bluuebunny/crossref_metadata_2025_split huggingface dataset:
DELAY TO ACL RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS IS ASSOCIATED WITH A LINEAR INCREASE IN THE RISK OF MEDIAL MENISCAL TEARS
Authors: Kolin David A. , Dawkins Brody , Park Joshua , Fabricant Peter D. , Gilmore Allison , Seeley Mark , Mistovich R. Justin 
Published: July 2021

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears—occurring after the initial ACL injury—are associated with greater delays from injury to ACL reconstruction (ACLR), but frequently use dichotomous categories of acute versus delayed ACLR. Purpose: As meniscal damage is likely accrued constantly over time, we investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population. Methods: We performed a retrospective review of all patients ≤18 years who underwent an ACLR between 2014 and 2018 at one of two tertiary academic hospitals. Outliers were excluded if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index. Logistic regression was used to model the predicted probability of medial meniscal tears. Results: 546 patients met inclusion criteria. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients had a meniscal tear. 169 (49.1%) tears occurred at the medial meniscus, and 257 (74.7%) occurred at the lateral meniscus (Table 1). Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.46; 95% CI, 1.20-1.77) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.77-1.31) (Figure 1). When considering all meniscal tears, time from injury to ACLR was not associated with increased risk of a tear (ARR, 1.01; 95% CI, 1.00-1.01). However, for medial meniscal tears, there was a significant association between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.01-1.03, P = 0.003). A ten-week delay was associated with a 20% increased risk of medial meniscal injury (Figure 2). Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased by 2% each week from injury to surgery. [Table: see text][Figure: see text][Figure: see text]
AEROBIC EXERCISE VOLUME, NOT PRESCRIPTION, INFLUENCES POST-CONCUSSION SYMPTOMS: A RANDOMIZED CLINICAL TRIAL
Authors: Howell David R. , Hunt Danielle , Aaron Stacey E. , Meehan William P. , Tan Can Ozan 
Published: July 2021

Background: Current recommendations for sport-related concussion uniformly emphasize the importance of physical activity. However, specifics of this recommendation remain vague and do not account for an exercise dosage or compliance. Purposes: First, we examined if an 8-week individualized sub-symptom threshold aerobic exercise prescription, initiated within the first two weeks of concussion, alleviates symptom severity or affects the amount of exercise performed during the study. Second, we examined whether prescription adherence, rather than randomized group assignment, reflects the actual impact of aerobic exercise in post-concussion recovery. Methods: For this single-site prospective randomized clinical trial, participants completed an aerobic exercise test within 14 days of injury, and were randomized to an individualized aerobic exercise program or standard-of-care, and returned for assessments 1 month and 2 months after the initial visit (Table 1). The aerobic exercise group was instructed to exercise 5 days/week, 20 minutes/day, at a target heart rate based on an exercise test at the initial visit. Participants reported their symptom exercise volume each week over the 8-week study period, and reported symptoms at each study visit (initial, 1 month, 2 month). Results: Initial symptom severity was not different between randomized groups (Figure 1A), and no significant differences in symptom severity were found at the 4-week (Figure 1B) or 8-week (Figure 1C) assessment. In addition, there was no significant differences between groups for average weekly exercise volume during the first four weeks (Figure 2A) or second four weeks (Figure 2B) of the study. During the first four weeks of the study, 65% (n=11/17) of the exercise intervention participants were compliant with their exercise recommendation (≥100 min/week), compared to 45% (n=9/20) of the standard-of-care group (p=0.33). During the second four weeks of the study, 71% (n=12/17) of the exercise prescription group exercised ≥100 min/week, compared to 55% (n=11/20) of the standard-of-care group (p=0.50). When grouped by exercise volume, the group who exercised ≥100 minutes/week during the first month of the study reported significantly lower symptom severity scores than those who exercised <100 minutes/week (Figure 3B), despite similar initial symptom severity scores (Figure 3A). Conclusion: Participant randomization within 14 days of concussion did not lead to a significant reduction in symptoms, or greater exercise volume. Given that greater exercise volume was associated with lower symptoms after one month of the study, researchers and clinicians should pay particular attention to adherence to aerobic exercise programs for the treatment of concussion. [Table: see text][Figure: see text][Figure: see text][Figure: see text]
PITCHING IN YOUTH SOFTBALL: HOW MUCH ARE PITCHERS THROWING?
