sahej S , Tran Emily P , Segovia Nicole A , Ganley Theodore J , Tompkins Marc , Ellis Henry , Shea Kevin G 
Published: July 2021

Background: Discoid meniscus epidemiology remains poorly defined for race and sex, in part, due to limitations of retrospective studies and small case series. A better understanding of epidemiology may improve clinical care and diagnostic precision. Purpose: Our purpose is to better define the epidemiology of discoid meniscus by analyzing a large, national database for incidence rates by sex and race. Methods: Analysis was conducted on the national-scale Clinformatics Data Mart Database by Optum. Proportions of the database’s racial categories (Asian, Black, Hispanic, White, and Unknown) in the total population of diagnosed discoid meniscus cases (n = 1,006) were calculated and compared via chi-squared tests to the total database population (n = 65,759,970). This analysis was repeated for the population of patients who received knee arthroscopies (81,205). Incidence rates were calculated from these populations as well. Finally, a multivariable logistic regression analysis based on the population of arthroscopy-receiving patients was performed to control for age, reported gender, and income. Results: Proportions of Asian, Black, Hispanic, and White racial categories in the discoid meniscus group were 5.7%, 7.3%, 20.6%, 66.4%, respectively; the proportions of each racial category in the total population were 5.2%, 10.3%, 13.5%, 71.0%, respectively. Incidence rates (per 10,000) for these groups in the arthroscopy population were 72.9, 25.6, 49.2, 25.6, respectively. Our logistic regression model indicated that race was not a statistically significant predictor for our dataset after income adjusting. Adjusting for other covariates, the odds of a discoid meniscus diagnosis decreased by 6% for each increase in age (p < 0.001) and were 41% lower for males compared to females (p < 0.001). Conclusion: Prior studies have suggested that race (Asian and Hispanic, is a predictor of higher incidence of discoid meniscus – this study did not show a difference in incidence based upon race. Patient sex and age was identified as significant predictors for discoid meniscus, and increasing age showed a decreasing incidence of this condition. This study’s analysis of a large, national claims database allows for a comprehensive epidemiological study on this topic, offering proportions and incidence rates by race appropriate for application to the US population. Its conclusions promote patient sex and age as significant predictors and question the beliefs on race-associated incidence often based on comparing results from the corpus of single-site cohort studies. Tables/Figures: [Table: see text]
Hybrid Transtibial Femoral Preparation for Transphyseal Anterior Cruciate Ligament Reconstruction: A Radiographic Comparison to Transtibial and Anteromedial Portal Techniques
Authors: Jarvis D.Landry , Vance Danica D. , Riboh Jonathan C. 
Published: July 2021

Background: Transphyseal anterior cruciate ligament (ACL) reconstruction remains the most commonly used technique for pubescent patients. The principles of creating vertical and central femoral tunnels are well accepted to minimize physeal area of injury and are typically accomplished with a transtibial (TT) technique. This, however, may come at the expense of a non-anatomic tunnel. The hybrid transtibial (HTT) technique offers the potential of combining an anatomic femoral position with tunnel geometry similar to the TT technique but has never been assessed in a clinical cohort. Hypothesis/Purpose: We hypothesized that tunnels created by a HTT technique would be similar in orientation and physeal location to TT tunnels, but significantly more vertical and central than tunnels created with an anteromedial portal (AM). Methods: We retrospectively screened all ACL reconstructions performed in children aged 10 to 16 years, at our institution between 2013 to 2019, with the requirements of having a transphyseal reconstruction and an available post-operative radiographs. Radiographs were then assessed for the coronal femoral tunnel angle (FTA), as well as the location of the tunnel-physis penetration on the AP (LTAP) and lateral (LTL) views. Physeal lesion surface area was calculated. Data were compared between the three groups using ANOVA. Results: Forty-seven patients met eligibility criteria with 9 TT, 18 AM, and 20 HTT patients. Mean patient age was 14.3 +/- 1.2 years. The FTA was significantly more vertical in the TT (60.7o +/-7.2) and HTT (54.4o +/- 5.7) groups as compared to the AM group (48.8o +/- 5.9); p = 0.0037 and p = 0.02 respectively. There was no significant difference between the TT and HTT groups ( p = 0.066). The LTAP was not significantly different between groups (p = 0.097). The LTL demonstrated that the HTT tunnels penetrated the physis at a more central location in the sagittal plane (28.9% +/- 4.8%) than the AM tunnels (20.0% +/- 5.1%, p = 0.00002), but was statistically indistinguishable from the TT (24.4%+/- 4.0%, p= 0.066) tunnels. Conclusion: The hybrid transtibial technique presents an option for transphyseal ACL reconstruction, with femoral tunnel obliquity and estimated physeal disruption similar to the TT technique, significantly less than the AM technique. The HTT also results in the most central physeal perforation of all techniques, predominantly in the sagittal plane. With the known ability of the HTT technique to recreate an anatomic femoral footprint, this may represent the “best of both worlds” for transphyseal ACL reconstruction. Tables/Figures: [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
CLINICAL OUTCOMES OF OPERATIVE MANAGEMENT OF CAPITELLAR OSTEOCHONDRITIS DISSECANS IN ADOLESCENT ATHLETES
Authors: Michelin Richard M. , Gornick Bryn R. , Schlechter John A. 
Published: July 2021

