bluuebunny/crossref_metadata_2025_split huggingface dataset:
DESCRIPTIVE EPIDEMIOLOGY STUDY OF THE JUSTIFYING PATELLAR INSTABILITY TREATMENT BY EARLY RESULTS (JUPITER) COHORT
Authors: Bishop Meghan E , Brady Jacqueline M , Gruber Simone , Veerkamp Matthew , Nguyen Joseph T , Green Daniel W , Wall Eric J , Parikh Shital , Shubin Stein Beth E ,   the JUPITER Group
Published: July 2021

Background: Patellar instability is a common injury in young patients and can lead to significant morbidity and arthritis. Its management is controversial. JUPITER (Justifying Patellar Instability Treatment by Early Results) is a hypothesis-driven, multi-center, multi-armed, prospective cohort study developed to describe clinical characteristics and predictors of clinical outcomes in the young patellar instability population. Purpose: To describe the formation of JUPITER and provide a descriptive, epidemiologic analysis of patient demographics and clinical features of the patients in this prospective cohort. Methods: After training and institutional review board approval, surgeons began enrolling patients between 10-30 years of age who sustained a patellar dislocation. Patient demographics, dislocation history, physical exam characteristics, and PROMs were collected. Results: By January 1, 2019, 28 surgeons from 12 sites had prospectively enrolled 661 patients (677 knees) with patellar instability. 62% were female and mean age was 15.8 years. 447 knees (66%) were in the operative group and 230 (34%) in the non-operative group. 55% of knees reported that they had more than 1 dislocation (operative group 73%; non-operative group 27%, p<0.001). Operative treatment was indicated in 39% of first-time dislocators and 85% of recurrent dislocators (p<0.001). Recurrent and operative group patients had more positive physical exam findings than first-time and non-operative group patients on the affected knee (p<0.05 for J-sign, apprehension, crepitus) and the contralateral knee (p<0.05 J-sign, apprehension). The recurrent group was nearly twice as likely to be ligamentously lax (Beighton score 5 or greater) compared to first-time patients (p<0.001). Baseline PROMs varied with the recurrent group having lower Pedi-FABS (p=0.001) and KOOS-QoL (0.008) scores and higher Kujala (0.009), KOOS ADL (0.008), KOOS Sports (<0.001), and Pedi-IKDC (0.014) scores than the first-time dislocator group. Conclusions: The JUPITER Group has been able to accumulate the largest prospectively collected patellar instability database to date. Over half of patients in this group reported they sustained more than one dislocation. Operative management was indicated in 39% of first-time dislocators, 50% of which had sustained an osteochondral fracture, and 85% of recurrent dislocators. Recurrent dislocators were more likely to have positive physical exam findings on both the affected and contralateral knee.
CLINICAL FEATURES AND OUTCOMES OF LITTLE LEAGUE ELBOW IN YOUNG ATHLETES
Authors: Heyworth Benton E. , Zheng Evan T. , Bae Donald S. 
Published: July 2021

Background: As participation and specialization in youth sports has increased, so too has the incidence of overuse conditions, such as medial epicondyle apophysitis, or Little League Elbow (LLE). Hypothesis/ Purpose: The study purpose was to assess the demographic features, clinical presentation, management, and outcomes of a population of skeletally immature athletes with this increasingly common, but understudied, condition. Methods: A retrospective analysis was performed of patients diagnosed with LLE between 2003 and 2017 at a tertiary-care pediatric hospital. All patients had open apophyses with a clinical history of repetitive overhead athletic activity and radiographic and/or physical exam findings consistent with LLE. Study variables were derived from the electronic medical record. Results: Three hundred seventeen subjects (mean age: 12.8 years, range 8yrs – 16yrs; 310 males, 98%) were identified. The vast majority were baseball players (n=310, 98%), though there were several tennis players (n=4, 1%) and football quarterbacks (n=3, 1%). Two-hundred sixty-eight patients (85%) presented with apophysitis, while 49 (15%) presented with acute avulsion fractures from throwing (with 84% reporting preceding medial elbow pain). The acute fracture patients are the subject of a separate study. In the apophysitis cohort, all of whom presented with medial elbow pain, other presenting findings/symptoms included decreased elbow range of motion (16%) and concomitant ipsilateral shoulder pain (13%). Amongst those with documented shoulder exams, a majority (55%) demonstrated glenohumeral internal rotation deficit (GIRD) with a significantly longer time from diagnosis to resolution of symptoms (p=0.025). All apophysitis patients were treated with rest (complete cessation 75%, relative rest/position change 25%). Mean follow up was 32 months (sd 33 months). Return to sports occurred at a median of 12 weeks from diagnosis (IQR 7wks – 18wks). Recurrence of elbow pain occurred a median of 24 months (IQR 11mo - 43mo) following initial diagnosis in 13% of patients, a sub-cohort with significantly longer duration of symptoms prior to index presentation (p=0.024). One patient also suffered a subsequent medial epicondylar avulsion fracture while throwing in the setting of non-compliance with recommended rest. Conclusion: Little League Elbow is most commonly seen in adolescent and pre-adolescent male pitchers but may rarely be seen in other overhead athletic sub-populations. Careful evaluation of the entire kinetic chain is critical to identify concomitant pathology such as GIRD, which may portend a prolonged recovery. Proper treatment is necessary to minimize recurrence and development of epicondyle avulsion fractures, which represent a potentially preventable, but severe variant of LLE.
VARIATION IN TREATMENT APPROACHES TO ADOLESCENT MIDSHAFT CLAVICLE FRACTURES IN PEDIATRIC VERSUS ADULT HOSPITALS
Authors: Zhang Dafang , Heyworth Benton E. , Liotta Elizabeth S. , Hergott Katelyn A. , Earp Brandon E. 
Published: July 2021

