bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHANGE IN KNEE SEPARATION DISTANCE IN ADOLESCENT ATHLETES AFTER A 6-WEEK NEUROMUSCULAR TRAINING PROGRAM
Authors: Gómez Jorge E. , Wilson P. Burke , Johnson Timothy 
Published: July 2021

Background: Existing neuromuscular injury prevention programs have relied principally on lower extremity strengthening, agility, cutting and landing technique to improve jump landing mechanics in order to prevent non-contact knee ligament injuries. Purpose: To determine whether a 6-week neuromuscular training program emphasizing core (back & hip) strengthening and dynamic balance exercises can significantly improve normalized knee separation distance (nKSD) during a standard counter-movement jump landing maneuver. Methods: Fourteen adolescent athletes (11 boys, 3 girls, ages 12-15) volunteered to undergo a 2 day/week, 6-week off-season training program. On the first day of training, the athletes underwent assessments that included 2 trials of a counter-movement jump from a 40cm platform. The tests were recorded using a video camera in the frontal plane. Using Dartfish motion analysis software, knee separation distance (KSD) was measured as the distance (cm) between the femoral condyles at the lowest point of the jump landing, and intertrochanteric distance (ITD) as the distance (cm) between the femoral trochanters. Normalized knee separation distance was computed as nKSD = KSD/ITD. The training program focused on three progressions; increasing difficulty of core strengthening exercises, balance exercises, and agility drills. One-hour training sessions were subdivided as follows; 5 min dynamic warm-up, 10 min stretching, 10 min body weight core exercises, 15 min balancing exercises, 10 min dumbbell core exercises, 15 minute agility drills, 5 min of rest/hydration breaks. The athletes repeated the counter-movement jump test at the end of the 6 weeks. Results: There was a significant improvement (t = 2.740, p = 0.017) in nKSD between post-test (0.789 + 0.372) and pre-test (0.683 + 0.323) Conclusion: A 6-week neuromuscular training program focused on core strengthening and balance significantly improved jump landing mechanics which may reduce the risk of knee ligament injury.
DIZZINESS, PSYCHOSOCIAL FUNCTION, AND GAIT ASSESSMENT FOLLOWING SPORT-RELATED CONCUSSION
Authors: Hunt *Danielle L. , Oldham Jessie , Aaron Stacey E. , Tan Can Ozan , Meehan William P. , Howell David R. 
Published: July 2021

Background: Dizziness after concussion can be detrimental to both the physical and psychosocial wellbeing of patients. Vestibular symptoms, in particular, can amplify postural instability, which may create a greater sense of mental and physical abnormality post-concussion. Purpose: To examine the three-way association between self-reported dizziness with concussion symptoms, depression and anxiety severity, and gait deficits within two weeks post-concussion. We hypothesized that participants who endorsed a moderate/severe level of dizziness would report a more severe concussion symptom burden, more severe depression and anxiety, and worse postural stability. Methods: For this cross-sectional study, participants ages 14-21, were recruited from either a regional sports concussion clinic or emergency department, and tested within 14 days of a diagnosed concussion. Participants completed the Dizziness Handicap Inventory (DHI), Post-Concussion Symptom Inventory (PSCI), and Hospital Anxiety and Depression Scale (HADS).They also completed an instrumented single/dual-task gait assessment (three trials per condition). The gait assessment included walking at a self-selected pace towards a target 8m ahead, then returning to the start line. Dual task trials included a cognitive task (months in reverse order, serial 7’s, and spelling a 5-letter word backwards) while walking. Descriptive statistics, independent t-tests, and Mann Whitney U tests were used to compare between those with moderate/severe dizziness (DHI score ≥36) and those with mild/no dizziness (DHI score <36), p<0.05. Results: 40 participants completed the study. 19 self-reported moderate/severe dizziness (63% female, 17.1±2.4 years of age, average DHI score 48.4±12.6) and 21 mild/no dizziness (38% females, 16.5±1.9 years of age, average DHI score 18.7±9.3). Those with moderate/severe dizziness reported significantly more severe symptoms (PSCI: 43.0±20.6 vs. 22.8±15.7, p=0.001), and had higher median HADS anxiety (6 vs. 2, p<0.001) and depression (6 vs. 1, p=0.001) scores than those with no/minimal dizziness. During steady-state gait, the moderate/severe dizziness group walked with significantly lower single-task cadence (Figure 1B) and dual-task cadence (Figure 1E) than the no/mild dizziness group. Conclusion: Participants who self-reported a moderate to severe level of dizziness within 14 days of a concussion reported worse symptom severity, anxiety, and depression than those with no/mild dizziness. Further, cadence during gait is negatively affected by the level of dizziness reported. Clinicians should be aware of the psychosocial and physical effects dizziness symptoms may play in a patient’s recovery. Gait deficits in the moderate/severe dizziness group further indicate the importance of evaluating how the feeling of postural instability affects gait following concussion. Word Count: 389/400 [Figure: see text]
SURGICAL TREATMENT OF OSGOOD-SCHLATTER DISEASE IN ADOLESCENT ATHLETES
Authors: Mun Frederick , Hennrikus William L. 
Published: July 2021

