bluuebunny/crossref_metadata_2025_split huggingface dataset:
ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY
Authors: Saloom Adam , Purcell Nick , Ruhe Matthew , Gomez Jorge , Santana Jonathan , Kushare Indranil 
Published: July 2021

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]
EARLY OUTCOMES AFTER SUTURE TAPE REINFORCEMENT OF QUADRICEPS TENDON AUTOGRAFT ACL RECONSTRUCTION IN ADOLESCENT ATHLETES
Authors: Saper Michael 
Published: July 2021

Background: Recently, anterior cruciate ligament reconstruction (ACLR) with suture-tape reinforcement has been popularized for protection of the graft during the revascularization and remodeling phase of incorporation. To date, there are limited short-term data regarding the outcomes of suture tape reinforcement to ACLR. Furthermore, its use with quadriceps tendon autograft (QT) ACLR is limited. Purpose: The purpose of this study was to review the early, preliminary results of ACLR in adolescent patients using QT autograft with suture tape reinforcement (QT-SR). Methods: A retrospective review was performed of skeletally mature adolescent patients who underwent primary ACLR with all-soft tissue QT-SR since 2018. Surgeries were performed by a single surgeon using an all-inside technique. All patients followed the same standardized rehabilitation protocol. Twelve-month patient-reported outcome measures (PROMs) and complications were analyzed. PROMs included the Pediatric International knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form, Lysholm knee scoring scale, and the Tegner activity level scale. Psychological readiness was assessed with the ACL-Return to Sport after Injury (ACL-RSI) scale. Results: 39 patients (24 girls, 15 boys) were identified. The mean age at the time of surgery was 15.7 ± 1.3 years (range, 13-18 years). 82% of patients were high school athletes. Soccer was the primary sport for 48.7% of patients. The mean graft diameter was 9.5 ± 0.4 mm. 51.3% of patients had concomitant meniscus repairs. The mean time to return-to-sport clearance was 10.1 ± 1.4 months. At 12 months, the mean postoperative Pedi-IKDC was 95.6 ± 4.0, the mean Lysholm score was 97.6 ± 3.9, and the mean Tegner score was 8.8 ± 0.9. All PROMs improved significantly compared to the preoperative scores (Pedi-IKDC: p = 0.003, Lysholm: p = 0.006, Tegner: p = 0.003). The mean ACL-RSI was 93.4 ± 4.7. Complications included return to surgery due to postoperative stiffness in two patients. There were no cases of postoperative instability, graft rupture, or contralateral ACL injury. Conclusion: QT-SR ACLR results in excellent clinical and patient-reported outcomes in adolescent athletes at 12 months follow-up. The long-term effect of QT-SR remains to be investigated.
FEMORAL NECK BONE STRESS INJURIES IN CHILDREN AND ADOLESCENTS: A LITERATURE REVIEW AND META-ANALYSIS
Authors: Magrini Danielle , Brown Naomi , Nussbaum Eric 
Published: July 2021

Background: Most bone stress injuries (BSI) affect weight-bearing bones of the lower extremity. While femoral neck BSIs (FNBSI) are less common, they occur in the pediatric and adolescent population, accounting for 0.7%-21.1% of all sports-related injuries. A recent publication showed a 4-fold increase in the incidence of pediatric BSI. Literature detailing FNBSI in the pediatric population is limited to small case studies. Recommendations are lacking for imaging protocols and grading of injury. Purpose: To assess available evidence-based literature for pediatric and adolescent FNBSI in order to better understand the incidence, risk factors, work up and treatment practices of pediatric and adolescent FNBSI. Methods: A systematic review was conducted to find FNBSI studies in the pediatric and adolescent population. Due to a paucity of literature, information was gleaned from adult FNBSI literature, other areas of BSI in pediatric patients and biomedical papers looking at pediatric growth and bone health. Papers discussing potential risk factors to bone health and pediatric, adolescent and collegiate athletes at higher risk for BSI were also included. Regarding meta-analysis: Search terms included “Femoral Neck,” “Bone Stress Injury; Hip,” “Stress Fracture,” “Stress Fracture + Adolescent.” For the meta-analysis, patients under 20 years of age were reviewed and available information documented. Patients were excluded if they had a known metabolic or chronic medical condition that could be the primary reason or main contributor to their BSI. Results: A total of 66 fractures (57 patients) were identified, 9 bilateral, ranging from 5-19 years. All but 9 (86%) had compression sided fractures; 4/9 tension sided fractures were displaced. 35% (23/66) occurred in military and 30% (20/66) were athletes. Radiographs were most often initial imaging; 22/55 (40%) of those were abnormal, 4 inconclusive. If initial radiographs were negative (or none obtained), 14/33 had repeat positive x-rays, 15/33 positive BS, 12/33 positive MRI. MRI frequently was used to confirm positive radiographs. 6/57 (11%) patients treated conservatively would go on to require surgical fixation. Conclusions: FNBSI is a diagnosis that must be considered in the young, especially when the chief complaint is hip, thigh or groin pain. Radiographs should be the initial diagnostic test, but further imaging is usually necessary to establish the diagnosis and determine a treatment plan. Understanding the specific risk factors to this population is crucial. Further studies in this population are needed to develop a pediatric specific understanding of FNBSI, formulate a proper workup and develop a treatment plan.
DIVERGENT INTERPRETATION OF POST-CONCUSSIVE SYMPTOMS BETWEEN PARENT AND CHILD
Authors: Kieschnick Jennifer , Seagraves Ben , Nieman Holly , Caze Todd 
Published: July 2021

