bluuebunny/crossref_metadata_2025_split huggingface dataset:
SOFT TISSUE CAM IMPINGEMENT IN ADOLESCENTS: MRI REVEALS IMPINGEMENT LESIONS UNDERAPPRECIATED ON X-RAY
Authors: Johnson Benjamin L. , Alizai Hamza , Ben Montanez , Wagner K. John , Youngman Tyler , Ellis Henry B. 
Published: July 2021

Background: The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. Hypthesis/Purpose: The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI. Methods: A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test. Results: Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<0.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome. Conclusion: In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.
SINGLE LEG SQUAT COMPENSATIONS ASSOCIATE WITH SOFTBALL PITCHING PATHOMECHANICS IN ADOLESCENT SOFTBALL PITCHERS
Authors: Oliver Gretchen D. , Friesen Kenzie B. , Shaw Regan E. , Shannon David , Dugas Jeffrey , Andrews James 
Published: July 2021

Background: Softball pitchers have an eminent propensity for injury due to the high repetition and ballistic nature of the pitch. As such, trunk pathomechanics during pitching have been associated with upper extremity pain. The single leg squat (SLS) is a simple diagnostic tool used to examine LPHC and trunk stability. Research shows a lack of LPHC stability is often associated with altered pitching mechanics consequently increasing pain and injury susceptibility. Hypothesis/Purpose: The purpose of this study was to examine the relationship between trunk compensatory kinematics during the SLS and kinematics during foot contact of the windmill pitch. The authors hypothesized there would be a relationship between SLS compensations and pitch kinematics previously associated with injury. In using a simple clinical assessment such as the SLS, athletes, coaches, parents, and clinicians can identify potential risk factors that may predispose the athlete to injurious movement patterns. Methods: Fifty-five youth and high school softball pitchers (12.6±2.2 years, 160.0±11.0 cm, 60.8±15.5 kg) were recruited to participate. Kinematic data were collected at 100Hz using an electromagnetic tracking device. Participants were asked to complete a SLS on their stride leg (contralateral to their throwing arm), then throw 3 fastballs at maximal effort. Values of trunk flexion, trunk lateral flexion, and trunk rotation at peak depth of the SLS were used as the dependent variables in three separate backward elimination regression analyses. Independent variables examined at foot contact of the pitch included: trunk flexion, trunk lateral flexion, trunk rotation, center of mass, stride length, and stride knee valgus. Results: The SLS trunk rotation regression, F(1,56) = 4.980, p = .030, revealed trunk flexion significantly predicted SLS trunk rotation (SE = .068, t = 2.232, p = .030) and explained approximately 7% of variance (Adj. R2 = .066). The SLS trunk flexion regression, F(1,56) = 5.755, p = .020, revealed stride knee valgus significantly predicted SLS trunk flexion (SE = .256, t = 2.399, p = .020) and explained approximately 8% of variance (Adj. R2 = .078). Conclusion/Significance: Additional trunk rotation and trunk flexion at peak depth of the SLS indicate increased knee valgus and trunk flexion at foot contact of the pitch, both of which suggest poor LPHC stability, may increase the potential for injury. Athletes, coaches and clinicians should acknowledge the risk of poor LPHC in softball pitching and implement exercises to improve LPHC stability in effort to decrease pitching pathomechanics and associated pain.
COACH EDUCATION IMPROVES ADHERENCE TO ACL INJURY PREVENTION PROGRAMS: A CLUSTER-RANDOMIZED CONTROLLED TRIAL
Authors: Janosky Joseph 
Published: July 2021

