bluuebunny/crossref_metadata_2025_split huggingface dataset:
NERVE BLOCKS FOR PEDIATRIC ACL RECONSTRUCTION: COMPARING FUNCTION, PATIENT-REPORTED OUTCOMES, AND EFFICIENCY
Authors: Leska Tomasina M. , Bram Joshua T. , Pascual-Leone Nicolas , Williams Brendan A. , Ganley Theodore J. 
Published: July 2021

Background: Previous studies have compared the use of continuous nerve catheter versus single-shot nerve block approaches to regional anesthesia in ACL Reconstruction (ACLR), but they have primarily focused on adult populations. A paucity of data exists comparing these regional anesthesia techniques in children. Hypothesis/Purpose: To compare postoperative pain, strength, and functional outcomes between pediatric ACLR patients undergoing femoral nerve catheter (FNC) placement with single-shot sciatic block and those receiving femoral and sciatic single-shot nerve blocks (SSNB). Methods: Pediatric patients (≤18 years) undergoing primary ACLR between 1/2018-8/2019 at an urban tertiary care children’s hospital were identified. Patients were grouped based on regional anesthetic technique (FNC vs. SSNB). Emergency department (ED) visits, clinic visits, and calls for uncontrolled pain and narcotic refills were compared between these two groups. Outcomes including PROMIS scores, strength testing, and active range of motion (AROM) were also compared. Multiple imputation analysis was used to reduce bias as a result of missed follow-up. Results: 78 patients met inclusion criteria (FNC-36 patients, SSNB-42 patients). There were no differences in age, sex, BMI, or surgical technique between cohorts (Table I). Block preparation time (p<0.001) and surgical duration (p<0.001) were significantly longer for the FNC group. Ropivacaine dose (mg) of the sciatic nerve block was significantly higher in the SSNB group (35.0 ± 7.5 vs. 30.1 ± 4.1, p=0.001). All SSNB cases were performed at a satellite surgical center compared to 1 (2.8%) FNC case (p<0.001). There were no differences in uncontrolled pain or required narcotic refills between groups, and at 1 week follow-up, the proportion of patients with continued opioid consumption was not different (Table II). At 1 week, SSNB patients reported higher PROMIS physical function - mobility scores (25.5 ± 5.6 vs. 22.1 ± 4.9, p=0.009) with no difference in PROMIS pain interference scores. PROMIS scores were not different between cohorts at 6 weeks, 3 months or 6 months. AROM in extension and flexion also showed no difference between groups. SSNB was associated with a higher hamstrings to quadriceps ratio (quadriceps deficit) at 3 months (77.4 ± 23.8 vs. 66.2 ± 18.0, p=0.028), but there were no differences in isokinetic strength at 6 months. Conclusion: SSNB was associated with shorter operative times and better PROMIS physical function – mobility scores at 1 week compared to FNC. No other differences were observed in post-operative pain management, and cohorts were without differences in AROM and isokinetic strength by 6 months. Tables/Figures: [Table: see text][Table: see text]
KNEE RADIOGRAPHS DEMONSTRATE SMALL BUT STATISTICALLY SIGNIFICANT INCREASE IN POSTERIOR TIBIAL SLOPE IN PATIENTS WITH OSGOOD-SCHLATTER DISEASE
Authors: Green Daniel W. , Aitchison Alexandra H. , Sidharthan Sreetha , Schlichte Lindsay M. , Fabricant Peter D. , Doyle Shevaun M. , Mintz Douglas N. 