Authors: Trotter Cameron A. , Greiner Justin J. , McGuine Tim , Baer Geoffrey S. 
Published: July 2021

Background: Softball is a popular sport among youth female athletes. While multiple youth baseball studies have evaluated the relationship of injury to pitch counts, there is a paucity of literature for youth softball. In contrast to the numerous youth baseball leagues adhering to pitching guidelines, pitch counts are frequently not enforced in youth softball which results in pitchers with exceedingly high volumes. Purpose: The purpose of this study was to perform a quantitative analysis of pitching volume in youth softball players. We hypothesized that the majority of pitches would be thrown by a small proportion of pitchers on each team. Methods: Seventy youth softball teams including 538 pitchers competing in age brackets eight and under (8U) to fourteen and under (14U) between Spring 2017 and Fall 2019. Game dates and pitch counts were collected for each player using an electronic application. Games played on two or more consecutive days were defined as a tournament. The three highest-volume pitchers from each team defined by total season pitches were analyzed for comparison to the average pitcher. Results: 538 pitchers on 70 teams were included. The average pitcher threw 813 pitches per year and appeared in 20.0% of games and the average high-volume pitcher threw 2500 pitches per year and appeared in 54.5% of games. The highest-volume pitcher from each team threw 40% of all recorded pitches, the second highest 27.2%, and the third highest 15.2%, totaling 82.4% of all team pitches. Single day pitch counts of >100 and >200 occurred in 17.7%, and 1.1% of same day games with the average pitcher and in 31.2%, and 2.4% of same day games with the average highest-volume pitcher. Tournament pitch counts of >100 and >200 occurred in 51.0% and 13.8% of tournaments with the average pitcher and in 81.4% and 30.8% of tournaments with the average highest-volume pitcher. The average and highest-volume pitcher threw pitches in two or more games on the same day in 37.5% and 48.6% of possible games while pitching two or more consecutive days in 64.0% and 79.6% of possible games, respectively. Conclusion: Softball pitchers throw high volumes of pitches while also pitching multiple days consecutively. A disparity among pitchers on softball teams exists as 82.4% of team pitches are thrown by three pitchers. These high-volume pitchers may be engaging in unsustainable pitching practices that could predispose to injury. Tables: [Table: see text]
GROWTH OF THE PEDIATRIC KNEE MENISCUS: A CADAVERIC STUDY
Authors: Vuong Brian , Segovia Nicole , Randhawa Sahej , Trivedi Sunny , Tran Emily , Ganley Theodore , Ellis Henry , Wilson Philip , Fabricant Peter , Shea Kevin 
Published: July 2021

Background: The menisci of the knee play a critical role in maintaining structural integrity, as well as in load bearing and shock absorption. In adolescent patients, meniscal tear is a very common sports injury, and is frequently associated with concomitant traumatic injuries including tibial eminence fracture or ACL tear. The incidence of pediatric meniscal tears is increasing, and anatomic studies to guide repair, saucerization and transplantation do not exist. Hypothesis/Purpose: This study’s purpose was to evaluate meniscus dimensions in the developing meniscus and provide anatomic parameters for repair, saucerization, resection, transplantation. Methods: From images of 29 dissected cadaveric knee specimens between 1 month and 132 months of age obtained on a copy stand (14 left knee, 15 right knee), we made direct length measurements from the inner to outer meniscus rim at 45 degree intervals (12, 1:30/10:30, 3:00/9:00, 4:30/7:30 o’clock, 6 o’clock) using Autodesk Fusion 360 software (Figure 1.1). We also measured width between the outer medial and lateral meniscus rims, as well as CT measurements of coronal and sagittal width of the tibial plateau using OsiriX DICOM software. Generalized linear models were used to evaluate the associations of meniscal length measurements with age, tibial width, and meniscal width measurements. All statistical analyses were completed