bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL EFFECTIVENESS OF TRANS-ARTICULAR VERSUS RETRO-ARTICULAR DRILLING OF STABLE OSTEOCHONDRITIS DISSECANS OF THE KNEE: A, PROSPECTIVE RANDOMIZED CONTROLLED TRIAL BY THE ROCK STUDY GROUP
Authors: Heyworth Benton E. , Ganley Theodore J. , Wall Eric J. , Myer Gregory D. , Nissen Carl W. , Edmonds Eric , Lyon Roger M. , Chambers Henry , Murnaghan Lucas , Liotta Elizabeth S. , Hergott Katelyn A. , Milewski Matthew D. , Green Daniel W. , Weiss Jennifer M. , Wright Patrick W. , Polousky John D. , Nepple Jeffrey J. , Carey James L. , Kocher Mininder S. , Shea Kevin G. 
Published: July 2021

Background: The most common presentation of knee osteochondritis dissecans (OCD) is a stable lesion on the lateral aspect of the medial femoral condyle (MFC) in an adolescent or pre-adolescent athlete. Standard of care for conservative treatment, include activity modification and weight bearing protection. Failed conservative management often leads arthroscopy and drilling of the lesion. Two different primary drilling techniques have been utilized, but no prospective studies have compared their relative effectiveness. Hypothesis/Purpose: The study hypothesis was that trans-articular (TAD) and retro-articular drilling (RAD) would demonstrate similar rates of healing, times to return to sports, and patient-reported outcome scores (PROs). Methods: Skeletally immature (n=113) patients presenting with radiograph indicated stable OCD of the MFC who did not demonstrate healing despite a minimum of 3 months of non-operative treatment were prospectively enrolled and randomized to TAD or RAD, for which 17 surgeon-investigators (at 14 centers, representing all major regions in the U.S.). Serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. Twelve patients were due to lesion instability detected at the time of surgery, Results: Ninety-one study subjects were included, consisting of 51 TAD and 40 RAD patients, with the two groups being of similar age (12.6 years vs. 11.9 years), sex distribution (45% vs. 27% female, p=0.081), and 2-year PRO response rate (both 90%). No significant difference between TAD and RAD was detected in follow-up Pedi-IKDC, Lysholm, Marx knee activity score, or KOOS QOL scores (Table 1). Revision/additional OCD surgery occurred in 10% of patients in RAD and 4% in TAD. 71% of TAD patients reached a ‘healed’ status at a mean of 1.15 years, compared with 58% RAD patients at a mean of 1.06 years. Conclusion: While both primary forms of OCD drilling (TAD and RAD) showed consistent post-operative healing, achieving a completely ‘healed’ status was often a more prolonged process, taking approximately 1 year, despite clinical improvement being achieved much sooner. While PROs were similar between drilling techniques, revision surgery rates were more than twice as common with RAD compared with TAD but the overall risk was low and the Absolute Risk was only 6%. [Table: see text]
SPONTANEOUS CORRECTION OF EXTERNAL TIBIOFEMORAL ROTATION AND TIBIAL TUBEROSITY-TROCHLEAR GROOVE DISTANCE OCCURS AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION IN FIXED OR OBLIGATORY DISLOCATORS
Authors: Aitchison Alexandra H. , Lin Kenneth M. , Green Daniel W. 
Published: July 2021

