bluuebunny/crossref_metadata_2025_split huggingface dataset:
ARE SEGOND FRACTURES OF THE TIBIA PATHOGNOMONIC FOR ACL TEARS IN THE PEDIATRIC AND ADOLESCENT POPULATION?
Authors: Kushare Indranil , Ghanta Ramesh Babu , Kastan Kristen , Stone Tracie , Wunderlich Nicole A. , McHorse Grant 
Published: July 2021

Background: Segond fractures (avulsion fractures of the proximal lateral tibia) are considered to be pathognomonic for anterior cruciate ligament (ACL) tears in adult patients. Purpose: To describe the largest case series of pediatric Segond fractures and associated intra-articular injuries of the knee to determine if these fractures are pathognomonic for ACL tears in young patients. Methods: IRB-approved retrospective study of patients under 20 years who presented with Segond fracture to a tertiary children’s hospital between 2009-2019. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected. Results: 55 patients (46 males, 9 females) with mean age 15.2 years (11.8-19.1) with Segond fractures of the proximal tibia on radiology imaging were identified (Fig.1.2). Diagnosis of associated injuries was established based on clinical examination, radiology report and findings during arthroscopy. Average Segond fracture size was 2.7 x 9.5mm as measured on standard knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/55(89%) patients. Associated injuries included anterior cruciate ligament (ACL) tears (39 patients, 70.9%), tibial eminence fractures (9, 16.4%), and all other injuries (7, 12.7%) (Table 1.1). Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. When age was compared between the patient group with ACL tears (mean 15.7 years) to the ones with tibial spine fractures ( mean 13.9 years), there was a statistically significant difference(p=0.007). 12/55 (21.8%) had associated articular cartilaginous injuries, 3 of which required surgical intervention. 37/55 (67.3%) patients had meniscal injury. 3 (5.5%) patients suffered multi-ligament injuries. Overall, 87.2% of the patients required surgical management for associated intra-articular injuries of the knee. Conclusion: The Segond (tibial avulsion) fracture is associated with intra-articular injuries the pediatric population, most commonly ACL tears and meniscus tears. However, the largest case series in the pediatric population suggests that they are not pathognomonic for ACL tears as a notable proportion of patients, especially the ones who are younger in age, have tibial eminence fractures or no ACL tears. [Table: see text][Figure: see text]
DOES A CONTINUOUS PERIPHERAL NERVE BLOCK REDUCE HOME OPIOID USE IN CHILDREN AND ADOLESCENTS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION? THE ENVELOPE PLEASE.
Authors: Schlechter John A. , Harrah Tanner , Gornick Bryn , Sherman Benjamin 
Published: July 2021

Background: Anterior cruciate ligament reconstruction (ACLR) is commonly performed in youth athletes. Opioid misuse and addiction have reached alarming proportions. Purpose: To evaluate whether a continuous peripheral nerve block (CPNB) with placement of an elastomeric reservoir ball would decrease the need for home opioid analgesia when compared to a single-shot peripheral nerve block (SPNB) following ACLR in children and adolescents. Methods: A continuous cohort was analyzed via retrospective review of prospectively collected data following ACLR by a single surgeon. Group 1 had ACLR at our in-patient hospital and received a 72-hour CPNB. Group 2 had ACLR at our outpatient surgery centers and received a SPNB. Post-operative pain management included cryotherapy, oral acetaminophen and ibuprofen. A prescription for 10 doses of hydrocodone/acetaminophen (5/325mg) was provided in a sealed envelope with instructions to only be used for uncontrolled pain. On a three-day written log all children recorded their post-op Visual Analog Scale (VAS), amount of ibuprofen, acetaminophen and hydrocodone taken. Those reporting no narcotics needed to provide the unopened envelope and unfilled prescription. Hydrocodone utilization was converted to morphine milligram equivalents (MME). 