bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Y-Balance Test Performance by maturation status in youth distance runners
Authors: Rauh Mitchell J. , Garcia Micah C. , Bazett-Jones David M. , Long Jason T. , Ford Kevin R. , Paterno Mark V. , Taylor-Haas Jeffery A. 
Published: July 2021

Background: Distance running is a popular interscholastic sport, but also has an associated high risk of running-related injuries. Recent literature suggests that functional tests may help to identify athletes at increased risk of injury. The Y-Balance Test (YBT) is an objective measure used to assess functional muscle strength and balance and to expose asymmetries between tested limbs. Purpose: To determine if YBT performance was associated with maturation status in healthy, youth distance runners. We hypothesized that mid-pubertal (MP) runners would demonstrate less functional reach distance than pre-pubertal (PrP) or post-pubertal (PoP) runners. Methods: A convenience sample of 142 (Females: n=79, Males: n=63) uninjured youth runners (ages 13.5±2.7 years; weekly running distance: 18.2±20.4 km) were recruited from the local community. All runners met inclusion criteria, indicating that they were between 9 and 19 years old and participated in long-distance running activities such as school/club track and field, cross country, road races, trail running, and/or soccer. The runners completed a modified Pubertal Maturational Observation Scale (PMOS), then were screened for right (R) and left (L) anterior (ANT), posteromedial (PM) and posterolateral (PL) reach distances (cm) normalized by lower limb length (cm). Composite reach distance was calculated by the sum of the three reach distances divided by three times the limb length multiplied by 100 for R and L limbs. ANOVA with Bonferroni post hoc tests were used to compare maximum normalized reach distances for the three directions and composite reach distance by maturation status and sex. Results: Overall, 31.7% were classified as PrP status, 26.1% as MP, and 42.3% as PoP, with similar percentages by sex ( p=0.84). The only significant mean difference was found for R ANT maximum normalized reach distance between PrP and PoP ( p=0.02), indicating a greater normalized reach in PrP athletes. No significant mean differences were found for R or L PM and PL maximum normalized reach distances, or for R or L composite reach distances, by maturation status or when stratified by maturation and sex ( p>0.05). Conclusions: In this sample of youth runners, the YBT was only a discriminator of anterior reach distance between pre-pubertal and post-pubertal runners. As decreased anterior reach is associated with reduced quadriceps muscle strength and anterior knee pain, reduced anterior reach in post-pubertal runners may potentially signify an increased risk of sustaining a running-related injury. Thus, preventive efforts to ensure good functional quadriceps muscle strength may be merited.
SEX, PATELLAR TENDON GRAFT, AND EARLY MOTION DEFICITS PREDICT ARTHROFIBROSIS AFTER PEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Ouweleen Abraham J. , Hall Tyler B. , Finlayson Craig J. , Patel Neeraj M. 
Published: July 2021

Background: Arthrofibrosis remains a concerning early complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Previous studies suggest that those receiving patellar tendon (PT) autograft may be at higher risk than hamstrings tendon (HT), but there is little data regarding this complication in patients receiving quadriceps tendon (QT) autograft. Purpose: The purpose of this study is to identify risk factors for arthrofibrosis following pediatric ACLR with attention to graft type. Methods: The medical records of patients that underwent primary ACLR at a single tertiary children’s hospital were reviewed for this retrospective cohort study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, or a modified MacIntosh reconstruction were excluded. Arthrofibrosis was defined as a deficit of 10 degrees of extension and/or 20 degrees of flexion at 3 months after ACLR. Demographic data, intra-operative findings and techniques, and post-operative motion and complications were recorded. Univariate analysis was followed by purposeful entry logistic regression to control for confounding factors. Results: A total of 378 patients were included in the analysis, of which there were 180 PT, 103 HT, and 95 QT grafts. The mean age was 15.9±1.7 years and 188 (49.7%) were female. In univariate analysis, the rate of arthrofibrosis was 1.9% for HT, 6.3% for QT, and 10.0% for PT (p=0.04). Females developed arthrofibrosis more frequently than males (10.6% vs. 3.2%, p=0.004). Additionally, those that ultimately experienced this complication had lower median flexion at 6 weeks after ACLR (88 vs. 110 degrees, p<0.001). After controlling for covariates in a multivariate model, PT graft raised the odds of arthrofibrosis 6.2 times compared to HT (95% CI 1.4-27.6, p=0.02), but there were no significant differences between QT and other graft types. Females were at 4.2 times higher odds than males (95% CI 1.6-10.8; p=0.003). Patients that were unable to attain 90 degrees of flexion 6 weeks after ACLR had 14.7 times higher odds of eventually developing arthrofibrosis (95% CI 5.4-39.8; p<0.001). Finally, those with an extension deficit of ≥5 degrees 6 weeks after ACLR had 4.7 times higher odds of experiencing this complication (95% CI 1.8-12.2, p=0.001). Conclusion: After adjusting for multiple covariates, PT autograft, female sex, and motion deficits at 6 weeks after ACLR (<90 degrees of flexion or extension deficit ≥5 degrees) were predictive of arthrofibrosis in children and adolescents. Quadriceps tendon autograft did not increase the risk of this complication.