Background: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. Hypothesis/Purpose: The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusion: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. Tables/ Figures [Table: see text][Table: see text]
PEDI-CHAMP© AGILITY TEST VARIES BY AGE, GENDER AND SPORT SPECIALIZATION 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 aimed to assess functional performance in children with and without sports medicine injuries or orthopedic conditions. The Pedi-CHAMP© assesses bilateral single limb balance, lateral agility, directional changes, and acceleration/deceleration. 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 stratified based on age, sex, and sport-type/specialization in youth athletes. Methods: Youth athletes were recruited to complete the Pedi-CHAMP© either as an independent test or as part of larger battery of tests (Specialized Athlete Functional Evaluation [SAFE] Program). Completion times for each test component were converted to points using age-sex matched scoring algorithms. Each participant also answered questions to determine specialization in organized sports (defined as competition with a referee, umpire, etc.). Kruskal-Wallis was used to assess differences based on age groups (elementary [E, 5-9yrs], preteen [PT, 10-12yrs], early teen [ET, 13-15yrs], late teen/young adult [LT, 16-22yrs]), with Mann-Whitney U pairwise post-hoc comparisons (α<0.05). Independent Mann-Whitney U tests were used to assess differences based on sex, sport type (low vs high impact) and specialization (single vs multi-sport) within each age group. Results: A total of 251 youth athletes (134 females, age 13.7±3.3yrs; BMI 20.9±5.9) completed Pedi-CHAMP© testing. Significant differences were seen with the Pedi-CHAMP© component and composite scores between all ages ( p<0.001, Table 1), however, there were no differences between ET and LT groups for the SLS or mESS. When assessing age and sex, elementary-aged girls demonstrated improved SLS balance ( p=0.017), and mESS scores were higher in preteen boys compared to girls ( p=0.022). However, all 3 agility components (mESS, L-Test, IAT) and the Pedi-CHAMP© composite scores were significantly higher in boys compared to girls for the ET and LT groups. When accounting for age, there were no differences in single-sport vs. multi-sport athletes. ET and LT low-impact athletes scored lower on the L-test compared to high-impact athletes. Conclusion: The Pedi-CHAMP© was able to detect differences based on age, sex and sport impact-type (low- vs. high-impact). Performance improves with age for the L-Test and IAT, however, no differences in SLS and mESS were seen between younger and older teens which may indicate a ceiling effect for these two components. Further research should focus on correlating the Pedi-CHAMP© to other performance measures in youth athletes. Tables/Figures: [Table: see text][Table: see text]
LOWER QUARTER Y-BALANCE TEST SCORES ARE ASSOCIATED WITH ISOKINETIC KNEE STRENGTH
Authors: Erdman Ashley L. , Wyatt Charles W. , Tulchin-Francis Kirsten , Ulman Sophia M. 
Published: July 2021

Background: Lower extremity asymmetry has been shown to be associated with increased risk of anterior cruciate ligament injury. Return-to-sport screens commonly involve assessing the restoration of symmetrical strength and balance. Therefore, it is important to understand how these measures are related. Hypothesis/Purpose: To determine if relationships exist between the Lower Quarter Y-Balance Test (LQ-YBT) component scores, composite scores, and isokinetic knee strength in healthy, female athletes. Methods: Female adolescent athletes completed the LQ-YBT and isokinetic knee strength as a part of a comprehensive evaluation in competitive level athletes (Tegner activity scale≥7). LQ-YBT anterior, posteromedial, and posterolateral component scores for the each leg were normalized to leg length, and composite scores for each leg were calculated for each participant. Knee flexion/extension strength was collected at 120°/second using a Biodex System 4. Peak torque was normalized by body weight, and paired t-tests were used to compare legs ( α<0.05). Spearman correlation coefficients were calculated to test whether any LQ-YBT measures were associated to knee strength. Results: A total of 106 participants (age 13.8±2.4 years; BMI 20.2±3.0) were tested, and all were right leg dominant. No differences were found between LQ-YBT right and left component (Table 1), or composite scores (right 97.9 vs left 98.2, p=0.29). Flexion and extension strength were significantly increased on the right side ( p=0.02, <0.01 respectively). There were significant, weak to moderate correlations between all LQ-YBT scores (components and composite) versus knee flexion strength (r=0.26 to 0.40) (Table 2). Left knee extension strength was weakly correlated to left anterior and posteromedial component scores (r=0.24, 0.34 respectively), as well as the left composite score (r=0.29). Right knee extension strength was only correlated to the right posteromedial component score (r=0.21) and the right composite score (r=0.22). Conclusion: Weak to moderate relationships exist between both component and composite LQ-YBT scores and knee strength. The strongest correlations were found between the LQ-YBT composite scores and knee flexion strength. LQ-YBT composite scores were relatively high, indicating a low chance of injury while differences were seen in knee strength between legs. Future injury prevention programs would benefit from utilizing both tools as the Y-Balance test evaluates motor control and isokinetic strength identifies muscular imbalance, both of which are important in reducing future injury risk. Tables/Figures: [Table: see text][Table: see text]
BIOMECHANICAL SIMULATION OF RADIAL HEAD SUBLUXATION IN CADAVERIC PEDIATRIC ELBOWS
Authors: Meadows Molly , Vuong Brian , Storaci Hunter , Tam Kaysie , Shea Kevin 
Published: July 2021