1 mg hydrocodone = 1 MME. A state Controlled Substance Utilization Review and Evaluation System (CURES) inquiry was made on all participants in the peri-operative period. Demographic and operative data were collected. This study was powered to detect a difference of 20% in rate of narcotic consumption, should one exist, at beta=0.80, alpha<0.05. All analyses were performed using SPSS v. 26 with alpha set at p<0.05 to declare significance. Results: One hundred ninety-six patients were included in the study with an average age of 15 years (range 10-19y). 58 (30%) took hydrocodone/acetaminophen post ACLR, 39 female (67.2%) 19 male (32.8%). The CPNB group consumed 4.7 MME 95 % Confidence Interval (CI) 2.5-6.9 vs 6.5 MME 95 % CI 4.3-8.7 in the SPNB group (p=0.427) There were no significant differences in demographics, operative data or VAS scores. (Table). Conclusion: Home narcotic use can be negated in 70% of children and adolescents following ACLR regardless of duration of peripheral nerve block. In those requiring narcotics, the average utilization was only 1.3 pills of hydrocodone/acetaminophen with no child using more than 10 pills. The MME can be diminished with a CPNB however not significant enough to recommend routine use. We postulate the sealed envelope was as a barrier and psychological deterrent to filling the opioid prescription. [Table: see text]
ASSESSING THE ACCURACY, QUALITY, AND READABILITY OF ONLINE PATIENT RESOURCES ON TARSAL COALITION
Authors: Zhang Hui , Foster Brian K. , Seeley Mark A. 
Published: July 2021

Background: The internet is an inexpensive and convenient source for health information. However, without regulation, the quality and accuracy of the information is unknown. Tarsal coalition is a common cause of pediatric foot pain and disability. Hypothesis/Purpose: We hypothesized that the online patient information on tarsal coalition is of low accuracy, low quality, and of poor readability. Additionally, we hypothesized that sources found on the first search page were of higher quality, greater accuracy, and more readable. Methods: A cross-sectional review of the internet was performed using the term “tarsal coalition” on the 3 most popular search engines. Unique sites were categorized based on authorship and search result order. Websites were evaluated using a novel content score based on the AAOS OrthoInfo site on tarsal coalition (max score: 20), JAMA Benchmark and DISCERN scores for quality, and Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) for readability. Results: A total of 47 unique websites were evaluated. They ranged from professional organization/society websites to websites for individual practices and professional blogs. The average content score was 13.1 (range: 4-20). The average DISCERN score was 34.2 (range: 19-57.5). We did find a positive correlation between the content score and DISCERN scores of the included resources (p=0.04). The average 11.4 (range 8.5-15.5). Only 2 of the websites (4%) were written at or below an 8th grade reading level, which has been documented as the average reading level of the general population in the United States. Websites that were authored by physicians had greater DISCERN and readability scores compared to academic and private practice websites (DISCERN 40.4 vs 32.3 (p=0.001) and 31.7 (p=0.01), respectively, FKGL 13.0 vs 10.4 (p=0.002) and 11.1 (p=0.03), respectively, FRE 31.5 vs 48.7 (p=0.0001) and 45.2 (p=0.025), respectively). Finally, we noted that websites which appeared on the first page of the search engine results were not of higher quality than those that appeared on later pages (DISCERN 32.6 vs 39.8, p=0.002). Conclusions: Online patient resources on tarsal coalition are of low quality, inaccurate, and too complex for the average reader. Physician authored websites may serve as better resources compared to academic or private practice sites. Physicians should caution patients using the internet for information on tarsal coalition.