Published: July 2021

Background: Previous research has demonstrated an association between Osgood-Schlatter disease (OSD) and increased posterior tibial slope (PTS) in a small subset of patients with MRI and clinical exam consistent with OSD. Hypothesis/Purpose: To determine if children diagnosed clinically with OSD have an increased PTS on routine radiographs compared to controls. Methods: Patients 10-18 years old with the clinical diagnosis of OSD and a true lateral knee X-ray between 2016 and 2019 were eligible for the OSD group. Subjects were excluded if they had other significant knee pathology (Figure 1). The same number of controls were selected from patients in the same age and date range with history of anterior knee pain and a true lateral knee X-ray but no evidence of OSD or other significant pathology on clinical exam or X-ray. Demographic data and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject. PTS measurements were performed on true lateral X-Rays by three blinded investigators. Independent samples t-test and chi-squared test were used to compare variable means and frequency between OSD and control knees. Logistic regression analysis was used to investigate the effects of OSD, age, sex, height, weight, and HSS Pedi-FABS score on PTS (≥12º versus <12º). Results: 258 total knees (129 with OSD and 129 controls) were included. Mean age was 12.9 ± 1.8 years and 53% knees were male. There were no differences in age, sex, BMI, or laterality of knees between groups (Table 1). Mean PTS was significantly higher in the OSD group (11.6º ± 2.9º) compared to the control group (9.3º ± 2.7º, p<0.0001). In the OSD group, 46% of knees had a PTS ≥12º and in the control group, 19% knees had a PTS >12º (p<0.001). Logistic regression analysis showed that patients with OSD had 3.63 greater odds (95% CI 1.78-7.40) of having PTS ≥12º compared to patients without OSD, when controlling for age, sex, height, weight, and HSS Pedi-FABS score (Table 2). Conclusion: This study further supports an association between OSD and a mild increase in PTS. Patients with OSD had 3.6 greater odds of having PTS≥12º. The clinical implications of this finding have not yet been elucidated. We speculate that in patients with OSD, stresses (or force) exerted from the quadriceps muscle group through the patellar tendon loads the anterior portion of the tibia tubercle disproportionately to the posterior segment and causes asymmetric growth and an increased PTS. Tables/ Figures [Table: see text][Table: see text][Figure: see text]
CORRELATIONS BETWEEN FUNCTIONAL TESTING AND THE PEDI-CHAMP© AGILITY TEST IN YOUTH ATHLETES
Authors: Tulchin-Francis Kirsten , Ulman Sophia 
Published: July 2021

Background: The Pediatric Comprehensive High-Level Activity Mobility Predictor (Pedi-CHAMP©) is a 4-part agility test which assesses balance, lateral agility, directional changes, and acceleration/deceleration. Designed to assess children with orthopedic conditions or sports medicine injuries, it is unclear if the agility assessed with the Pedi-CHAMP© correlates to other clinical performance measures in uninjured healthy youth athletes. Hypothesis/Purpose: To determine if the Pedi-CHAMP component (Single-Limb-Stance [SLS], modified Edgren Side Step [mESS], L-Test, Illinois Agility Test [IAT]) and composite scores are correlated to the Lower Quarter Y-Balance Test (LQ-YBT) and sprint speed. Methods: Uninjured youth athletes were recruited to undergo a battery of tests as part of the Specialized Athlete Functional Evaluation (SAFE) Program. Completion times for each component of Pedi-CHAMP© were converted to points using age-sex matched scoring algorithms. Each participant completed the LQ-YBT and a single repetition of 10m and 20m sprints. Spearman correlations assessed relationships between the Pedi-CHAMP© component and composite scores and the LQ-YBT components, LQ-YBT composite score, and sprint times. Results: Forty-two, right-leg dominant youth athletes (30F, age:13.9±2.6yrs; BMI:20.±3.1) completed functional testing. 