Background: Radial head subluxation, known as pulled elbow or Nursemaid’s elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an elbow that is pronated and extended. Although the stability of the proximal radioulnar joint has been previously examined in cadaveric models, there are no current studies quantifying the biomechanics of nursemaid’s elbow. The purpose of our study was to demonstrate and quantify the axial traction force required to produce a nursemaid’s elbow in a pediatric cadaver specimen. Methods: Two fresh-frozen cadaveric elbows from a single 3 year-old male donor were dissected by a fellowship-trained orthopedic surgeon. An Instron 5944 testing machine with a 2 kN load cell was used to perform uniaxial testing. The radius and humerus were mounted to the Instron machine, and loaded in the axial direction with the elbow in full extension. Loading occurred at a rate of 10 mm/sec for 4 seconds, during which the force and actuator displacement were continuously recorded. The local instantaneous load and extension displacement at the time of subluxation were recorded, and data was synced with high-frame-rate video footage used to confirm the annular ligament subluxation. Results: The load to failure required to produce the nursemaid’s elbow injury in the first elbow was 31N, with a failure displacement of 4.6mm. The second elbow demonstrated a load to failure of 26N, with a failure displacement of 4.6mm. After subluxation, we reduced the annular ligament from the first specimen. The elbow was then re-tested and demonstrated a load to failure of 20N, with a failure displacement of 2.6mm. Conclusion: Axial traction applied to a pediatric cadaver specimen results in subluxation of the annular ligament into the radiocapitellar joint. The mean load to failure is 28.5N, and a lower load to failure was required to produce a recurrent subluxation in a previously injured specimen. Lower load for a recurrent subluxation may be attributed to damage on the annular ligament due to the first subluxation. [Figure: see text]
TIME LOSS INJURIES AMONG FORMER COLLEGIATE GYMNASTS: THE INFLUENCE OF FEMALE ATHLETE TRIAD SYMPTOMS
Authors: Fryar Caroline , Howell David R , Seehusen Corrine N. , Tilley David , Casey Ellen , Sweeney Emily A 
Published: July 2021

Background: Female college gymnasts have one of the highest injury rates in the NCAA and are at risk for female athlete triad syndrome. While female athlete triad syndrome leads to bone stress injuries, little research has been done on specific injury location and type. Purpose: Our objective was to compare injuries sustained during gymnastics between former collegiate gymnasts who did and did not report experiencing symptoms of Female Athlete Triad Syndrome during college, including disordered eating (DE) or menstrual irregularity (MI). Methods: 465 former collegiate gymnasts completed an online survey distributed via social media. Participants were grouped based on mensural irregularity and whether they had a history of DE/ED of not. We compared injury outcomes (time-loss injuries and injuries resulting in surgery) and injury locations between groups using Chi-square analyses. Results: A significantly greater proportion of those who reported MI during college reported a time-loss wrist/hand and injury during gymnastics compared to eumenorrheic gymnasts (Table 1). A significantly greater proportion of those who reported MI during college sustained an injury that required surgery relative to those who reported regular periods during college (52% vs 65%, p=0.009). Specifically, they reported a greater proportion of hip/pelvis (2% vs. 7%, p=0.02) and leg/ankle/foot surgeries (23% vs. 33%, p=0.009). A significantly greater proportion of the group who reported DE during college reported a time-loss gymnastics injury during college that did not require surgery or retirement, relative to those who did not report DE (78% vs 66%, p= 0.005) (Table 2). Specifically, they reported a greater proportion of spine (25% vs. 14%, p=0.002), hip/pelvis (8% vs. 2%, p=0.001), and leg/ankle/foot injuries (53% vs. 41%, p=0.01). There was a significantly greater proportion of gymnasts who reported DE during college who sustained a hip/pelvis (7% vs. 3%, p=0.04) and leg/ankle/foot injury (34% vs. 23%, p=0.02) requiring surgery compared to those who did not report DE during college. onclusion: College gymnasts who experienced triad symptoms were more likely to experience a time-loss injury, or have an injury requiring surgery. Clinicians and providers should be aware of the association between injuries and DE and MI in gymnasts. Early intervention for athletes with triad symptoms should be undertaken to decrease the risk of musculoskeletal injury.
RADIOGRAPHIC FOLLOW-UP AFTER MILD SLIPPED CAPITAL FEMORAL EPIPHYSIS: WHAT IS THE INCIDENCE OF SUBSEQUENT SURGERY FOR FEMORACETABULAR IMPINGEMENT?
Authors: Skelton Anne , Martino Rachael , Mayer Stephanie , Selberg Courtney 
Published: July 2021