SLIPPED CAPITAL FEMORAL EPIPHYSIS ACETABULAR ORIENTATION AND SHAPE: A THREE-DIMENSIONAL CT STUDY
Authors: Paez Conner , Bomar James D. , Farnsworth Christine , Bandaralage Harsha , Upasani Vidyadhar 
Published: July 2021

Background: Previous studies have analyzed the acetabulum in patients affected by slipped capital femoral epiphysis (SCFE), however controversy remains over how the acetabular shape may be altered in hips experiencing SCFE. In particular, changes in acetabular over-coverage and acetabular version are thought to contribute to SCFE. Hypothesis/Purpose: The purpose of this study was to determine the acetabular morphology in hips with SCFE and compare them to normally developing children. Methods: Images from patients with the diagnosis of SCFE who had a computed tomography (CT) exam of their pelvis were compared to images from an age- and sex-matched cohort of patients with CT exams of the pelvis/abdomen for a non-orthopedic related evaluation (controls). Three dimensional (3D) reconstructions were created from each CT exam (MIMICs software). Custom MATLAB software was used to uniformly align and calculate acetabular parameters from the 3D reconstructions. The acetabular parameters calculated were articular surface area, acetabular tilt, acetabular version, and acetabular coverage angles measured in a radial fashion in 5 out of 8 octants. Results: Two-hundred-ninety-eight hips were evaluated, including 67 hips with SCFE, 39 unaffected contralateral hips in patients with SCFE, and 192 normal controls. The SCFE group consisted of 33 males and 34 females. Acetabular version was similar amongst all SCFE affected hips, unaffected contralateral hips, and normal controls (p=0.575). Control hips had higher acetabular tilt than SCFE affected hips (p=0.001) and unaffected contralateral hips (p=0.012). Acetabular surface area was higher in SCFE affected hips compared to controls (p=0.003)(Table 1). SCFE affected hips had significantly increased acetabular coverage compared to controls in the superior, superior-anterior, and anterior octants (p<0.01). The unaffected contralateral sides had significantly increased acetabular coverage compared to controls in all five regions (p<0.02)(Table 2). Conclusions: Contrary to some previous studies, we did not find the acetabulum to be retroverted in hips with SCFE compared to normal hips. Both the affected and unaffected hips of SCFE patients have decreased acetabular tilt. Acetabular surface area is high in both the affected and unaffected sides in SCFE, suggesting it may be involved in the pathogenesis of the condition. There is increased acetabular coverage in the superior regions of SCFE hips. The shared morphological characteristics of both affected and unaffected sides in SCFE patients suggest that their hip anatomy may predispose them to slips. [Table: see text][Table: see text]
EFFECT OF AUTOGRAFT TYPE ON RECOVERY OF KNEE EXTENSOR MECHANISM FUNCTION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: VandenBerg Curtis D. , Katzel Mia J. , Beltran Veronica , Conrad-Forrest Adriana S. , Wren Tishya A. L. 