Background: Self-report symptom scales are often given to both parents and the injured child to rate a child’s symptoms following concussion. Previous research has shown that individual symptom reporting may not reflect agreement between parent and child. While total calculated scores may reflect agreement, looking at the total number of items reported may provide more insight into consistency between parent and child symptom rating following concussion. Purpose/Hypothesis: To evaluate the degree of divergence in post-concussive symptom reporting between parent and child. It was hypothesized the parent would endorse their child as having more symptoms following their concussion than self-reported by the child. Methods: The concussed child and their parent completed the Post-Concussion Symptom Inventory (PCSI), a self-reported concussion symptom scale to document symptoms related to the injury. The concussed child completed the age-appropriate version (8-12 years-old or 13-18 years-old) of the PCSI while the parent reported their perception of symptoms experienced by the child. The parent version of PCSI has 26 items, the adolescent version has 25 items, and the child version has 23 items. The total number of symptoms endorsed were calculated by recoding each symptom as a 0 or 1 variable to account for the item differences on the scales. A difference in total items reported, between parent and child as well as parent and adolescent PCSI, were calculated. Results: A total of 36 patients, 15 males and 21 females aged 8-18 (13.8±12.1 years), filled out the PCSI with 10 patients filling out the 8-12 years-old version and 26 filling out the 13-18 years-old version. The 10 parents of children ages 8-12, endorsed 2.9±2.7 more concussion symptoms. Of the 26 parents to adolescents ages 13-18, 1.08±6.28 more concussion symptoms were reported. Conclusion: Current results suggest the parents endorse their child experiencing more symptoms following their concussion than what is self-reported by the child. A future study to investigate the impact of parents’ elevated PCSI score(s) (i.e. total score or endorsed items) when compared to patient’s duration of recovery is recommended. This research would provide more comprehensive guidelines for recovery by means of patient and parent education.
PROSPECTIVE EVALUATION OF IN SITU SCREW FIXATION FOR STABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS
Authors: DeVries Clarabelle , Baird Samuel G. , Bomar James D. , Upasani Vidyadhar V. 
Published: July 2021