with a two-sided level of significance of 0.05. Results: All radial length measurements were predicted to increase significantly with age (p < 0.01), as coronal tibial width increases (p < 0.05), and as lateral-medial meniscal width increases (p < 0.001) (Figure 1.2). Other than the lateral 3 o’clock measurement (p = 0.119), all radial measurements were predicted to increase significantly as sagittal tibial width increases (p < 0.05). The posterior zones of the medial meniscus (6:00, 4:30/7:30) were found to increase in radial length at a faster rate than the anterior zones. The anterior zones of the medial meniscus (12:00, 1:30/10:30) had the slowest rate of growth. Discussion/Conclusion: Meniscus radial length is related to age, tibial plateau width, and lateral-medial meniscus width. Radial dimensions from normal lateral menisci may allow the surgeon to obtain ideal size of resection, saucerization of discoid menisci. The growth of medial meniscus posterior zones is greater than the anterior zones. This may be attributed to increased posterior region load bearing which increases with ambulation in the developing child. Improved anatomic understanding may help surgeons plan for discoid resection/saucerization/repair, and also support appropriate selection of meniscus allograft for transplantation. [Figure: see text][Figure: see text]
Opioid Overprescription in Adolescents and Young Adults Undergoing Hip Arthroscopy
Authors: Hassan Mahad M. , Rahman Omar F. , Hussain Zaamin B. , Burgess Stephane L. , Yen Yi-Meng , Kocher Mininder S. 
Published: July 2021

Background: Previous studies have examined factors related to the increased use of opioids after hip arthroscopy in adults. However, few have focused on the adolescent population. Purpose: The purpose of this study was to compare the opioids prescribed to opioids consumed after hip arthroscopic procedures in adolescent and young adult patients, and to determine patient or surgical factors associated with increased postoperative opioid use. Methods: Adolescent and young adult patients who underwent hip arthroscopy and associated arthroscopic interventions between January 2017 and January 2020 were included. Patients with a diagnosed pain syndrome or history of chronic pain, as determined by the patient taking opioid medications prior to surgery, were excluded. Daily postoperative opioid intake was recorded via pain-control logbooks. The outcome of the study was defined as the average total number of opioid tablets consumed postoperatively. Results: Fifty-eight patients returned completed logbooks, 72% of whom were female patients. The average age was 21.30 years (range, 14.9 – 34.2). Most patients (73%) were prescribed 30 oxycodone tablets. The median amount of tablets consumed was 7 (range, 0-41) over a median duration of 7 days (range, 1-22). The median ratio of tablets consumed to prescribed was 20% and the 95th percentile of opioids consumed was 28 tablets. Bivariate analysis showed that patient age at surgery was positively correlated to the total amount of tablets consumed (r=0.28, p=0.04) and to the ratio of tablets consumed to prescribed (r=0.30, p=0.03). Duration of surgery was negatively correlated to the number of days tablets were consumed (r=-0.31, p=0.03). Multivariate analysis showed that patients who were prescribed more than 30 tablets took on average 7.8 more tablets overall compared to those prescribed 30 or fewer tablets (p=0.003), and that for each additional year of age, the ratio of tablets consumed to prescribed increased by 1% (p=0.02). Conclusion: After undergoing hip arthroscopy and associated arthroscopic procedures, adolescents and young adult patients are commonly overprescribed opioids, consuming on average only one-fifth of the tablets prescribed. This finding mirrors trends in the pediatric knee arthroscopy literature and provides an opportunity to reassess current opioid prescribing behaviors in the adolescent and young adult populations. [Table: see text][Table: see text][Table: see text][Table: see text][Table: see text]
ANXIETY, FEAR, AND MOVEMENT FOLLOWING SPORTS-RELATED CONCUSSION: HOW DOES KINESIOPHOBIA CORRELATE TO SYMPTOMS AND REACTION TIME?