Background: Slipped capital femoral epiphysis (SCFE) is characterized by translation of the proximal femoral epiphysis posterior and medial relative to the metaphysis. The gold standard treatment of mild SCFE, defined as a slip angle <30°, remains in-situ pinning (ISP) to stabilize the epiphysis in its current position after slippage. Methods: 127 hips from 113 individuals met inclusion criteria: mild SCFE (Southwick angle <30°) that underwent ISP with available pre- and post-procedure radiographs. Medical records were reviewed to collect demographic data, preoperative symptoms, surgical details, radiographic measurements, and post-operative follow-up. Six hips were identified as having undergone additional joint preserving surgery of the hip (JPSH) while seven other hips were identified as having undergone screw removal and/or replacement within two years of initial ISP. Anterior-posterior (AP) and frog-leg lateral alpha angles, femoral epiphyseal-metaphyseal offset angle, and Southwick angle were all measured preoperatively, post-operatively, and at final radiographic follow-up. Chi-squared analyses, binary logistic regression models and Kruskal-Wallis tests were used to evaluate the association between clinical and radiographic parameters and the occurrence of additional surgery or screw failure. Results: Demographic variables, including age, body mass index, prodrome pain, sex, laterality, and chronicity were not found to significantly influence the likelihood of additional surgery. Preoperative AP alpha angle, frog-lateral alpha angle, epiphyseal-metaphyseal offset angle, and Southwick angle did not significantly impact the likelihood of additional surgery or screw failure. Radiographic measurements taken after ISP demonstrated that AP alpha angle significantly increased the likelihood of additional surgery. For every one degree increase, the likelihood of additional surgery increased 1.091 times (average 70.264° for no additional surgery and 82.333° for additional surgery, p=0.017). Conclusion: Mild SCFE can progress to residual pain and limited hip motion even after initial treatment with ISP. Of our cohort of 127 hips, six (4.72%) went on to have secondary JPSH while an additional seven (5.51%) presented with screw failure within two years of initial ISP. Increased AP alpha angle after ISP was correlated with an increased likelihood of secondary JPSH. This increased AP alpha angle may contribute to intra-articular pathology due to CAM-type morphology which may lead to the necessity of JPSH. These findings suggest that patients with increased AP alpha angle after ISP may need to be followed long-term for the development of further joint symptoms and may need to be counseled after ISP for mild SCFE for the risk of secondary JPSH. Tables/Figures: [Table: see text][Table: see text][Table: see text]
HURDLE STEP COMPONENT SCORE FROM THE FUNCTIONAL MOVEMENT SCREEN IS ASSOCIATED WITH STRENGTH, SPEED, AND JUMP PERFORMANCE
Authors: Ulman Sophia M. , Saleem Laura , Tulchin-Francis Kirsten 
Published: July 2021

Background: The Functional Movement Screen (FMS) is a tool designed to establish a baseline for fundamental movement capacity, highlight limitations and limb asymmetries, and identify potential injury risk. Previous research has shown that individual components of the screen are also indicative of injury risk, as well as potential predictors of athletic performance unlike the FMS composite scores. However, this literature is limited and lacks statistical power. Identifying which component scores are predictive of injury risk and athletic performance would provide a quick, powerful tool for coaches and trainers to evaluate athletes. Purpose: To determine if individual component scores of the FMS are associated with athletic performance in highly-active youth athletes. Methods: Youth athletes participated in the Specialized Athlete Functional Evaluation (SAFE) Program. Data collection was extensive, however, for the purpose of this abstract, only a selection of data was analyzed – age, BMI, years played, total number of past injuries, isokinetic knee strength, 10- and 20-meter sprint, single-leg hop (SLH) distance, and FMS scores. Seated knee flexion/extension strength was collected at 120°/second using a Biodex System 4, and peak torque was normalized by body weight. The maximum distance of three SLHs was recorded for each leg and normalized to leg length. FMS scores used for analysis included the total composite and component scores, including the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, and rotary stability. Wilcoxon Signed Ranks Tests were used to determine side-to-side differences, and Kruskal-Wallis tests were performed to determine differences in athletic performance based on FMS scores ( α<0.05). Results: A total of 38 highly-active, youth athletes (26F; 15.4±2.6 years; BMI 21.0±5.3) were tested. Participants reported playing organized sports for 8.7±3.4 years, having 2.0±1.2 past sports-related injuries, and 74% reported specializing in a single sport. No side-to-side differences were found. While the composite FMS score significantly differed by number of past injuries ( p=0.036), it was not associated with athletic performance. Alternatively, left knee strength, sprint speeds, and right hop distance significantly differed by the hurdle step component score (Table 1). Conclusion: While the composite FMS score was not an indicator of athletic performance, the hurdle step component score was associated with strength, speed, and jump performance. This individual task could be a beneficial tool for coaches and trainers when evaluating athletic ability and injury risk of athletes. Tables/Figures: [Table: see text]