Background: Osgood-Schlatter disease is an apophysitis of the tibial tubercle causing pain and difficulty kneeling. A majority of cases resolve spontaneously at skeletal maturity when the tibial tubercle apophysis fuses. Treatment is symptomatic when the physis is open. Adolescent athletes with closed physes and continued symptoms can benefit from surgery. Purpose: The purpose of this study is to report the outcomes of ossicle excision and tubercleplasty for unresolved Osgood-Schlatter disease that has failed conservative treatment. Methods: A retrospective review was performed on 6 athletes who underwent ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease. Data collected include age at onset of symptoms, age at surgery, gender, laterality, radiographic findings, sports played, time to return to sport, length of follow up, and complications. Surgery involved an open ossicle excision, tubercleplasty, and repair of the patella tendon to bone using a suture anchor. A longitudinal incision was made over the antero-lateral aspect of the patella tendon. The patella tendon was reflected medially to gain access to the ossicle and bump. A direct anterior incision was avoided to minimize post-operative pain with kneeling. Post-operatively, patients were allowed to fully weight bear in an extension knee brace for 4 weeks, and then allowed to gradually resume activity. Results: 4 males and 2 females were studied. The right knee was involved in 3 cases and the left knee in 3. The average age at onset of symptoms was 15.8 (range 12-18). The average age at surgery was 17.3 (range 17-18). Radiographic findings included a large bump in 3 cases, an ossicle in 2 cases, and free fragments at the tendon insertion in 3 cases. Sports played included basketball, football, running, and dancing. All patients returned to sports at an average of 23.9 weeks post-surgery (range 5-56). The average length of follow up was 14.2 weeks (range 5-27). No patients reported post-operative pain with kneeling, limp, need for a cane, locking sensations, giving way sensations, pain, swelling, difficulty climbing stairs or difficulty squatting. No patients needed additional surgery. Conclusion: Surgical treatment of unresolved Osgood-Schlatter disease was successful in 100% of adolescent athletes in this series. For symptomatic patients after closure of the growth plate, we recommend removal of the ossicle and adjacent bursae, smoothing down the bump with a burr, and repairing the reflected patella tendon to bone using suture anchors. The outcomes were excellent in all patients with no complications.
Trends in Adolescent Hip Arthroscopy From the PHIS Database: 2008 to 2018
Authors: Hassan Mahad M. , Hussain Zaamin B. , Rahman Omar F. , Kocher Mininder S. 
Published: July 2021