Authors: Reinking Sarah , Seehusen Corrine N. , Walker Gregory A. , Wilson Julie C. , Howell David R. 
Published: July 2021

Background: Fear of pain with movement, also known as kinesiophobia, has been widely studied in various musculoskeletal injuries, yet little is known about its relationship to concussion. Given that concussion can negatively affect neuromuscular control and anxiety, re-integration into sports following a concussion may be associated with kinesiophobia. Hypothesis/Purpose: Our primary purpose was to examine kinesiophobia, among youth athletes with concussion compared to uninjured controls. Secondarily, we sought to examine correlations between kinesiophobia with concussion symptom severity and reaction time. We hypothesized adolescents with concussion would demonstrate greater kinesiophobia compared to controls. Additionally, we hypothesized that greater kinesiophobia would be correlated with higher symptom severity and slower reaction times. Methods: We conducted a repeated measures study of 48 youth athletes. Participants were evaluated at two time points. The concussion group was assessed within 14 days of injury and once cleared for return to play (RTP) by physician. The control group was tested initially and again approximately 28 days later. Participants completed Tampa Scale of Kinesiophobia (TSK), Post-Concussion Symptom Inventory (PCSI), and clinical reaction time (CRT) assessments. We compared mean group differences and assessed the correlation of TSK with PCSI and CRT, at each assessment. Results: We included 26 participants with a concussion and 16 controls (Table 1). The concussion group reported significantly greater TSK scores at the initial assessment (38.0±5.6 vs. 29.3±6.9; p<0.001; Figure 1) and a significantly greater proportion of “high” TSK scores (>36) compared to controls (69% vs. 19%; p = 0.004; Table 1). At the follow-up assessment, there were no significant between group differences in TSK scores (32.8±7.0 vs. 30.4±7.5; p=0.35; Figure 1), or the proportion of “high” TSK scores (38% vs. 25%; p=0.51; Figure 1). TSK scores were significantly and moderately correlated with PCSI for the concussion group at both assessments (r=0.53; p=0.006 at visit 1, r=0.47; p=0.01 at visit 2; Figure 2), but not for controls (Figure 2). Furthermore, TSK scores were significantly and moderately correlated with CRT for the concussion group (r=0.50; p=0.01; Figure 2), but not controls (r= -0.26; p=0.37; Figure 2) at the follow-up assessment. Conclusion: Adolescents recovering from concussion commonly reported high kinesiophobia at initial concussion assessment, while many no longer reported high kinesiophobia when given RTP clearance. Furthermore, kinesiophobia was significantly correlated with self-reported concussion symptoms and clinical reaction time scores. The correlation between kinesiophobia and reaction time suggests a perception-behavior relationship with post-concussion movement deficits may exist. Tables/Figures: [Table: see text][Figure: see text][Figure: see text]
IS NEAR POINT OF CONVERGENCE ASSOCIATED WITH SYMPTOM PROFILES OR RECOVERY IN ADOLESCENTS AFTER CONCUSSION?
Authors: Walker Gregory A. , Wilson Julie C. , Seehusen Corrine N. , Provance Aaron J. , Howell David R. 