Published: July 2021

Background: While multiple studies have shown clear benefits of autograft over allograft for anterior cruciate ligament reconstruction (ACLR) in young athletes, disagreement remains regarding the optimal autograft choice. Recovery from ACLR may be influenced by autograft type, which can include iliotibial band (IT), hamstring tendon (HT), quadriceps tendon (QT), or patellar tendon (PT) depending on skeletal maturity and surgeon preference. Hypothesis/Purpose: This study compared knee joint function among pediatric athletes with different types of ACLR autografts. We hypothesized that knee extensor function would recover faster for graft types that did not disrupt the knee extensor mechanism (i.e., IT and HT vs. PT and QT). Methods: This retrospective study examined 138 pediatric athletes (73 female; mean age 15.5, SD 2.2, range 8-21 years) who had undergone sports biomechanical testing in our motion analysis laboratory following recent unilateral ACLR (mean 7.7, range 3-18 months post-surgery). All reconstructions used autografts including 20 IT, 26 HT, 37 QT, and 55 PT. Lower extremity sagittal plane kinematics and kinetics were measured during vertical drop jump landing (41 cm height) and 45° cutting. Maximum knee flexion angles, internal knee extensor moments, and energy absorption during the landing phase (initial contact to peak knee flexion) of each movement were compared among graft types and sides (ACLR vs. contralateral) using linear mixed models with sex, age, and time since surgery as covariates. Results: Knee flexion was significantly lower on the operated vs. contralateral side for HT, QT, and PT during drop jump and for QT and PT during cutting (p<0.001). All graft types exhibited lower knee extensor moments and energy absorption on the operated side (p<0.05). This asymmetry was most pronounced for QT and PT and least pronounced for IT (Figure 1.1). Loading on the operated limb decreased from IT to HT to QT and PT, while loading on the contralateral limb increased similarly. Asymmetry of kinetics was significantly lower for IT compared with both QT and PT during both movements (p<0.01). Similar patterns were observed for HT but were not always statistically significant. No differences in asymmetry were observed between IT and HT or between QT and PT. Conclusion: Young athletes with IT and HT autografts exhibit greater engagement of the knee extensors during dynamic loading than peers with PT or QT autografts in the 18 months following ACLR. This may be due to extensor mechanism donor site morbidity associated with PT and QT grafts. Tables/Figures: [Figure: see text]
OPEN REDUCTION OF MEDIAL EPICONDYLE FRACTURES IN CHILDREN AND ADOLESCENTS: SUPINE VERSUS PRONE POSITION
Authors: Baghdadi Soroush , Harwood Kathleen , Arkader Alexandre , Lawrence John Todd 
Published: July 2021

Background: Operative treatment of medial epicondyle (ME) fractures can be performed in either supine or prone position. In the supine position, visualization and fixation of the fracture is difficult. However, the prone position requires extensive patient repositioning but may improve visualization. Purpose: The purpose of this study was to compare the results of ORIF of ME fractures between supine and prone positions. Methods: In a retrospective review, patients <18 who underwent open reduction of an acute ME fracture from 2011-2019 were identified. Results and complications were compared between the supine and prone positions. Results: 204 patients were included, with a mean age of 11.7 years. 133(65.1%) were sports injuries, and 67(32.8%) had concomitant dislocation, with 17(8.3%) having an incarcerated fracture. 122(60%) patients were in the supine group, and 82(40%) in prone. The mean wheels in-wheels out time was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Mean tourniquet time was 53.1 and 55 minutes in supine and prone positions (P=0.4). C-arm usage was 27.9 and 26.9 seconds in the supine and prone groups, respectively (P=0.7). Displacement of the fracture on the first post-operative x-rays was 2.06 and 1.1 millimeters for the supine and prone groups (P<0.001). A total of 39(19%) patients had some ROM limitation at follow-up, with the majority (33 patients) having <10° loss of ROM. Five patients (2.5%) underwent 7 reoperations due to stiffness, 2 patients due to tardy ulnar nerve palsy, 2 due to non-union, and 53(26%) had a surgical hardware removal. Surgical position was not predictive of complications/reoperation. All of the nine surgeons (out of 16) who have operated at least one patient in the prone position have changed their preferred surgical position to prone. Conclusion: With the largest study population in the literature, the results of our study show that surgical stabilization of medial epicondyle fractures is safe, with minimal complications. While the prone position requires additional time in the operating room, presumably for positioning, the surgical procedure takes the same time and the prone position allows for a more accurate reduction. While the clinical significance of a 1mm difference in reduction quality is unknown, the observation that no surgeon that has tried the prone position had ever gone back to the supine position suggests that the surgical procedure is technically easier in this position.