Background: ACL injury prevention programs have demonstrated limited impact on population health, due in part to poor adherence to expert recommendations by sports coaches. Neuromuscular training (NMT) serves as a protective factor against ACL injury and serves as a key component of many ACL injury prevention programs. The objective of this study was to determine the effect of an educational workshop for sports coaches on adherence to neuromuscular training (NMT) implementation recommendations. Methods: In a cluster-randomized controlled trial, 22 teams in 8 high schools were randomized to either the intervention or control group. The intervention schools included 12 teams (5 female), and the control schools included 10 teams (4 female). The sports included basketball, volleyball, track and field, baseball, softball, and lacrosse. Coaches in the intervention group participated in a 60-minute educational workshop designed to teach coaches how to effectively implement a NMT program as a warm-up prior to team practice sessions and games. The schools in the control arm received print materials on recommended NMT exercises. Adherence to NMT implementation recommendation by sports coaches was the primary outcome. Eight data collectors, who were blinded to the teams’ assignment, were trained to observe each team’s practice or game 2-3 times a week. At each session, they completed a study questionnaire to identify the exercises completed by athletes during the team’s warm-up. They then recorded whether the coach 1) delivered exercise instructions, and 2) provided corrective cues. Generalized estimating equations (GEE) were used to account for potential correlations among teams at the same school. Results: A total of 399 practices or games were observed over 2 seasons. A greater proportion of coaches in the intervention group provided cues to correct improper technique compared to coaches in the control group [difference=0.04 (95% CI: 0.01, 0.07, p=0.006]. In addition, more coaches in the intervention group completed a full NMT program [OR=4.62 (1.22, 17.50), p=0.02]. There was a similar proportion of coaches in the intervention and control groups who provided exercise instructions [difference=0.01 (95% CI: -0.02, 0.04), p<0.44]. Conclusions: Coach education can improve adherence to NMT implementation recommendations and the delivery of corrective cues during NMT sessions, which are both critical to reducing the risk of ACL injury. All coaches should receive in-person training that highlights the salience of NMT and provides the knowledge and skills required to effectively implement NMT sessions with young athletes.
THE IMPACT OF SOCIAL MEDIA USE ON SLEEP QUALITY AND PERFORMANCE AMONG COLLEGIATE ATHLETES
Authors: Watkins Rhonda A. , Sugimoto Dai , Hunt Danielle L. , Oldham Jessie R. , Stracciolini Andrea 
Published: July 2021

Background: Social media (SM) use among young adults has increased significantly in recent years and has been linked to poor sleep quality. College athletes pose a unique risk for poor sleep given their many demands. Currently, limited research is available on the impact of SM use on sleep quality, or the competition performance of college athletes. Hypothesis: College athletes who use more SM will have worse sleep quality and worse competition performance. Methods: A cross-sectional study design was employed among local NCAA Division III athletes. Data was collected via a SM use form, lifestyle survey, and PROMIS sleep disturbance questionnaire. SM volume (hours of SM use per day over 7 days) was recorded using the iPhone screen time function. The main outcome measures were sleep quality, using the PROMIS T-score, and performance, collected through publicly available competition results. Participants were divided into 3 groups based on their SM volume; 1) moderate SM users (SM time ≤ 2hours/day), 2) active SM users (SM time < 2 - ≤5hours/day), and 3) super active SM users (SM time > 5hours/day). For sleep quality, an ANCOVA was used to identify differences in the 3 groups while controlling for covariates (i.e. injury status, caffeine use, number of roommates, academic load, catastrophic life event, life balance and sleep medication use) that might impact sleep and performance. For performance, a binary logistic regression model was used to determine the independent association between each variable and competition performance after adjusting for confounders. Results: 87 athletes (age:19.5±1.2 years, 40 males, 47 females) completed the survey. All males participated in track and field, while the females consisted of 37 track athletes and 10 swimmers. Controlling for the effect of lifestyle variables, a difference in sleep quality was identified among the three groups (p=0.025), (Table 1. A pairwise comparison indicated that the sleep quality of super active SM users was worse than moderate SM users (p=0.033) (Figure 1). For competition performance, an independent association was found between increased Facebook time and poor performance after adjusting confounders (aOR: 0.989, 95%CI: 0.978-0.999, p=0.038), (Table 2,3). Conclusion: High SM use appears to have a negative impact on sleep quality. Also, greater SM use may hinder competition performance among college athletes. These findings may have implications for developing SM use guidelines for college athletes to improve their sleep quality and performance. Tables/Figures: [Table: see text][Table: see text][Table: see text][Figure: see text]
THE UTILITY OF A MULTIDIRECTIONAL SUBMAXIMAL EXERTIONAL STEP AS PART OF AN EXERTIONAL REHABILITATION PROTOCOL AFTER CONCUSSION
Authors: Koschmeder Katelyn , Johnson Kyle , Marx Tyler , Minor Jon , Streeter Leslie , Pita Monica , Braden Gaige , Frino Libby , Peterson Erin , Handmaker Hirsch , Mortazavi Mo 
Published: July 2021

