bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of Tanner Stage and Hypermobility with Meniscal and Articular Cartilage Injury in the Pluto Cohort
Authors: Matava MJ , Gibian J , Hutchinson LE , Miller PE ,   PLUTO Study Group, Kocher MS 
Published: May 2022

Background: ACL injuries in adults are frequently accompanied by meniscal and articular cartilage damage. However, little is known regarding the correlation of Tanner stage and hypermobility in ACL-deficient skeletally immature patients and the risk of these associated injuries. Hypothesis/Purpose: The relationship between hypermobility and meniscal and/or articular cartilage injury varies by stage of pubertal development. Patients with hypermobility will have a lower risk of meniscal and articular cartilage injury than patients with normal laxity. Methods: At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Beighton score was collected at the preoperative physical exam; bone age was determined from a hand/wrist radiograph; and the presence of meniscal tears and articular cartilage injuries was collected from the surgical assessment. Tanner stage was documented at time of surgery. Univariable and multivariable logistic regression analysis was used to assess the effect of Tanner stage and Beighton score on the likelihood of cartilage injury and meniscal tear. Results: Seven hundred forty-seven skeletally immature patients with complete ACL tears were analyzed with an average age at surgery of 12.3 years; the cohort was 62% male. Eighty-five patients had documented cartilage injuries for an event rate of 11.4%. Bivariate analysis found that those with cartilage injuries had a slightly higher bone age (13.9 versus 13.1 years; p=0.001) and a higher Tanner stage (p=0.009). For each additional Tanner stage, the odds of cartilage injury increased by approximately 1.6 (p<0.001). No association was detected between hypermobility and the likelihood of a cartilage injury. Four hundred twenty-three patients had documented meniscal tears for an event rate of 56.6%. Bivariate analysis found that those with meniscal tears were slightly older (12.6 versus 12.0 years; p<0.001), had a slightly higher bone age (13.5 versus 12.8 years; p<0.001) and a higher Tanner stage (p=0.002). For each additional Tanner stage, the odds of a meniscal tear increased by approximately 1.3 times (p<0.001). No association was detected between hypermobility and the likelihood of a meniscal tear. Conclusion: There is a high rate of concomitant articular cartilage and meniscal injuries in skeletally immature patients who sustain ACL tears. The risk of concurrent injury is associated with increasing bone age and Tanner score. There was no association between these concurrent injuries and hypermobility. [Figure: see text][Figure: see text]
Physician Preferences on Surgical Technique and Graft Type for Anterior Cruciate Ligament (ACL) Reconstructions for Pediatric Patients with ACL Injuries
Authors: Nice Emily , Uquillas Carlos , Heidel Eric ,   Shriners Sports Medicine Consortium, Corinna C Franklin, MD
Published: May 2022

Introduction: The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Most surgeons elect to reconstruct the ACL in young, active patients to facilitate the resumption of sports and restore stability to the knee. Surgical technique and graft type preferences depend on the surgeon and skeletal maturity of the patient, but there is no clear standard based on age. Hypothesis/Purpose: This study aims to evaluate physicians’ preferences for choosing a surgical plan for pediatric and adolescent patients with an ACL injury. Methods: A voluntary survey link was sent to members of Pediatric Research in Sports Medicine (PRiSM). Consent was obtained by the participants taking part in the survey. Results: Forty-five (n=45) physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty completed pediatric orthopaedic fellowships, six completed sports medicine fellowships, and nineteen completed both pediatric orthopaedic and sports medicine fellowships. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. The majority prefer the over the top technique for 8 to 10-year-old males over the all epiphyseal, partial transphyseal, and transphyseal techniques. The technique preference is split for 11, 12, and 13-year-old males. Twenty-five respondents prefer the partial transphyseal technique for 14-year-old male patients. A majority (n=42, n=43) prefer the transphyseal technique for 16 year old males and skeletally mature males. The technique preferences for female patients 9 years or less is the over the top technique. The technique preference is split for 10, 11, 12, and 13-year-old females. The majority (n=37, n=44, n=44) prefer the transphyseal technique for 14-year-old, 16-year-old, and skeletally mature female patients. The graft preference for males 11 years old or younger is the iliotibial band (ITB). The graft preference for males 12-year-old and older was split among the hamstring, ITB, bone-tendon-bone (BTB) and quadriceps grafts. When looking at the preferred graft for female patients, a majority prefer ITB for patients 10-years-old and younger. The participants’ graft preferences for female patients 11-years-old and older is split. Conclusion: Results of this survey suggest that graft type and surgical technique preferences for pediatric and adolescent patients with ACL tears change based on the patient’s age, with more agreement among surgeons at the extremes of patient ages. Further research is needed to track the impact of each surgical technique and graft choice on pediatric and adolescent patients. [Table: see text]
Rates of Infection After Pediatric ACL Reconstruction: A Marketscan Database Study of 44,501 Patients
Authors: Block Andrew M. , Eisenberg Matthew , Vopat Matt , Nepple Jeffrey J. 
Published: May 2022