Background: Optimal treatment of midshaft clavicle fractures in adolescents remains a topic of controversy. While adolescent midshaft clavicle fractures have historically been treated nonoperatively, recent randomized controlled trials of displaced midshaft clavicle fractures in the adult literature have raised the question of decreased symptomatic nonunion and malunion and improved functional outcomes with surgery. Consequently, the rates of surgical treatment of adolescent midshaft clavicle fractures, particularly in the older adolescent age group, has increased, despite a paucity of high-level evidence to justify this trend. Hypothesis/Purpose: To identify differences in treatment approach for isolated, displaced midshaft clavicle fractures in ‘older’ adolescent patients at adult versus pediatric hospitals. The secondary objective was to identify factors associated with surgery. Methods: Adolescents aged 15 to 18 years with isolated, displaced midshaft clavicle fractures treated at one of two adult tertiary care hospitals or one pediatric tertiary care hospital. Exclusion criteria included open fractures, skin tenting, nondisplaced fractures, medial third or distal third clavicle fractures, non-isolated injuries, and delay from injury to presentation of more than 2 weeks. Bivariate analysis and multivariable logistic regression analysis were used to identify factors associated with surgical treatment. Results: Two hundred and fourteen patients (median age: 16 years, mean BMI: 22.5, 85% male) were included. The cohort from the pediatric hospital was significantly younger, had lower BMI, had fewer comminuted fractures, and a higher proportion of angulated fractures (Table 1). One hundred six (50%) patients underwent surgical treatment. Bivariate analysis showed that older age (p = 0.004), higher BMI (p = 0.002), dominant upper extremity injury (p = 0.001), and treatment at an adult hospital (p < 0.0001) were associated with surgery. The fracture characteristics of comminution (p < 0.0001), greater displacement (p < 0.0001), and greater shortening (p < 0.0001) were associated with surgery. Multivariable logistic regression analysis showed superior-inferior fracture displacement (OR 1.13, 95% CI 1.06 to 1.20), dominant upper extremity injury (OR 2.60, 95% CI 1.19 to 5.67), and treatment at an adult hospital (OR 5.28, 95% CI 2.28 to 12.2) to be independently associated with surgery. Conclusions: After controlling for relevant demographic and fracture characteristics, adolescent patients treated at adult hospitals for displaced midshaft clavicle fractures have more than 5 times the odds of surgical treatment than those treated at a pediatric hospital. Significant practice variation across institutions reflects ongoing controversy in surgical indications and underscores the need for high quality prospective outcomes studies. [Table: see text]
BORDERLINE ACETABULAR DYSPLASIA: THREE-DIMENSIONAL DEFORMITY PREDICTORS OF THE DIAGNOSIS OF SYMPTOMATIC INSTABILITY TREATED WITH PERIACETABULAR OSTEOTOMY
Authors: Graesser Elizabeth , Schwabe Maria , Garrido Cecilia Pascual , Clohisy John C. , Nepple Jeffrey J. 
Published: July 2021

Introduction: Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups. Results: Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92. Conclusion: We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia. Summary: This study attempts to define 3D CT characteristics to help distinguish between patients with impingement-based vs instability-based symptoms of borderline acetabular dysplasia.
PATIENTS WHO ATTEND FORMAL PHYSICAL THERAPY FOR THE ENTIRE DURATION OF RECOVERY AFTER ACLR DEMONSTRATE EXCELLENT FUNCTIONAL OUTCOMES
Authors: Link Meredith , Greenberg Elliot 
Published: July 2021