ATHLETIC IDENTITY IN YOUTH ATHLETES: A SYSTEMATIC REVIEW
Authors: Edison Bianca , Rizzone Katherine , Christino Melissa 
Published: July 2021

Background: Athletic identity (AI) is an important part of the sporting culture that ties in multiple components of how an individual relates to their sport. Adult-based research has described positive and negative sequelae from adopting a robust AI, but there has been less studied on this social trait in younger age groups. Purpose: To systematically review the literature to investigate and describe epidemiological characteristics of athletic identity in athletes younger than 22 years old. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Group (PRISMA) guidelines. PubMed, Embase, PsycInfo were searched to identify studies that quantitatively assessed athletic identity. Three independent reviewers performed data extraction and quality assessment. Study eligibility criteria included English-language publications from 1945-present with an athletic identity outcome in individuals 22 years old and younger. Assessment for study bias was evaluated using the Appraisal Tool for Cross-Sectional Studies (AXIS). Results: Ten studies met the study’s inclusion criteria, eight were cross-sectional design, one was a case series, and one involved a longitudinal design. For these studies, three out of the ten were deemed good quality by AXIS and the remainder were of fair quality. Eight of the ten studies utilized the Athletic Identity Measurement Scale and two utilized the Athlete Identity Questionnaire. Constructs examined include sports and physical activity participation, mental health, sports-related injury, and demographics such as gender and ethnicity. Scores did not vary by gender, but did by race/ethnicity. Two studies found that adolescence was a time of increased athletic identity as opposed to later in one’s training. The studies that focused on mental health and AI showed higher levels may have a protective effect against burnout, but in injured athletes, it may increase the likelihood of depression. In a study examining AI and injury, there was a bimodal association of both low AI and high AI athletes having higher risk of injury. Conclusions: Our systematic review of the literature resulted in very heterogeneous results, preventing analyses of common measures and outcomes. There was cross-study evidence that in adolescence, the transition to a higher level of play can be correlated with a stronger sense of athletic identity. Several studies examined the effect athletic identity can have on the mental health of youth. Further study is needed in pediatric athletes to better understand the relationship between AI and different components of sport.
CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP
Authors: Allahabadi Sachin , Pandya Nirav K. 
Published: July 2021

Background: Medial patellofemoral ligament (MPFL) reconstruction has gained popularity as a tool to manage recurrent patellar instability. The use of allograft for reconstruction includes benefits of quicker surgical time and obviating donor-site morbidity. In anterior cruciate ligament (ACL) reconstruction hesitancy exists to use allograft in younger patients based on data demonstrating higher graft failure rates. However, a similar trend of allograft failure has not been demonstrated for reconstruction of the MPFL, which has a lower tensile strength than that of the ACL. Hypothesis/Purpose: The purpose of this study is to evaluate outcomes including recurrent instability after MPFL reconstruction utilizing allograft tissue in pediatric and adolescent patients. Methods: A retrospective review was performed to identify patients of a single surgeon with MPFL reconstructions with allograft for recurrent patellar instability with minimum two-year follow-up. Surgical management was recommended after minimum six weeks of nonoperative management including bracing, physical therapy, and activity modification. Pre-operative x-rays were evaluated to assess physeal closure, lower extremity alignment and trochlear morphology, and Insall-Salvati and Caton-Deschamps ratios. MRIs were reviewed to evaluate the MPFL, trochlear morphology, and tibial tubercle trochlear groove distance (TT-TG). The allograft was fixed with a bioabsorbable screw. Descriptive statistics were used to characterize data. The primary outcome was recurrent instability. Results: 20 patients (23 knees) 14 females (17 knees) with average age 15.8 years (range: 11.5-19.6 years) underwent MPFL reconstruction with allograft with average follow-up of 3.6 years (range: 2.2-5.9 years). Physes were open in 8 knees. Average Insall-Salvati ratio was 1.08 ± 0.16 and Caton-Deschamps index was 1.18 ± 0.15. Eighteen patients were noted to have trochlear dysplasia pre-operatively and TT-TG was 15.4 ± 3.9 mm. The three knees (13.0%) with complications had open physes – two (8.7%) had recurrent instability requiring subsequent operation and one sustained a patella fracture requiring open reduction internal fixation. The average Insall-Salvati of these three patients was 1.26 ± 0.21, Caton-Deschamps was 1.18 ± 0.21, and TT-TG was 18.3 ± 3.5mm. There were no growth disturbances noted post-operatively. Conclusion: MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at mid-term follow-up with few complications and low rate of recurrent instability. Anatomic factors for may contribute to recurrent instability and complications post-operatively, though larger numbers are needed for statistical analyses. Further prospective and randomized evaluation comparing autograft to allograft reconstruction is warranted to understand graft failure rates.