Background: In situ screw fixation is the standard of care for the treatment of stable slipped capital femoral epiphysis (SCFE), however, recent studies recommend treatment of all slip-related cam deformity to prevent degenerative changes due to femoroacetabular impingement (FAI). Hypothesis/Purpose: The purpose of this study was to prospectively evaluate radiographic and patient reported outcomes after in situ screw fixation for stable SCFE with minimum 2-year follow-up. Methods: After obtaining IRB approval, we prospectively collected data on all consecutive stable SCFE patients who underwent in situ screw fixation at a single institution. Demographic information, Southwick slip angle (SSA) and alpha angle were recorded. The Hip disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected. Basic descriptive statistics, the Mann-Whitney test, and correlation analysis was performed. Results: Forty-four hips in 38 patients with an average pre-op SSA of 41.1±20.0˚ were studied. Cohort characteristics can be found in Table 1. We observed no surgical complications of the index procedure and no cases of avascular necrosis (AVN). Twelve hips (27%) went on to have a secondary procedure (SSA range: 34˚ to 101˚) on average 2.6±2.4 years after the index surgery. These were performed to correct residual deformity, limited hip range of motion, or symptomatic impingement; one patient (2 hips) was referred for total hip arthroplasty due to significant degenerative osteoarthritis at 7.8 years follow-up. There were five complications of the secondary procedures (three implant failures and two mal-positioned implants). Our mean post-op HOOS and WOMAC scores were 84.2±16.8 and 87.8±13.9, respectively. Severe slips were 19.3 times more likely to undergo a secondary procedure than mild and moderate slips (p<0.001), however we found no correlation between slip severity and patient reported outcomes (p>0.6). Conclusion: With minimum 2-year follow-up, 27% of patients went on to require a secondary surgery after in situ screw fixation for stable SCFE. Patient reported outcomes did not correlate with slip severity (p>0.6) but were found to be significantly higher in SCFE patients that did not require a secondary procedure (p=0.023). Prophylactic treatment of all slip-related cam deformity was not found to be necessary in this prospective cohort. While in situ screw fixation can be used to safely treat mild to moderate stable slips, patients with moderate to severe stable slips may require secondary surgery and have a higher complication rate with worse patient reported outcomes. Level 2 [Table: see text]
IDENTIFYING QEEG EVOKED POTENTIAL VOLTAGE PATTERNS IN PEDIATRIC CASES WITH PERSISTENT POST-CONCUSSION SYMPTOMS (PPCS): A RETROSPECTIVE STUDY
Authors: Phu Nancy , Thirunagari Prem Kumar , Tramutolo David , Marx Tyler , Streeter Leslie , Minor Jon , Mortazavi Mo 
Published: July 2021

Background: Persistent post-concussion symptoms (PPCS) encompasses a broad spectrum of mood and cognitive impairments related to traumatic brain injury from sport activities. There has been limited studies conducted on determining the significance of quantitative EEG (qEEG) testing in the pediatric population. Hence, investigations on P300 evoked potential patterns may provide insight on PPCS course, prognosis, and management. Purpose: The purpose of this study is to identify possible P300 evoked potential voltage trends in PPCS pediatric patients. Methods: A retrospective study of pediatric patients with PPCS (defined as symptoms greater than one month) from 7/2018 to 12/2019 at a private concussion clinic in Tucson, AZ. Patients were excluded if they had a history of learning disorders, seizure disorder, or complex concussions with a skull fracture or intracranial hemorrhage, or no qEEG data. Patients were tested between 6-12 weeks post injury using the standard oddball audio P300 EEG protocol and measures extracted included P300 voltage. Patients were further classified into substages of PPCS (1: 1-3 months; 2: 3-6 months; 3: 6-12 months; 4: 12-36 months) to compare mean P300 voltage score among stages. Results: We identified 33 pediatric patients (age 8-21) with available qEEG data. 10 patients were in stage 1; 12 in stage 2; 8 in stage 3; and 3 in stage 4. Stage 1 group had an average P300 voltage of 17.4μV. Stage 2 group had an average of 10.9μV. Stage 3 group had an average of 13μV. Stage 4 group had an average of 10.3μV. There was a significant difference in the average P300 voltage seen in PPCS symptoms duration less than 3 months compared to 3 months or longer (p=0.018). Conclusion: There is a potential trend in declining P300 voltage with progressive PPCS stage. Our data suggests that chronic cognitive dysfunction represented by reduced P300 voltage may be most common in PPCS durations that are beyond 3 months. Future studies are needed to further validate this initial finding and to identify the significance of voltage patterns in concussion prognosis and management.
COMPLICATIONS OF ARTHROSCOPIC DRILLING IN THE TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE IN CHILDREN AND ADOLESCENTS
Authors: Baghdadi Soroush , Isaacs David , Chan Calvin , Wells Lawrence , Ganley Theodore J , Lawrence John Todd 
Published: July 2021