HEALTH OUTCOMES AMONG FORMER FEMALE COLLEGIATE GYMNASTS: THE INFLUENCE OF SPORT SPECIALIZATION, CONCUSSION, AND DISORDERED EATING
Authors: Sweeney Emily A , Howell David R , Seehusen Corrine N. , Tilley David , Casey Ellen 
Published: July 2021

Background: Over 1,500 collegiate gymnasts compete each year. Injury rates among these athletes are high, yet little is known about their long-term health outcomes. Hypothesis/Purpose: The purpose of our study was to describe health-related outcomes of former collegiate gymnasts and to evaluate how early sport specialization, concussion history, and disordered eating (DE) influence current health. We hypothesized that gymnasts who specialize early would report more injuries and would have worse physical health currently; that gymnasts who sustained concussions will be more likely to seek mental health treatment during their sport careers; and that gymnasts with DE would report more injuries. Methods: 473 former female collegiate gymnasts completed a survey (Table 1) that was distributed through social media. Participants were grouped according to early (<14 years) or late (> or equal to 14 years) specialization, whether they sustained a concussion during gymnastics participation, and whether they reported a history of DE or not. We determined the number of participants who had time-loss injuries, menstrual dysfunction, reasons for retirement from sport, functional outcome measures, and whether participants had sought mental health care during college. Results: The median age of gymnastics specialization was 8 years [interquartile range=6-11 years]. A significantly greater proportion of early specializers sustained injuries requiring surgery (60% vs. 44%; p=0.02), however, the proportion of time-loss injuries sustained during college, reasons for retirement, and current pain and physical function scores did not significantly differ between the early and late specializers (Table 2). Forty-two percent of participants sustained a concussion. Those with a concussion were more likely to have sought mental health treatment during college (32% vs. 23%; p=0.03), and to have a diagnosis of anxiety disorder (16% vs. 9%; p=0.01) than those with no concussion history (Table 3). Thirty-four percent reported DE during college. Those in the DE group had an increased risk of osteoporosis during college (4% vs 0%; p=0.003), secondary amenorrhea (16% vs 9%; p=0.02), and had an increased risk of time-loss injury (78% vs 65%; p=0.004) (Table 4). In addition, they had worse PROMIS pain (11.5 vs 10.2; p=0.007) and physical function scores (12.2 vs 11; p=0.01) after college. Conclusion: It is important for clinicians, coaches, and gymnasts to be aware of the risks of early specialization, concussions, and DE, all of which are common in former collegiate gymnasts. Counseling regarding these risks and prevention strategies for these health problems should be a focus of further research. [Table: see text][Table: see text][Table: see text][Table: see text]
STRONGER THAN EVER! ADOLESCENT ATHLETES SHOW STRENGTH GAINS WITHIN THE UNINJURED LEG AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Greenberg Elliot , Bram Joshua , Ganley Theodore 
Published: July 2021

Background: The restoration of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is critical to restore optimal patient function and reduce the incidence of secondary ACL injury. Strength is typically quantified during return to sport assessments, by comparing the strength in the involved limb to that of the uninvolved limb. A limb symmetry index (LSI) is calculated and used to determine if any residual strength deficits persist. Recent evidence demonstrates that the uninvolved limb may lose strength during ACLR recovery and suggests that pre-operative uninvolved limb strength values may offer a better representation and more stringent indicator of strength recovery after ACLR. However, this body of literature is limited and no studies have specifically evaluated this occurrence within youth athletes. Purpose: To evaluate the change in strength in the uninvolved limb from pre-operative to 6 months post-ACLR, and assess the effect of pre-operative strength comparison on 6-month post-op LSI. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary ACLR from 1/2018-1/2020 without concomitant multi-ligamentous reconstruction was conducted. Isokinetic peak torque values for the uninvolved and involved quadriceps were extracted at pre-operative (uninvolved only) and 6 months post-operative. Strength changes were analyzed using paired-samples t-test. Results: Complete data was available for a total of 17 subjects (mean age 15.1±1.7, 53% female). Pre-operative strength assessment was performed a mean of 11.5 days (range 1-26) prior to surgery. The mean 6-month post-operative assessment occurred at 177 days (range 127-246). The uninvolved limb was significantly stronger (p<0.001) at 6 months compared to preoperatively, with a mean improvement of 12.1ft/lbs (95%CI 18.3 – 7.2) with a change from 82.4ft/lbs to 95.1 ft/lbs. The LSI was calculated using both pre-operative and 6-month post-operative uninvolved limb values and demonstrated substantially lower LSI values when using concurrent 6-month data (LSIpre 91.3% vs LSI6M 76.9%). Conclusions: Among this sample, the uninvolved limb got stronger during post-ACLR recovery and comparison to concurrently assessed strength values led to a more stringent determination of LSI. Differences in rehabilitation programming, adolescent physiology, and pre-injury training patterns may explain why these results differ than those found in older cohorts.