Background: Capitellar osteochondritis dissecans (OCD) is commonly encountered in youth athletes. There are limited reports on long term outcomes using validated outcome scores following surgical treatment of elbow OCD in adolescents. Purpose: To examine the outcomes of operative treatment of elbow OCD in adolescent athletes and investigate return to sport rate as well as athletic and daily function. Methods: 17 adolescent athletes (average age 14.2 ± 1.5 years) and 18 elbows with OCD treated arthroscopically were retrospectively reviewed. The average duration of symptoms prior to surgery was 15.4 ± 12.5 months and average follow up was 4.4 ± 3.7 years. Data points examined included pre-operative lesion grade/size, range of motion (ROM), and bone age; intra-operative lesion grade/size; and post-operative ROM, Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Results: All patients were treated with initial diagnostic arthroscopy. 14/17 patients were definitively treated with arthroscopic debridement and marrow stimulation/microfracture. 3/17 patients required open treatment with two patients amendable to osteochondral fixation and one patient to open marrow stimulation/microfracture. 14/17 athletes returned to their sport post-operatively with 12/17 returning to the same level or higher, and 2/17 returning to a lower level of recreational play. 3/17 athletes did not return to sports but advised that this was by choice not due to their elbow OCD. Overall, there were significant improvements in elbow ROM post-operatively as well as excellent QuickDASH (average 1.9 ± 4.4) and KJOC scores (average 93 ± 8.0) seen amongst all athletes. There was no correlation between pre-operative lesion grade/size, bone age, or open versus arthroscopic treatment with outcome. Conclusion: Operative treatment of elbow OCD in adolescent athletes not only leads to high return to sports rates but also high levels of athletic and daily functional activity long term.
CHANGES IN DUAL-TASK GAIT VELOCITY COST FOLLOWING CONCUSSION
Authors: Ernest Kristin M. , Davis Tyler , Dugan Eric L 
Published: July 2021

Background: Changes in gait velocity have been identified in the literature between concussed and non-concussed individuals. Concussed patients demonstrate slower gait speed; the gait velocity cost has not been evaluated as extensively. Hypothesis: Hypothesis 1: Dual-task gait velocity cost will decrease at time of clearance compared to initial testing. Hypothesis 2: Subjects with a SRC will demonstrate greater decreases in gait velocity costs than those with non-SRC. Hypothesis 3: Symptom severity will be positively correlated to dual-task gait costs within the first 5 days after concussion. Methods: Patients evaluated for concussion in primary care sports medicine clinic within five days of injury were recruited between October 2017 and May 2019. The mechanism of injury was documented and used to classify sport-related (SRC) versus non sport-related (non-SRC) concussion. A standard concussion evaluation was performed at each visit to assess history, symptoms, neurocognitive, neuromuscular and vestibular dysfunction. Dual-task walking trials were incorporated with a cognitive task such as reciting the months of the year in reverse order or spelling words backwards. During the walking trials, gait velocity was measured using an Xsens MVN BIOMCH system (Xsens Technologies BV, Enschede, The Netherlands). A two-way mixed ANOVA with one within-subjects factor (time) and one between-groups factor (mechanism of injury) was used to determine if dual-task gait velocity costs differed over time and between those with a SRC versus those with a non-SRC. A Pearson’s product-moment correlation was used to assess the relationship between symptom severity scores and dual-task gait costs at initial visit. Results: There was no statistically significant interaction between the mechanism of injury and time on gait velocity cost, F(1, 79) = .033, p = .86. The main effect of time showed a statistically significant difference in mean gait velocity cost from initial to clearance, F(1, 79) = 6.19, p = 0.015, generalized η2 = .0.013. There was no main effect of mechanism of injury in mean gait velocity costs, F(1, 79) = 0.800, p = 0.374, generalized η2 = 0.008. There was a statistically significant, small positive correlation between symptom severity and dual-task gait velocity costs, r = .30, p < .007, with symptom severity explaining 9 % of the variation in dual-task gait velocity costs. Conclusion: The gait velocity cost demonstrates a statistically significant change from the time of injury to clearance in concussion patients. A small but significant relationship also exists between symptom severity and gait velocity cost.
EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES
Authors: Heldt Brett , Attia Elsayed , Guo Raymond , Kushare Indranil , Shybut Theodore 
Published: July 2021

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.