Background: Arthroscopic drilling is a well-established treatment for stable intact OCDs of the knee in children when non-operative treatment fails. The decision to proceed to operative treatment requires a discussion regarding the risks and benefits of surgical intervention. While there is abundant data suggesting that OCD drilling is a highly effective treatment strategy, there is little data specifically evaluating the risks and complications of this procedure. Purpose: The goal of this study was to assess the complications of drilling of stable OCDs of the knee, and the risk factors for developing complications. Methods: In a retrospective chart review from 2009-2017, data from patients <18 years old who underwent arthroscopic drilling for stable intact OCD lesions of knee were collected. Lesions treated with other techniques (fixation, chondroplasty, OATS), and those with <3 months of follow-up were excluded. Characteristics of the lesions, treatment approach, and post-operative course were recorded. For bilateral surgeries, each knee was considered a separate record. Results: 139 knees in 131 patients were evaluated, of which 102 (73%) were male. The mean age was 12.7years. 108 knees (77%) had an open physis at the time of operation. Patients were managed conservatively for a mean of 6.76 months pre-operatively (SD=6.6). Average follow-up was 14.8 months after the initial surgery (SD=13.25). 53 patients (38%) were obese or overweight at the time of surgery. All patients regained full ROM within 5° of the contralateral knee at a mean 12.9 weeks post-op (SD=3.2), with all but 7 (5 %) returning to activities of daily living at the 3-month visit. No cases of infection, stiffness, arthrofibrosis, or other procedure-related complications were recorded. 6 knees (4.3%) underwent 7 additional surgeries during the follow-up period, all of which were for treatment failure in non-healing lesions (loose body removals, chondroplasty, or repeat drilling). In a multiple logistic regression model, age, gender, status of the physis at the time of surgery, BMI percentile, and OCD size were not predictive of the need for additional surgeries. Discussion: Our findings suggest that arthroscopic drilling for OCDs of the knee is a safe procedure with minimal risk of complications. The majority of patients return to their pre-operative daily activity level with full ROM by 3 months after surgery. Complications, including reoperation, were related to the progression of the OCD, rather than the surgical procedure.
Graft Failure in Adolescent Patients Undergoing Adult-Type ACL Reconstruction with Bone Patellar Tendon Bone or Hamstring Autograft
Authors: Mittal Ashish , Allahabadi Sachin , Coughlan Monica , Pandya Nirav 
Published: July 2021

Introduction: Anterior cruciate ligament (ACL) injuries represent a quarter of high school knee injuries. Adult-type ACL reconstruction (ACL-R) is the treatment of choice for skeletally mature adolescent patients with a complete ACL tear. Graft choice is individualized to the patient, taking into account the patient’s anatomy, activity level, and athletic participation. This subset of patients is at perhaps the highest risk of failure due to demands on the reconstruction after surgery. Hypothesis/Purpose: The purpose of this study was to evaluate outcomes including graft rupture between bone-patellar tendon-bone (BTB) versus hamstring autograft in adolescent patients undergoing adult-type ACL reconstruction. Methods: A retrospective review of patients under the age of 21 undergoing primary adult-type ACL-R by a single surgeon using BTB or hamstring autograft between 2011 and 2019 was performed. Patient demographics, athletic participation, concomitant injuries, graft utilized, graft size, femoral and tibial fixation devices, compliance with rehabilitation protocol, complications, and rates of revision surgery were evaluated. Factors associated with graft failure were compared using Fisher’s exact test with statistical significance < 0.05. Results: 269 patients with an average age of 16.5 years (range 12.4-20.6) and an average follow-up of 2.1 years (range 0.4-6.6 years) were included. 52.5% of the patients were female. The overall graft rupture rate was 4.8%. There was no difference in average age, sex, compliance, and participation in high risk sports between graft type groups. Graft size was larger in patients with BTB autograft than patients with hamstring autograft (9.0 vs. 8.3; p<.001). There was no difference in the overall rate of re-operation between BTB and hamstring autografts (8.6% vs. 10.6%; p=0.81). There was no significant difference in rate of graft rupture with BTB and hamstring autograft (2.9% vs. 5.5%; p=0.26). Average time to revision surgery in those with ruptures was 1.7 years (range 0.7-4.7 years). 46% of patients had revision ACL-R with a different surgeon. There was no difference in age or participation in high risk sports between patients with and without graft tear. There was a higher percentage of documented compliance issues in patients with graft tear (46%) than without graft tear (29%), though not statistically significant (p=0.17). Conclusion: Rates of graft tear after ACL-R did not differ with BTB versus hamstring autograft. Rates of compliance and participation in high risk sports did not significantly differ in patients with and without graft tear. Many patients had a change in surgical provider for revision surgery.