62% of participants specialized in a single sport and 83% participated in high-impact sports. There were no significant correlations between the SLS component score and functional tests (Table 1). While the posteromedial and posterolateral components of the LQ-YBT showed significant, fair correlations to the mESS (PM:r=0.338, PL:r=0.379), L-Test (PL only:r=0.374), IAT (PM:r=0.307, PL:r=0.407) and Pedi-CHAMP© composite scores (PM:r=0.370, PL:r=0.361), the anterior component and LQ-YBT composite scores were not significantly correlated to the Pedi-CHAMP©. There were strong correlations between the 10m and 20m sprints and the mESS (10m:r=-0.660, 20m:r=-0.693), L-Test (10m:r=-0.663, 20m:r=-0.736), IAT (10m:r=-0.704, 20m:r=-0.693) and Pedi-CHAMP© composite score (10m:r=-0.617, 20m:r=-0.678, all p<0.001). Conclusion: Performance on the mESS, L-Test, and IAT components of the Pedi-CHAMP© correlated to sprint times and posterior components of the LQ-YBT. The SLS component of the Pedi-CHAMP© may not be challenging enough for the older youth athlete, as this simple 30sec single limb balance test was designed for children with injuries or underlying orthopedic conditions. Replacing the SLS with one or more LQ-YBT components may be more appropriate for uninjured youth, particularly elite athletes. It is not surprising that forward sprint speeds were highly correlated with the agility portions of the Pedi-CHAMP© in this cohort of relatively high-level youth athletes. Future work should focus on evaluating the ability of the Pedi-CHAMP© to detect differences based on sport. Tables/Figures: [Table: see text]
MANAGEMENT OF FIRST-TIME PATELLAR DISLOCATION: A SURVEY OF PRISM MEMBERS
Authors: Parikh Shital N , Veerkamp Matthew ,   *PF RIG, Ellington Matthew , Finlayson Craig J , Molony Joseph , Friel Nicole , Green Daniel W , Mikutis Jeffery L , Milbrandt Todd A , Pace James L , Pendleton Albert M , Redler Lauren H , Rhodes Jason , Safier Shannon D , Schlechter John A , Stein Beth E Shubin , Vandenberg Curtis , Vaughn Jeffrey M , Wall Eric J , Warnick Drew E , Yaniv Moshe , Parikh Shital N 
Published: July 2021

Background: There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. Purpose: To develop consensus-based guidelines for management of first-time dislocation in adolescents. Methods: A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral RIG. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed Results: 81/276 (29%) members responded to the survey and 6 consensus-based guidelines were generated from those responses. [Table: see text] There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process. Conclusion: There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes.
ISOLATED MPFL RECONSTRUCTION VS. TIBIAL TUBERCLE OSTEOTOMY AND MEDIAL RETINACULAR PLICATION FOR RECURRENT PATELLAR INSTABILITY: A MATCHED, COHORT ANALYSIS OF CLINICAL OUTCOMES COMPARING TWO TECHNIQUES
Authors: Heyworth Benton E. , Zheng Evan T. , Hussain Zaamin B. , Wilson Benjamin R. , Nunally Kianna D. , Kocher Mininder S. , Yen Yi-Meng , Kramer Dennis E. , Micheli Lyle J. 
Published: July 2021

Background: Historically, the most commonly utilized technique to address recurrent patellofemoral instability (PFI) was a combined proximal and distal realignment, specifically the tibial tubercle osteotomy (TTO) with a proximal medial retinacular plication/reefing/tightening/repair (MRP). Rising interest in the medial patellofemoral ligament reconstruction (MPFLR) over the last decade, now frequently performed as a more powerful isolated proximal realignment procedure, has prompted debate over the optimal technique to treat this common condition. Hypothesis/Purpose: The study hypothesis was that no difference would be detected in recurrent PFI rates or revision surgery rates between patients who underwent TTO-MRP vs. MPFLR. Methods: With cohorts derived from a large, single-center PFI database of 523 patients who underwent a variety of stabilization procedures, 114 eligible MPFLR patients were matched to 109 TTO patients based on age, gender, BMI, and TT-TG