Background: This study aimed to identify whether a 5 Step Exertional Rehabilitation Protocol including a submaximal multi-directional stage (Step 5) has clinical utility for functional activity and sport clearance. Exertional Rehabilitation (EP) is a graded protocol of aerobic exercise ranging from light linear exertion (Step 1) to submaximal linear exertion (Step 4)1,2. In our 5 Step Protocol, Step 4 is followed by standardized multi-directional functional movements at high intensity intervals (Step 5) to rule out ongoing exertional intolerance. Hypothesis/Purpose: We aim to investigate if Step 5 testing demonstrates statistical evidence for its use in determining concussion recovery timelines and its diagnostic usefulness. Methods: This retrospective-chart review analyzed 60 Step 5 EP test attempts in post-concussion patients, ages 21 or younger, between Jun2019-Jun2020. Tolerance was determined by a concussion specialist who evaluated for the onset of signs/symptoms by surveying the patient throughout exercise and autonomic assessment with cardiac monitoring and pre/post orthostatic testing. Pre/Post exertion King-Devic (K-D) and vestibular testing on Force Plate were completed following Balance Error Scoring System positions. A positive change in K-D was defined as a ≥2 second delay in score on two of three reading cards from the pre-exertion testing. A positive change in vestibular testing was defined as a ≥0.2deg/sec change in the composite balance score from the pre-exertion testing. Results: The total number of failed Step 5 attempts was 21.7%. Of the failed attempts, 38.5% demonstrated dysautonomia, 92.35% had symptoms, and 30.8% demonstrated both dysautonomia and symptoms. Force Plate balance scores significantly worsened in failed attempts 15.4% of the time while passed attempts only 2.1% of the time. K-D scores did not show a statistically significant difference although failed attempts did have slightly worsened scores. Conclusion: Formal Step 5 testing is a useful diagnostic tool for understanding recovery stage, activity tolerance, and sport clearance. Autonomic, visual, and vestibular testing can be useful as objective markers of test tolerance. Tables/Figures: [Figure: see text][Figure: see text] Citations: 1) Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, Suffoletto HN, Leiter J, Cordingley DM, Willer B. Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2019 Apr 1;173(4):319-325. 2) Gagnon etal. Another look at active rehabilitation for slow-to-recover sport-related concussion in children and adolescents: further evidence to support its effectiveness. BJSM, 2013.
GENDER PREFERENCES OF YOUTH ATHLETES FOR THEIR SPORTS MEDICINE PROVIDERS: A SYSTEMATIC REVIEW
Authors: Chung Jane S. , Merkel Donna , Carter Cordelia W. , Kraus Emily , Rizzone Katherine 
Published: July 2021

Background: A multidisciplinary approach is an intrinsic part of the sports medicine management process as providers, therapists and athletic trainers frequently interact to deliver optimal care to athletes both in clinic and on the sideline. Establishing effective communication and engaging athletes in the decision making process as treatment plans are developed may help increase compliance and improve health outcomes. Gender preference of patients for their providers has been found to influence patient satisfaction and health outcomes but has not been studied in depth. Purpose: The purpose of this study was to systematically review the literature to identify and characterize young athletes’ gender preferences for their sports medicine providers. Methods: This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses Group (PRISMA) guidelines. Pubmed, Embase, CINAHL and PsycInfo databases were searched utilizing MeSH terms, with results limited to English-language publications from the year 1945 to present day. The investigators assessed study eligibility independently and limited to studies that had quantitative outcome measures related to gender preference and participants ≤ 22 years of age. The Appraisal Tool for Cross-Sectional Studies (AXIS) was utilized to assess studies for bias. Results: Six cross-sectional studies met the eligibility criteria. Across studies, there were a total of 2,159 participants with mean ages ranging from 14.7 to 21.0 years. Of the five studies that reported the gender of participants, 50.6% were female. Participants were more likely to have a preference for a gender-concordant sports medicine provider when their chief complaint was related to their genital region and/or their sexual health. Participants of both genders favored a female provider when the health issue pertained to behavioral and/or psychosocial health, such as depression. Female athletes preferred a female provider when the issue was related to body image and/or disordered eating. For strength and conditioning coaches, male athletes reported a strong preference for male providers, but female athletes did not express a gender preference. Two of the studies’ quality was categorized as “good” by the AXIS criteria and four were “fair”. Conclusions: Young athletes’ gender preference for their sports medicine providers is situation-dependent. However, there is a paucity of studies examining gender provider preferences in pediatric athletes. Further studies are necessary to address this void in the literature as this may impact health outcomes.
SPORT SPECIALIZATION, ATHLETIC IDENTITY, AND COPING STRATEGIES IN YOUNG ATHLETES
Authors: Christino Melissa A. , Coene Ryan P. , O’Neil Madeline , Daley Mary , Williams Kathryn A. , Ackerman Kathryn E. , Kramer Dennis E. , Stracciolini Andrea 
Published: July 2021