Comparison of Anterior Cruciate Ligament Injury Rates In High School and Middle School Sports Over a 30-year Period
Authors: Rauh Mitchell J. , Schmitt Laura C. , Paterno Mark V. 
Published: July 2021

Background: Anterior cruciate ligament (ACL) injuries are a major concern in interscholastic sports. Comparison of ACL injuries between high school (HS) and middle school (MS) athletes over multiple years is limited. Purpose: To examine the incidence of ACL injury in HS female [HS-F] and male [HS-M], and MS female [MS-F] and male [MS-M] sports over a 30-year period. Methods: We studied 55,147 athletes who competed in interscholastic sports at a secondary school from 1988 to 2018. Data included ACL injuries incurred during interscholastic sports, and clinically confirmed by a physician. Injury rates per 100,000 AEs (practice and games where the athlete was at risk of ACL injury) were calculated for gender, sport, and contact status. Incidence rate ratios [RR] and 95% confidence intervals (CIs) were used to compare injury rates. Results: The incidence rate of ACL injury for HS athletes (4.15/100,000 AEs) was almost three times greater (RR=2.63, 95%CI: 1.7-4.2; p<0.0001) than the incidence rate for MS athletes (1.58/100,000 AEs). The risk of sustaining an ACL injury among HS-F athletes (4.26/100,000 AEs) was similar to HS-M athletes (4.06/100,000 AEs) (RR=1.05, 95%CI: 0.7-1.6; p=0.81). The risk of sustaining an ACL injury among MS-F athletes (1.06/100,000 AEs) was less than MS-M athletes (1.96/100,000 AEs) (RR=0.54, 95%CI: 0.2-1.4; p=0.21). While the risk of incurring an ACL injury occurrence was four times greater (RR=4.01, 95%CI: 1.7-9.4; p=0.0002) among HS-F athletes than MS-F athletes, the risk of ACL injury was twice as high (RR=2.08, 95%CI: 1.2-3.7; p=0.009) among HS-M athletes than MS-M athletes. ACL injuries were incurred in 15 HS sports and was greatest for HS-F basketball (25.5/100,000 AEs; p<0.001), HS-M football (20.6/100,000 AEs), and HS-F soccer (20.4/100,000 AEs). ACL injuries were sustained in 7 MS sports and was highest for MS-F softball (9.1/100,000 AEs), MS-M basketball (6.3/100,000 AEs) and MS-M football (5.0/100,000 AEs). The risk of contact-related ACL injury (1.73/100,000 AEs) was almost two times greater than non-contact-related ACL (0.96/100,000 AEs) (RR=1.80, 95%CI: 1.2-2.7; p<0.001). The rate of contact ACL injury was highest among HS-M (3.38/100,000 AEs) while the rate for noncontact ACL injury greatest among HS-F (2.44/100,000 AEs). Conclusions: The risk for ACL injury is higher in HS than in MS for both sexes. Non-contact ACL injuries were more likely to occur among HS-F athletes while contact injuries were highest for HS-M athletes, suggesting the effects of maturation and competition may play a role with increasing competition level.
NATIONWIDE ETHNIC/RACIAL DIFFERENCES IN SURGICAL TREATMENT OF DISCOID MENISCUS IN CHILDREN: A PHIS DATABASE STUDY
Authors: Milewski Matthew D. , Coene Ryan P. , McFarlane Kelly H. , Williams Kathryn A. , Feldman Lanna , Beck Jennifer J. 