Background: Previous studies have suggested that hip arthroscopy has been performed with increasing frequency. Few studies have examined this trend in the adolescent population. Purpose: The purpose of this study was to evaluate the trend in the frequency of hip arthroscopy in adolescents standardized by total orthopaedic surgeries in adolescents at pediatric hospitals in the United States. Methods: The Pediatric Health Information System (PHIS) database was queried for patients aged 10 to 19 years who underwent orthopaedic surgery at any of the PHIS-participating hospitals from 2008 to 2018. The subgroup of patients in this age cohort who underwent hip arthroscopy was identified using Current Procedural Terminology (CPT) procedure codes. The yearly rate was expressed as the number of hip arthroscopies per 1000 orthopaedic surgeries. A linear model was used to fit the data and illustrate the relative trend. Results: A total of 432309 orthopaedic surgeries including 9491 hip arthroscopies were performed for patients 10 to 19 years of age. Hip arthroscopies were performed at a yearly rate of 22 per 1000 orthopaedic surgeries. Over the 10-year period, the number of hip arthroscopies increased 6.2-fold, whereas the number of orthopaedic procedures increased 1.6-fold. There was a 3.9-fold increase in hip arthroscopies relative to total orthopaedic surgeries. Conclusion: The number of hip arthroscopic procedures in adolescent patients has increased by 3.9-fold times relative to total orthopaedic surgeries in adolescents over a 10-year span. This finding mirrors the trends in the adult population over similar time periods. This may be due to increasing participation in sports in the adolescent population as well as a better understanding of the diagnosis and treatment of femoroacetabular impingement and other sports-related hip pathologies. [Table: see text][Figure: see text]
ANTERIOR CRUCIATE LIGAMENT RECONSRUCTION IN CHILDREN: OUTCOMES OF QUADRICEPS VERSUS HAMSTRING AUTOGRAFTS
Authors: Bram Joshua T. , Gans Itai , Parisien Robert , Greenberg Elliot , Ganley Theodore J. 
Published: July 2021

Background: Emerging evidence has suggested reduced donor site pain and equivalent/improved functional outcomes in adults undergoing ACL reconstruction (ACLR) with quadriceps (QT) autograft versus hamstrings (HT) grafts. No studies in children comparing QT versus HT autografts have assessed postoperative strength or active range of motion (AROM) in addition to more commonly accepted patient-reported outcome measures (PROMs). Hypothesis/Purpose: The purpose of this study was to directly compare clinical and patient-reported outcomes of pediatric patients undergoing QT and HT autograft ACL reconstructions. We hypothesized that use of QT autografts would result in similar clinical and PROMs to HT autografts. Methods: A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary transphyseal ACLR from 1/2018-12/2019 without concomitant multiligamentous reconstruction was conducted. Outcomes at 3 and 6 months, including isokinetic strength testing, PROMIS and IKDC scores, and AROM were compared between patients receiving either HT or QT autografts. Hamstrings to quadriceps (H/Q) ratios were calculated using the ratio of the respective peak torque values normalized to body weight. Multiple imputation was utilized to minimize bias resulting from missed follow-up appointments. Results: 84 patients met inclusion criteria (Table 1). The 40 patients receiving QT were more often male (62.5% vs 34.1%, p=0.009). There were no differences in operative time (p=0.053) or proportion of patients requiring meniscus repair (p=0.958). At 3 months postoperative, those with HT had lower H/Q ratios (62.2 ± 15.8 vs 78.6 ± 19.9, p<0.001) and limb symmetry index (LSI) in flexion (86.1 ± 17.1 vs 94.3 ± 17.6, p=0.042), while patients with QT had lower LSI in extension (66.8 ± 13.2 vs 77.3 ± 12.6, p=0.001). The H/Q ratio was also lower at 6 months among patients receiving HT (59.7 ± 11.2 vs 66.3 ± 8.2, p=0.004). IKDC, PROMIS physical function, and PROMIS pain interference scores were not different between cohorts at either 3 or 6 months. There was no difference in AROM in flexion or extension between groups at all postoperative visits. Patients with QT were more likely to have a postoperative wound issue (20.0% vs 2.3%, p=0.012). Conclusion: Significant differences in quadriceps and hamstrings strength at 3 months were observed for ACLR patients by graft type. This contributed to higher H/Q ratios at 3 and 6 months postoperatively for patients receiving QT. QT grafts appear to have a higher rate of postoperative infection/wound issues. Tables/Figures: [Table: see text]
Reliability of Two-Dimensional Video-Based Analysis in Adolescent Runners
Authors: Matsuzaki Yukiko , Heath Madison R. , Khan Julianne M. , Spitzer Elad , Fabricant Peter D. 
Published: July 2021