Background: Limitations in insurance coverage and higher out-of-pocket expenses create challenges for physical therapists rehabilitating pediatric athletes after anterior cruciate ligament reconstruction (ACLR). While recovery may last 9-12 months, rehabilitation typically lasts <7 months. Unfortunately, research indicates many pediatric athletes have poor functional performance at the time of returning to sports. This may indicate incomplete rehabilitation within our current model of treatment. Understanding how rehabilitation utilization relates to functional outcomes may help optimize physical therapy (PT) treatment for pediatric patients post-ACLR. Purpose: To report the pattern of visit usage and functional outcomes of ACLR patients who were cared for within a large, pediatric specialty care network. Methods: A retrospective study of ACLR patients ≤18 years-old who underwent surgery between December 2016 and August 2019. All subjects must have completed rehabilitation within the sponsoring institutions PT centers and completed a functional hop testing battery, consisting of four single leg hop tests, prior to 10 months post-operative. The frequency of subjects able to achieve ≥90% limb symmetry (LS) on all hop tests was calculated and served as the main outcome of interest. Results: Out of 120 potential subjects, 53 were excluded for missing data, treatment at other facilities or care extending outside the designated time-frame, leaving 67 subjects (mean age 14.6 ± 1.5 SD, 38% female) for analysis. On average, PT began 14 days (range 5-33) post-operatively and subjects attended a mean of 40 visits (range 16-64) throughout 9 months of rehabilitation. The mean (range) number of sessions attended during rehabilitation was as follows: 0-6 weeks: 6 sessions (1-12), 7-12 weeks 10 sessions (2-15), 3 to 6 months 14 sessions (1-25), 6 to 9 months 9 sessions (0-23). Hop testing was completed 8 months post-surgery (range 5-10) with 85% of subjects achieving >90% LS on all tests. Conclusion: Physical therapy at a pediatric specialized center resulted in superior functional performance compared to existing literature. Interestingly, visit frequency was maintained throughout a 9-month period, which is not typical practice. Treatment during this latter phase of rehabilitation, involves advanced plyometric and sports conditioning, which may explain the high level of performance seen. Sampling bias and limitations is sample size, warrant caution in interpreting these results; however this data demonstrates that PT within a specialized setting, encompassing the entire duration of recovery after ACLR, yields excellent functional outcomes. Future investigations, within a larger and diverse sample are necessary to more fully understand these factors.
The Impact of COVID-19 Related School Closures and SPORT CANCELLATIONS on the Health of Adolescent Athletes
Authors: McGuine Timothy , Biese Kevin , Hetzel Scott , Kliethermes Stephanie , Reardon Claudia , Bell David , Brooks M Alison , Watson Andrew 
Published: July 2021

Background: In March 2020, schools were closed to in-person teaching and interscholastic sports cancelled in an attempt to slow the spread of the COVID-19. Child health experts have stated that school closures may have profound psychosocial consequences for students and need further study. Hypothesis/Purpose: To identify how COVID-19 related school closures and sport cancellations impacted the health of adolescent athletes. Methods: Adolescent athletes in Wisconsin were recruited via social media to complete an online survey in May 2020 while schools were closed to in-person teaching and interscholastic and club sports were cancelled. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. PHQ-9, PFABS and PedsQL scores were compared with historical data (HD) of Wisconsin adolescent athletes (N = 5,231) collected during normal school and sport operations in the years 2016–2018. Results: A total of 3,243 (58% female, Age = 16.1+1.2 yrs., grades 9 – 12) participated in the study. May 2020 participants reported higher (worse) PHQ-9 scores than the HD participants (mean: 8.0 (95%CI: 7.8, 8.2) vs 3.3 (3.1, 3.5), p < 0.001) as well as a higher prevalence of moderate to severe levels of depression (32.9% vs 9.7%, p < 0.001). May 2020 Participants also reported lower (worse) PFABS scores (mean: 12.2 (95%CI: 11.9, 12.5) vs 24.7 (24.5, 24.9) p < 0.001) and lower (worse) PedsQL total scores compared to athletes in the HD group (78.4 (78.0, 78.8) vs. 90.9 (90.5, 91.3) p < 0.001). Females in May 2020 reported increased moderate and severe anxiety percentages than the males in May 2020 (27.7% vs 22.3%, p < 0.001). Conclusions: COVID-19 related school closures and sport cancellations in Wisconsin were associated with increased anxiety and depression as well as decreased physical activity and quality of life in adolescent athletes. The potential negative health impacts of prolonged school closures and sport cancellations should be taken into account when evaluating steps to limit the spread of COVID-19.
PRE-OPERATIVE EXPECTATIONS FOR RETURN TO SPORTS AND OUTCOMES FOLLOWING ACL RECONSTRUCTION: A SURVEY OF ADOLESCENT PATIENTS AND THEIR PARENTS
Authors: Varakitsomboon Shing , Saper Michael 
Published: July 2021