distance. Propensity score matching was conducted using logistic regression models to produce 1:1 matching, and a caliper of 0.2 standard deviations of the estimated propensity score was used to for the nearest neighbor matching algorithm. Final matching procedure resulted in 84 MPFLR patients and 84 TTO patients. These were compared on demographics and post-operative clinical results. Results: Demographic and radiologic comparisons of the cohorts are shown in Table 1, with the only difference between groups being an expected higher rate of patients with open physes in the MPFLR cohort. Table 2 shows the TTO-MRP group had longer follow up times, but comparable rates of return to sports. The MPFLR group had a higher rate of recurrent instability, but not to a significant degree, and a significantly higher incidence of revision patellar stabilization surgery (p<0.001). The TTO group had a higher rate of additional knee surgery, the majority of which were implant removal for TTO screws. Conclusion: The TTO-MRP shows equivalent or superior results to the MPFLR for treatment of PFI. However, implant removal may be common with TTO, though this may be somewhat technique-dependent. In the current landscape of increasing interest and utilization of MPFLR as an all-encompassing PFI surgery, the influence of distal bony realignment to minimize recurrence should not be underappreciated. Tables/Figures: [Table: see text][Table: see text]
SURGICAL OUTCOMES OF ACCESSORY NAVICULAR IN ADOLESCENT ATHLETES
Authors: Yang A , Hennrikus WL. , Bone Penn State Hershey Pediatric ,   Institute Joint, Hershey PA 
Published: July 2021

Introduction: An accessory navicular (AN) is a plantar medial enlargement of the navicular bone of the foot. Patients with AN present with a foot bump. Only some patients are symptomatic with pain. The purpose of this study is to report the surgical outcomes in a consecutive series of adolescent athletes with symptomatic AN. Methods: The study was approved by the College of Medicine IRB. 16 patients were evaluated. Patient gender, age, complaints, family history, sports played, conservative treatments attempted, duration of symptoms, surgical technique, complications, outcomes, average follow up, time to return to normal activity, # that returned to sports, and the time to return to sports were recorded. Radiographs were used to identify the type of AN (Coughlin system), skeletal maturity, and presence of pes planus. Pes planus was determined by standing lateral foot radiograph talo-first metatarsal angle. Results: 16 patients and 17 feet were studied. 15 were female (94%). The average age at surgery was 13 years (range 10 to 18 years). 0 patients had a family history of AN. The presenting complaint was foot pain and a bump. Sports including 2 basketball, 2 cheer, 4 gymnastics, 3 soccer, 1 volleyball, 1 dance, 1 softball, 2 multiple sports. The average duration of symptoms was 22 months (range 1 to 36 months). Conservative care methods attempted included: shoe inserts, activity modification, anti-inflammatory medications, icing, crutches, and changes in footwear. Pre-op radiographs demonstrated 9 Coughlin Type 1, 3 Type 2, and 5 Type 3 AN’s. Pre-op radiographs demonstrated 8 feet (47%) had flat foot. 9 feet (53%) had fused the calcaneal growth plate. All patients had a simple excision of the AN and 13 feet (76%) had an additional reefing of the posterior tibial tendon. The average time to return to normal activities was 13 weeks (range 8 to 16 weeks). 15/16 patients (94%) were able to return to their pre surgery sports. The average follow-up time was 8.5 months. At final follow up, 13 feet (76%) reported no pain, 3 (18%) with minimal pain, and 1 (6%) with no change in pain. No complications were reported. Discussion and Conclusion: Symptomatic AN is more common in females. Surgical success was unrelated to a closed growth plate. Surgery eliminated pain in 76% of patients and allowed 94% of patients to return to sport. Residual pain in 4 patients was correlated with a pre-op flat foot (4/8 patients: 50%).