Background: Running analysis is an essential component of evaluation of both injured runners and uninjured runners seeking advice on injury prevention. Reliability of two-dimensional (2D) video analysis has been reported in the adult running population. However, these findings may not apply to youth runners given their unique state during growth and development. The reliability of quantitative and qualitative video-based running gait analysis in the adolescent population is unknown. Purpose: The purpose of this study was to determine the intra-rater and inter-rater reliability of sagittal and frontal plane kinematics using 2D video analysis in healthy adolescent runners. Methods: High-definition videos were recorded of 10 healthy runners between 14-18 years old running on a treadmill at self-selected speed with markers attached to the thoracic spine, pelvis, and lower extremities. Kinematic variables in the sagittal and frontal planes were measured using Dartfish Motion Analysis Software™ (Fribourg, Switzerland) by three raters. Intra- and inter-rater reliability were calculated using Intraclass Correlation Coefficients (ICCs). Results: Of the 10 runners, 4 (40%) were male and the mean age was 16 ± 1.5 years. The intra-rater ICC for all kinematic variables ranged from 0.574 to 0.999 for the primary sports physical therapist, and 0.367 to 0.973 for the inexperienced research assistant. The inter-rater ICC for all raters ranged from -0.01 to 0.941. Eleven kinematic variables showed substantial agreement and 4 showed almost perfect agreement. Step width and foot progression showed fair and poor agreement, respectively. Conclusion: The results of this study demonstrate that a 2D video-based running analysis can be reliably performed in an adolescent population on all kinematic variables except for step width and foot progression. Inexperienced raters can be properly trained in the video analysis of running kinematics using Dartfish Software in order to consistently assess the same runner. [Table: see text][Table: see text]
ATHLETE IDENTITY AND COMMON BENEFITS AND BARRIERS TO SPORT PARTICIPATION AMONGST ADOLESCENT SLED HOCKEY PLAYERS
Authors: Napolitano Jonathan , Iliescu Daniela , Hoehn Jessica , Berner Theresa , Meyer Carlie , Jackson Kristen , Kemp Erika 
Published: July 2021

: The physical, psychological, and social benefits of sports participation in adolescents have been well reported in the able-bodied population. However, those with physical disabilities encounter many barriers to participating in sports, which limits access to these benefits. Additionally, due to their disabilities, these individuals are often not viewed as athletes by the general population and therefore may not identify as one themselves. : Our study seeks to use qualitative research techniques to identify the themes influencing adolescents’ participation in sled hockey and determine their identity as athletes. : Cross-sectional qualitative interview. Our IRB approved study recruited athletes at sled hockey practices and tournaments where interviews were moderated and transcribed. Transcriptions were coded according to common themes mapped in Figure 1. : We surveyed 19 youth sled hockey players (range 10-24 years old, mean 15.3) with multiple physical disabilities, the most common diagnosis being spina bifida (14) (Table 1). Our qualitative analysis identified the most prevalent themes that influence participation in adaptive sports to be: social factors, intrapersonal factors, motivators to start sport, access, physical and mental health, and athletic identity (Figure 1). Initial motivators to start involvement included encouragement from parents, role models, adapted sports organizations, healthcare providers or personal interest in the sport itself. Despite the perceived medical and financial barriers, support from teammates and funding assistance in purchasing equipment facilitated continued involvement. Our population also reported many perceived benefits to continued participation in adaptive sports, each reporting “having fun” while playing a sport they “love”. Other benefits were connecting with friends of similar disabilities and capabilities, who encourage them, serve as role models, and make them feel included. Furthermore, the mentorship the coaches provide, pushing the athletes to achieve, creates an atmosphere of competitiveness and a feeling of physical and mental wellbeing. Ultimately, this competitive environment allows for formation of an athletic identity, reported by 18 out of the 19 interviewees. : Despite encountering barriers to participating in a team sport that requires expensive equipment and travel and negotiating the limitations of physical disabilities requiring frequent medical procedures and time away from sport, the overpowering benefits of participation allow majority of our adolescent population to thrive and to identify as athletes. Among the main facilitators to continued involvement are mentorship and support from coaches and parents, comradery and competition, all which lead to physical and mental wellbeing and feeling of inclusiveness and accomplishment. [Figure: see text][Table: see text]
A PILOT STUDY EVALUATING THE TIMINGOF VESTIBULAR THERAPY AFTER SPORT-RELATED CONCUSSION: EARLIER IS BETTER
Authors: Ahluwalia Ranbir , Miller Scott , Dawoud Fakhry M. , Malave Jose O. , Tyson Heidi , Bonfield Christopher M. , Yengo-kahn Aaron M. 
Published: July 2021