Published: July 2021

Background: Visual impairments, including oculomotor impairments, are common following concussion. Accurate, efficient, and objective measurement of post-concussion visual impairments may help guide treatment pathways. Less is known about how specific concussion symptoms are associated with visual impairments. Hypothesis/Purpose: Our purpose was to compare the clinical and injury characteristics of concussion patients who demonstrated receded near point of convergence (NPC) (defined as measurement >6 cm using accommodation rule from bridge of nose) to those with normal NPC (≤6 cm). We hypothesize that patients demonstrating receded NPC would show greater symptom burden and have longer recovery when compared to those with normal NPC. Methods: Concussion patients who were seen within 14 days of injury were included. We performed univariable demographic, injury, and clinical characteristic comparisons between those with and without receded NPC break point using independent samples t-tests and Chi-square analyses. We compared NPC break point between those who did not recover within 28 days of injury (PPCS; persistent post-concussion symptoms) and those who did (no PPCS). A multivariable linear regression model was constructed to identify which factors were associated with NPC break point distance. Results: We evaluated 123 patients using a multimodal concussion evaluation within 14 days of injury. Those with receded NPC (n=77) were significantly younger than those with normal NPC (n=46; Table 1). The receded NPC group had a significantly greater proportion of patients reporting headaches at initial assessment, as well as significantly greater overall, cognitive and somatic symptom severity (Table 2). The group who went onto experience PPCS had a significantly greater NPC at initial evaluation than those without PPCS (p=0.02; Figure 1). The receded NPC group committed more modified Balance Error Scoring System (mBESS) errors than the normal NPC group, but there were no significant differences for tandem gait test performance (Table 3). In our multivariable model, we observed that among all potential predictor variables, more severe somatic symptoms were significantly associated with a greater NPC (Table 4). Conclusion: Those with receded NPC at initial evaluation showed an increased symptom burden, most notable with somatic symptoms, compared with those without receded NPC. Additionally, we were able to elucidate that those who went on to develop PPCS had greater NPC than those recovered within 28 days. Visual disorders may be an important driver of symptom profiles following concussion in adolescents. The impact of visual disturbance treatment following concussion in adolescents on symptom resolution should be further evaluated. Tables/Figure: [Table: see text][Table: see text][Figure: see text][Table: see text][Table: see text]
PARENTS AND ATHLETES PERCEIVE PAIN AND PEER RELATIONSHIPS DIFFERENTLY: EARLY RESULTS OF A PROMIS DYAD STUDY
Authors: Franklin Corinna C , Moran Kevin ,   PRiSM Female Athlete Research Interest Group,   Shriners Sports Medicine Consortium
Published: July 2021

Introduction: Parents/caregivers are a crucial part of young athletes’ support systems, as their beliefs can have a profound effect on the athletes’ treatment and recovery. However, it is unknown to what degree sports medicine patients and their parents/caregivers are in agreement about their function. We recently instituted the use of a Patient Reported Outcome Measurement Information System (PROMIS) for all patients in our hospital system. In this study, we propose to use PROMIS scores to evaluate whether parents/caregivers have the same perception of their child’s function as the child them self. This is a report of our early findings from one site. Methods: IRB approval was obtained for this study. Patients already take PROMIS evaluations as part of their clinical care. After obtaining informed consent, one parent (ideally the primary caregiver) per patient at one visit took the parent-proxy version of PROMIS, in which the parent is asked to answer identical questions on the child’s behalf, without consulting either the patient or their physician. PROMIS domains included mobility, upper extremity, pain, and peer relationships. All parent-child dyads were through sports medicine clinic with an injury or diagnosis related to sports medicine. Patients and parents were compared using independent samples t-tests. Results: Twenty-four ( n=24) patient-parent dyads were included in this analysis. Fourteen patients ( n=14) were female and n=10 male. Sixteen patient/parent ( n=16) dyads had similar genders and n=8 were opposite genders. There were significant differences between the patient and their parent for both the pain and peer relationship domains ( p=0.02 for both). Parents rated the patients’ pain as more severe ( M=48.1, SD = 9.3) than the patient rated their own pain ( M=42.2, SD=7.3). Parents also rated the patients’ peer relationships as worse/more affected ( M=53.0, SD=9.4) than did the patients themselves ( M=58.9, SD=7.2). No significant differences were found for the mobility and upper extremity domains, p>0.05. There was no significant difference in concordance between same or opposite gender dyads, p>0.05. Conclusion: Early results of this study suggest that parents rate athletes with sports injuries as having more pain and worse/more affected peer relationships than do the athletes themselves. Further study is required to elucidate the impact of this difference on athletes’ performance and recovery.