EFFECTIVENESS OF PRE-SEASON PHYSICAL PERFORMANCE TESTS IN IDENTIFYING IN-SEASON LOWER EXTREMITY INJURIES IN ADOLESCENT GYMNASTS
Authors: Farzanegan Danielle A , Francione Emily , Melfi Nicole 
Published: July 2021

Background: Artistic competitive gymnastics results in a wide, unique spectrum of injuries. Due to the high number of injuries and the current lack of research related to pre-competitive testing in adolescent gymnasts, it is crucial to find a method to predict the likelihood of an athlete sustaining an in-season injury. Purpose: The purpose of this study was to 1) describe the frequency and type of pre-season and in-season injuries, 2) determine if there were differences in physical performance tests between those who had a lower extremity (LE) injury in-season and those who did not, and 3) determine if there were differences in age, level, sex, BMI, sport modifications, previous injury, and current injury between those who had a LE injury and those who didn’t. Methods: Thirty-seven adolescent gymnasts (average age: 12.81 years) were included with levels ranging from 5 (novice) to 10 (elite). Participants (15 males and 22 females) were surveyed for previous and current injury. The athletes completed a performance battery before the competition season including: Lower Quarter Y-Balance Test (LQYBT), Closed Kinetic Chain dorsiflexion (CKCDF), single hop (SH), triple hop (TH), and the Functional Movement Screen (FMS). Follow-up data was collected at the end of the competitive season for comparison. The data was analyzed using descriptive methods and comparative analyses including chi-square and independent t-tests with an alpha level set at .05. Results: Sixty-five percent reported an injury in the last year and seventy-eight percent reported pre-season injuries at testing day. The most common location for pre-season injury was the ankle/foot (24% and 31% respectively). There were no differences between injured and non-injured athletes when comparing asymmetries in CKCDF, LQYBT posteromedial or posterolateral reach, hop testing, or FMS. The LQYBT-anterior scores were significantly different at p=.049 between the injured versus uninjured groups, with 91% of the in-season injury group having a difference <4cm. Similarly, the LQYBT-composite score using a cut-off of 95% was significant at p=.043 with those >95% category being more likely to get injured. There were no significant differences in demographic information comparing injury occurrence. Conclusion: The tested physical performance battery may be useful in tracking gymnasts over time, but may not be beneficial in forecasting injuries in a sport with high percentages of acute injuries. The collected injury volume may not be reflective of a standard season as COVID-19 decreased the number of competitions. Additional research to identify athletes at risk for injury requires further investigation.
CHARACTERISTICS OF FOREARM RE-FRACTURE IN YOUTH ATHLETES
Authors: Kapadia Ami , Wyatt Charles W. , Montgomery Gerad K. , Wilson Philip L. , Ellis Henry B. 
Published: July 2021

Background: The forearm is the most common site of fracture, and perhaps re-fracture, in the pediatric population. Although both bone forearm (BBFA) fractures represent approximately 30% of pediatric upper extremity fractures, little is known about BBFA re-fractures, particularly among youth athletes. Purpose: To evaluate characteristics of BBFA re-fracture and recurrent fractures. Methods: An IRB-approved retrospective chart review based on CPT and ICD-9/10 codes of forearm fractures (ages 10-18 years) treated by a single academic pediatric orthopedic group from June 2009 to May 2020 was conducted. All BBFA, radial, or ulnar fractures with ipsilateral same-site, or non-identical ipsilateral or contralateral forearm fracture were included. Demographics, injury characteristics, length of immobilization, timing of return to activity, and radiographic data (angulation, distance between radius fracture and ulna fracture [in mm], position of fracture within bone, and radiographic healing). An analysis was performed to evaluate associations of ipsilateral same-site re-fracture versus ipsilateral or contra-lateral non-identical site fractures. Results: Twenty-nine of 686 BBFA and distal radius fractures were identified to have recurrent fracture (4.23%), with an average age of 11.5 years and male-to-female ratio of 6.25:1. 67% of ipsilateral same-site re-fractures occurred within one year. The most common mechanisms of primary fracture were contact sports (40%) and tumbling (30%), and re-fracture occurred 182 days after original fracture. 52% percent of recurrent fractures were ipsilateral same-site re-fractures, while 48% occurred in a non-identical site, either ipsilaterally or contralaterally. The most common mechanisms of recurrent fracture were contact sports (38%), falls (38%), and tumbling (14%). Ipsilateral same-site re-fractures compared to other recurrent fractures, were significantly associated with a mid-shaft location (p=0.0029), increased radius to ulna fracture distance (21.14 mm versus 11.3 mm, p=0.0277) [Figure 1], and earlier occurrence following index fracture (re-fracture= 397.33 days versus non-identical recurrent fracture= 884.07 days, p=0.0056). Degree of angulation was not significantly associated with re-fracture. Conclusion: Recurrent fracture may occur at different times and locations following primary injury treatment. Ipsilateral same-site re-fractures tend to occur within the first year of treatment following mid-shaft fractures incurred during contact sports and tumbling, with widely spaced radial and ulnar fracture sites. Further research may be warranted to evaluate biologic, bone health, or personality traits that may lead to recurrent and re-fractures in pediatric forearm fractures. [Figure: see text]