Background: There is limited data regarding patient and parent expectations regarding return to sport (RTS) and outcomes following anterior cruciate ligament reconstruction (ACLR) in adolescent athletes. Purpose: To investigate RTS and outcome expectations of adolescent patients and their parents before ACLR and determine any differences between groups. Methods: For this cross-sectional study, sets of patients (aged 10 to 18 years) and parents were separately asked to complete the same questionnaire relating to knowledge and expectations regarding the patient’s upcoming ACLR. The custom survey consisted of 12 questions and was administered before being seen by a single sports medicine surgeon in the clinical setting of a tertiary care referral center from June 2019 through June 2020. Statistical analysis was performed to compare differences between patient and parent/guardian responses. Results: 28 sets of patients (53.6% female) and parents (64.3% female) completed the survey with average ages of 14.5 ± 2.0 years and 45.6 ± 7.0 years, respectively. 75% of families were Caucasian and 85.2% had private insurance. The most common sports played were basketball (25%) and soccer (17.9%). Overall, nearly 68% of consults were for a second opinion. 50% of patients and 82.1% of parents researched or read of ACL injuries and/or surgery prior to the visit. Most patients (46.4%) and parents (51.9%) expected the surgeon to consider full, unrestricted RTS/activities at 9 months. Only 7.1% of patients and 3.7% of parents believed full RTS would occur >12 months. 50% of patients and 67.9% of parents expected RTS at the same level. Both patients (53.6%) and parents (64.3%) believed fear of re-injury was the most common reason for not returning to sport or returning at a decreased level. There were no statistically significant differences in RTS expectations between patients and parents ( p>0.05). Most patients (38.5%) believed the risk of graft rupture in adolescent athletes was 5%, whereas most parents (37%) believed the risk to be at 25%, but the difference was not statistically significant ( p>0.05). Both patients and parents believed the risk of graft rupture was highest within the first 6 months (77.8% vs. 50%, respectively). More parents felt the risk of graft rupture was highest within the first year (39.3% vs. 22.2%), but the difference was not statistically significant ( p>0.05). Conclusion: Adolescent patients and their parents had similar knowledge and expectations regarding RTS and outcomes following ACLR. Further study is needed to better understand factors affecting those expectations.
Knee arthroscopy in patients over 64 years suffering from primary gonarthrosis
Authors: Lopez Alejandro Alvarez 
Published: July 2021

Objectives: to evaluate the results of the arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years. Methods: an analytical observational study was carried out in 40 patients older than 64 years treated arthroscopically with the diagnosis of primary gonarthrosis, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from October 2012 to May 2019. The research has a level of evidence IV recommendation D. Results: the average age of the 40 patients studied was 69,6 years, with a predominance of female to male, with a ratio of 3 to 1. Tricompartmental disease predominated in most patients as well as grade IV according to the Outerbridge RE classification. The cartilage and associated meniscus injuries predominate. Grades III and IV of the Kellgram JH and Lawrence JS classification were the most found. The most commonly used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance between a before and after was detected. Conclusion: the results of the investigation show that the procedures performed through the arthroscopic route for patients with primary gonarthrosis over 64 years of age are effective in more than half of the patients.
Senior Citizen Homes: Search for a Viable Business Model
Authors: Agrawal Gautam , Chhabra Sakhhi , Chhikara Ritu , Garg Ruchi 
Published: July 2021

The case pertains to the decision regarding business model to be decided by the developer of a proposed senior citizen homes. Due to a number of reasons, enumerated in the study, the elderly people prefer to live in community living projects. The protagonist Mr Pankaj Pawa, MD, Pawa Group, wants a scalable Old Age Home (OAH) concept, which can be replicated across India. Accordingly, he has identified upper-middle-class senior citizens as the potential segment. As per his surveys, this segment is neglected till date. The project will need to be planned as a community project, where the residents become part of the community by sharing common resources. The developer’s main concern is selecting the best business model, which allows him to expand. Simultaneously, the project should not lead to his capital blockage as the real estate market has faced liquidity crisis. Furthermore, he needs to be convinced that the senior citizens are a financially viable customer segment, and an exclusive project for them will be self-sustaining in the long term.