FUNCTIONAL RECOVERY AFTER REVISION ACL RECONSTRUCTION WITH A SECOND AUTOGRAFT: A MATCHED COHORT ANALYSIS IN ADOLESCENT PATIENTS
Authors: Wilson Benjamin R. , Heyworth Benton E. , Coene Ryan P. , Sugimoto Dai , Micheli Lyle J. , Kocher Mininder S. , Christino Melissa A. 
Published: July 2021

Background: Young patients are the highest risk demographic for ACL graft failure and revision surgery. Previous studies have shown higher rates of graft failure with the use of allograft tissue for ACL reconstruction (ACLR) in both primary and revision surgeries. However, questions remain regarding the functional consequence of taking a second autograft from the same knee for revision ACLR. Purpose: The purpose of this study was to evaluate 6-month functional testing in patients who underwent revision ACLR with a second autograft from the same knee compared to matched cohorts of primary ACL patients. Methods: We retrospectively reviewed prospectively collected data from patients aged 19 or younger who had revision ACLR with a second autograft at our institution. We excluded patients with iliotibial band autografts, two autografts from a synergistic muscle groups, or grafts from the contralateral knee. Patients with previous significant injury or surgery to the contralateral leg, and those with multiligamentous knee injuries were excluded. Patients underwent functional testing 5-8 months after revision surgery including anthropometric measures, isometric strength, Y-Balance, and hop testing. Side-to-side deficits were then compared to age, sex, and BMI matched cohorts of primary ACLR patients, with hamstring or patellar tendon autografts. Multivariate analysis of variance (MANOVA) was used, and if significance was detected, pairwise comparison was performed by Bonferroni post-hoc correction. Statistical significance of p<0.05 was applied. Results: Thirty-seven adolescents underwent functional testing at 6.25±0.56 months after revision ACLR with a second autograft. These patients were matched to 62 patients who underwent primary ACLR with hamstring autograft, and 47 who underwent ACLR with patellar tendon autograft (Table 1). Revision ACLR patients showed comparable knee extension strength deficits to the patellar tendon group (-9.45±12.09% vs -8.81±13.83%, p=0.999) which were significantly greater than hamstring group (-9.45±12.09% vs -0.99±12.00%, p<0.05). Greater strength deficits were seen in knee flexion strength in the hamstring group than the revision group (-38.90±16.21% vs -28.13±23.22%, p=0.009) which had significantly greater knee flexion strength deficits than the patellar tendon group (-28.13±23.22% vs -1.17±12.41%, p=0.001). The hamstring primary group also showed greater triple hop deficit (-21.08±25.99%) than the other two groups (-21.08±25.99% vs -10.75±12.85 vs -6.84±23.81, p=0.024), which were similar. Conclusions: After revision ACLR with a second autograft from the same knee, adolescents show similar knee extension strength deficits compared to primary ACL patients with patellar tendon grafts, but improved knee flexion strength deficits compared to primary ACL patients with hamstring grafts. Tables/Figures: [Table: see text]