Background: Vestibular dysfunction, characterized by nausea, dizziness, imbalance and/or gait disturbance, represents an important sport-related concussion (SRC) subtype associated with prolonged recovery. Vestibular physiotherapy is important to promote recovery; however, the benefit of earlier therapy is unclear. Purpose: To determine if earlier vestibular therapy for young athletes with sport-related concussion is associated with earlier return-to-play (RTP), return-to-learn (RTL), and symptom resolution. Study Design: Retrospective Cohort Study Methods: Patients ages 5-23 with sport-related concussion who initiated vestibular therapy from 1/2019-12/2019 were included and patient records were reviewed. Therapy initiation was defined as either early, ≤ 30 days post-injury, or late (>30 days). Univariate comparisons between groups, Kaplan-Meier plots and multivariate Cox proportional hazard modeling were performed. Results: Overall, 23 patients were included (10 early,13 late) aged 16.14±2.98 years and 43.5% male. There was no difference between group demographics or medical history. Median initial total and vestibular symptom scores were comparable between groups. The late therapy group required additional time to RTP (110[61.3,150.8] vs. 31[22.5, 74.5], 95% CI-115.0—8.0, p=0.028), but not to RTL (12[3.5,26.5] vs. 17.5[8,20.75], 95%CI -11.0-12.0, p=0.085. Most notably, the late therapy group required more time to achieve symptom resolution (121.5 days [71,222.8] vs. 54 days [27,91] 95%CI -150.0-9.0, p=0.018). Adjusting for age and initial total symptom score, earlier therapy was protective against delayed symptom resolution (HR 0.988, 95%CI 0.98-0.99, p=0.008). Conclusion: This pilot study evaluating vestibular therapy timing suggests that initiating VRT within the first 30 days following SRC is associated with earlier RTP and symptom resolution. Further prospective trials to evaluate if even earlier VRT to resolve post-concussion syndrome should be pursued. Tables/Figures: [Figure: see text]
45° FLEXION ANTEROPOSTERIOR ELBOW RADIOGRAPHS IMPROVE DIAGNOSTIC ACCURACY OF CAPITELLUM OSTEOCHONDRITIS DISSECANS
Authors: Saper Michael , Burton Monique , Menashe Sarah , Nagle Kyle , Schmale Gregory , Bompadre Viviana , Thapa Mahesh 
Published: July 2021

Background: The initial diagnosis of capitellum osteochondritis dissecans (OCD) is typically confirmed using standard anteroposterior (AP) and lateral elbow radiographs, despite low sensitivity, which is approximately 44-47%. An AP image of the elbow in 45° of flexion has been suggested to increase diagnostic accuracy. Purpose: To assess the diagnostic performance, inter- and intra-observer reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP) in pediatric and adolescent patients. Methods: This was a retrospective study including pediatric and adolescent patients with capitellum OCD and a healthy control group. Independent clinicians were blinded to the official radiologists’ reports and reviewed images on a picture archiving and communication system on two separate occasions 1 week apart. A 5-point Likert scale was used to assess the clinicians’ level of confidence (1-not at all confident; 5-very confident). Inter- and intraobserver reliability was determined using kappa statistics. Results: The study included 28 elbows (24 patients) with a mean age of 12.5 ± 2.0 years. 64.3% were female. There were no differences in age ( P = 0.18), sex ( P = 0.62), or laterality ( P = 1.0) between the two groups. There were marked variations in the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each of the following views: AP: Sensitivity 85.1; Specificity 89.3; PPV 88.8; NPV 85.7; accuracy 87.2. Lateral: Sensitivity 73.2; Specificity 91.7; PPV 89.8; NPV 77.4; accuracy 82.4. 45° flexion AP: Sensitivity 91.7; Specificity 91.1; PPV 91.1; NPV 91.6; accuracy 91.4. Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the three combined views was 100%. Confidence levels in the clinicians’ diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (k=0.65 and k=0.60, respectively) but highest for the 45° flexion AP radiographs (k=0.72). Intraobserver reliability for all views was moderate to perfect (k=0.52 to 0.93). Conclusion: The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, capitellum OCD can be diagnosed in 100% of cases.