Background: Child and adolescent sports participation continues to rise, often with specialization in a single sport at an early age. Psychological associations with sport specialization have been reported, although targeted research is lacking. Hypothesis/Purpose: The purpose of this study was to examine associations between sport specialization, levels of athletic identity, and coping skills among adolescent athletes. Methods: A cross-sectional survey study of sports medicine patients, 12-18 years, was performed. Athletes completed a one-time, voluntary, anonymous survey. Surveys included demographics, sport participation information, Athletic Identity Measurement Scale (AIMS,10-item, range 7-70), Jayanthi Sport Specialization Scale (range 0-6), and Athletic Coping Skills Inventory (ACSI, 7 subscales, range 0-84). Statistical analysis included Fisher’s exact tests, t-tests, Pearson correlations, and linear regression. Results: 334 out of 430 eligible patients completed surveys, with a response rate of 78%. Mean age was 15.0±1.8 years and participants were 64.6% female. 97.7% of participants designated participation in a primary sport, where they spent most of their time. Athletes reported starting this primary sport at a mean age of 7.2±3.7 years. Using the Jayanthi scale, 52.1% of respondents were classified as low specialization (score 0-3) and 47.9% as highly specialized (score 4-6). Sport specialization patterns did not significantly differ by age, sex, or sport. AIMS and Jayanthi scores positively correlated (r=0.39, p<0.0001), and athletes with the highest athletic identities (top 25%) were significantly more specialized than those with the weakest (bottom 25%) athletic identities (4.1 vs 2.5, p<0.001). Regression analysis demonstrated that every 1 point increase in the Jayanthi specialization scale was associated with an AIMS score increase of 2.7 points (p<0.001). The AIMS score also increased 0.83 points for every one month increase in playing their primary sport (p<0.001), and decreased 0.42 points with each year delay in starting their primary sport (p=0.02). Highly specialized athletes had significantly higher overall coping skills scores compared to low specialization athletes (51.6 vs 48.4, p<0.02), particularly on ACSI subscales of Coachability, Concentration, Confidence & Achievement Motivation, and Goal Setting & Mental Preparation (Table 1), however highly specialized athletes reported less Freedom From Worry compared to those with less specialization (5.8 vs 6.7, p=0.02). Conclusion: Athletic identity was higher in athletes who were more specialized and started their primary sport earlier in life. Greater sport specialization may confer some advantages in developing coping strategies in young athletes, however these athletes may be at risk for more worry compared to less specialized athletes. [Table: see text]
BIOPSYCHOSOCIAL RISK FACTORS ASSOCIATED WITH SUBOPTIMAL OUTCOMES FOLLOWING ACLR IN THE PEDIATRIC ATHLETE
Authors: Stapleton Emily J. , Cerza Shelby , Wagner K. John , Ellis Henry B. , Wilson Philip L. , Gale Emily 
Published: July 2021

Background: Anterior cruciate ligament reconstruction (ACLR) is associated with acute postoperative pain, decreased function, and psychological distress. Studies examining risk factors in pediatric populations following ACLR are limited; however, pediatric studies have found low socioeconomic status and fear of re-injury associated with poor outcomes. Hypothesis/Purpose: This study aims to expand the understanding of biopsychosocial risk factors for postoperative outcomes in pediatric ACLR populations. Methods: A retrospective review of patients that underwent ACLR at a pediatric sports medicine clinic from 5/12/17-5/15/19 was performed. Patients were included in the retrospective chart review if they were between the ages of 12 to 18 years, completed the ACSI-28, PROMIS Global Health 7+2 (PGH-7+2), Pedi-IKDC, and HSS Pedi-FABS, and underwent arthroscopic ACLR for a primary ACL lesion. Medical records were reviewed for demographic, sport involvement, injury, and treatment data collected at initial, pre-operative, first post-operative, one-year post-operative, and final post-operative visits. Results: 107 patients (55F) with an average age of 15.69 years (range 12-18), meeting inclusion criteria were included in this review. Patients were cleared to return to sport (RTS) on average 350.23 days post-surgery. Both days between injury and surgery (109.65 days) and days between initial presentation and surgery (92.64 days) were found to be moderately correlated with RTS (r=0.478; p<0.001 and r=0.525; p<0.001, respectively). Between group comparisons were conducted comparing younger (<14yos) and older (≥14yos) patients. When looking at the PGH-7+2; the <14yos cohort reported significantly higher self-evaluation of health than the ≥14yos cohort (54.93 v 50.08; p=0.004). This younger cohort passed their functional test whereas older counterparts did not (n=13; 1 v 1.15; p=0.045). Patients who passed the functional test during their treatment course (i.e., through final follow-up) reported better pre-operative overall and physical health than those who ultimately failed (PGH-7+2Q1; 4.18 v 3.38, p=0.012; Q3; 4.03 v 3.15, p=0.002). Younger patients were more likely to pass the functional test (15.49 v 17.07 years, p=0.002). Lastly, a comparison between patients who did and did not reinjure their knee post-operatively was reviewed. Reinjured patients reported having increased levels of performance related worry pre-operatively (ACSI-28, FFW; 5.22 v 7.36, p=0.034). Conclusion: These findings suggest older athletes (≥14yos), those with lower perceived overall and physical health ratings, with performance related worry, and/or longer time between injury or initial presentation and surgery will need more pre-, peri-, and post-operative support and resources for optimal outcomes.