Published: July 2021

Background: Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No United States population-based studies have examined the discoid meniscus ethnic/racial distribution. Hypothesis/Purpose: In pediatric patients undergoing meniscus surgery, we hypothesize that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with isolated medial meniscus tears. Methods: The Pediatric Health Information System (PHIS) was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using ICD-10 codes. A cohort of patients treated surgically for discoid meniscus was compared to a cohort of patients treated surgically for medial meniscal tear. These two populations were compared based on age, gender, ethnicity/race, CPT® code, insurance, urban vs rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations. Results: A discoid meniscus cohort of 399 children (median age, 13.0 years) was compared to a medial meniscus tear cohort of 3157 children (median age, 16.0 years) (p<0.001) (Table 1). Hispanic/Latino children accounted for 36.8% of the discoid meniscus and 22.7% of the medial meniscus populations (p<0.001). Among pediatric patients that had surgery for discoid meniscus or medial meniscus, Hispanic/Latino children had 2.4 times the odds of surgery for discoid meniscus compared to white patients after adjusting for age and insurance (p<0.001) (Table 2). Asian children also had 2.4 times the odds of surgery for discoid meniscus compared to white patients (p=0.017). Conclusion: This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients that had surgery for discoid or medial meniscus, Hispanic/Latino and Asian patients were significantly more likely to have surgery for discoid meniscus than white patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a discoid meniscus versus medial meniscus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus. [Table: see text][Table: see text]
Title: CHANGES IN SUBJECTIVE AND OBJECTIVE SLEEP MEASURES DURING RECOVERY IN PEDIATRIC CONCUSSION
Authors: Wilson Julie C. , Seehusen Corrine N. , Simon Stacey L. , Howell David R. 
Published: July 2021

Background: Sleep problems after concussion have been associated with longer recovery times and more severe symptoms. Early research has primarily evaluated sleep via subjective measures; however, actigraphy data may help objectively understand sleep patterns after pediatric concussion. Purposes: Our study examined changes in subjective and objective sleep measures during pediatric concussion recovery. We also evaluated whether sleep measures at initial assessment predict concussion symptom resolution time. Methods: Pediatric patients evaluated within 14 days of concussion were given a commercial activity tracker to be worn full-time, including during sleep, through return-to-play (RTP) clearance. During the initial and RTP assessments, patients completed the Pittsburgh Sleep Quality Index (PSQI), self-reporting sleep duration, time spent in bed, and sleep quality. PSQI score >5 indicates poor sleep quality. Activity tracker-recorded sleep duration and time spent in bed from the first 3 nights after initial assessment and 3 nights prior to the RTP clearance assessment were also used for analysis. Results: Patients (n=32, 15.1±1.7 years, 41% female) completed initial and RTP clearance assessments (Table 1). On the PSQI, patients reported significantly worse overall sleep quality despite longer sleep duration and more time in bed at initial assessment relative to RTP assessment (Table 2). A majority of patients reported PSQI score >5 at both initial and RTP assessments (Table 2). There were no significant differences across time for sleep duration or time in bed as measured by actigraphy (Table 2). Patients perceived that they spent longer in bed compared to objective measures with initial assessment, and perceived longer sleep duration compared to objective measures for both initial and RTP assessments (Table 3). In each regression model, higher symptom severity was significantly associated with longer symptom resolution time (Table 4). In addition, longer time in bed after the initial assessment measured by actigraphy was significantly associated with longer symptom resolution time (Table 4). Conclusion: Patients reported obtaining more sleep and spending longer time in bed at the initial assessment compared to actigraphy measures, and a majority of patients reported poor sleep quality throughout recovery. Concussion symptom duration increased by 1 day for every 13 additional minutes spent in bed, as measured by actigraphy. Increased time in bed may indicate poor sleep habits during recovery. Both subjective and objective assessment of sleep following concussion offer valuable, yet differing, information. Future research assessing the impact of sleep intervention after concussion on symptom resolution should be considered. [Table: see text][Table: see text][Table: see text][Table: see text]