Introduction: Anterior cruciate ligament reconstruction (ACL-R) is increasingly performed in pediatric patients. Infection after ACL-R is among the most serious complications. The use of administrative data has been validated for the assessment of infection after ACL reconstruction. While infection after ACL-R has been well investigated in adults, the literature is limited for ACL reconstruction in pediatric patients. Purpose: Describe and analyze the rates of infection after ACL-R among pediatric patients, compared to young adult patients, utilizing the MarketScan database. Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals aged 5-30 years old. ACL-R records performed between 2006 and 2018 were obtained using Current Procedures Terminology (CPT) and International Classification of Diseases Ninth Revision (ICD-9) and Tenth (ICD-10) codes. The presence of postoperative infection requiring reoperation was assessed utilizing previously published algorithms. All patients had at least 180 days of insurance coverage after intervention. Results: The ACL-R cohort included 44,501 individuals under 18 years old and 53,915 individuals aged 18-30 years old. The rate of infection after ACL-R in patients under 18 years of age was 0.52%, and was similar to patients 18-30 years old (0.47%, p=0.213). Among patients <18 years old, patients <15 years old had a significantly lower rate of infection at 0.37% compared to adolescents (15.0-17.9 years old) at 0.55% (p=0.039). For those less than 18 years old, males were significantly more likely to have an infection after ACL-R (0.73%) compared to females (0.53%, p=0.008). Discussion: Utilizing an insurance database, this study demonstrated that rates of infection after an ACL-R are relatively low (0.52%) and are similar to rates in young adults, despite the differences in graft utilization. Both age less than 15 and female sex were associated slightly lower rates of infections in pediatric patients. [Figure: see text]
Findings from the Prism Concussion Rig: Does the 5P Risk Score Predict Persistent Postconcussive Symptoms in a Multi-Center Sample of Youth Athletes?
Authors: Miller Shane M. , Zaslow Tracy L. , Wilson Julie C. , Master Christina L. , McLeod Tamara C. Valovich , Snedden Traci R. , Halstead Mark E. , Grady Matthew F. , Fazekas Matthew L. , Santana Jonathan A. , Howell David R. ,   the PRiSM Concussion Research Interest Group
Published: May 2022

Background: Persistent postconcussive symptoms (PPCS) can negatively impact quality of life, school, and return to sport. The Predicting and Preventing Postconcussive Problems in Pediatrics [5P] clinical risk score has been validated in the Emergency Department setting to predict pediatric patients at risk of PPCS using 9 variables. Hypothesis/Purpose: To determine if the 5P risk score, obtained within 14 days of concussion, predicts which athletes seen in an athletic training or pediatric sports medicine clinic setting develop PPCS in a multi-center sample. Methods: Data were prospectively collected from participants enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study between September 2018-May 2021 across seven sites. Participants aged 6-18 years diagnosed with a concussion who presented within 14 days of injury were included. Demographics, medical history, and the Postconcussion Symptom Inventory (PCSI) were reviewed to calculate the 5P risk score. 5P risk scores were stratified as low (0-3 points), medium (4-8 points), and high risk (9-12 points). Participants were grouped based on symptom resolution time: PPCS (≥28 days) and no PPCS (<28 days). We compared total symptom resolution time among the 5P risk categories using one-way ANOVA and assessed the odds of developing PPCS based on 5P risk score using a binary logistic regression model. Results: We included 117 participants: 23 with PPCS (19.7%). A higher proportion of the PPCS group were female, were seen in a sports medicine clinic setting, and had a longer time to initial presentation (Table 1). Both PCSI symptom severity and 5P risk score were significantly higher in the PPCS group compared to the no PPCS group (p<0.001). Participants with high risk 5P scores had a significantly longer mean symptom resolution time compared to those with low risk scores (Figure 1; 28.4±18.2 vs 7.1±6.8 days, p=0.009). After adjusting for potential confounding variables of initial symptom severity, time to presentation, and assessment setting, each point increase on the 5P risk score was associated with a 1.7x odds of developing PPCS (odds ratio=1.66; 95% CI=1.13, 2.41; p=0.009). Conclusion: In a multi-center sample of youth athletes, the 5P risk score accurately predicted which athletes were at risk for developing PPCS. The odds of developing PPCS increases with each point increase on the risk score. The 5P risk score can help clinicians identify which athletes are likely to develop PPCS, which may aid in educating families on expectations of recovery and/or provide opportunities for targeted intervention to facilitate sooner recovery. [Table: see text][Figure: see text]
Direct Costs of Care for Adolescent Patients with and Without Persisting Concussion Symptoms in United States Secondary Schools: A Report from the Athletic Training Practice-Based Research Network
Authors: Weber Rawlins Michelle L. , Marshall Ashley N. , Lam Kenneth C. , Valovich McLeod Tamara C. 
Published: May 2022

Background: Concussions present significant public health concerns and associated medical costs, especially for those with persisting concussion symptoms. Purpose: To compare direct costs of care for adolescent patients managed within the secondary school setting with and without persisting concussion symptoms. Methods: Our study was a retrospective analysis of medical records using the Athletic Training Practice-Based Research Network which included records from 59 secondary schools in the United States. Participants included 282 adolescent patients following a concussion (male=199, female=83, age=15.5 years, 95% CI:15.3, 15.6). Complete patient cases were identified using International Classification of Diseases and Related Health Problems diagnostic codes for concussion between 2010-2017. We calculated summary statistics for common services and direct costs of care, calculated based on reimbursement rates for Current Procedural Terminology codes. Patients were grouped as with (symptoms experienced 28 days; n=38) and without (symptoms experienced <28 days; n=238) persisting concussion-related symptoms. A Mann-Whitney U test was used to determine if direct cost of care differed between groups (n=276, α=0.05). We used a linear regression to determine cost for each additional day of care. Results: The most common service was an athletic trainer re-evaluation (n=1012/1560, 64.9%). The average total direct costs of care was US $286.30 per adolescent patient (95% CI: US $260.14-312.45). Significantly higher direct costs of care were reported for patients with persisting symptoms ( p<0.001; persisting: median=US $471.07, IQR=US $281.21-564.93, 95% CI: US $367.05-528.11; without persisting: median=US $210.95; IQR=US $117.45-337.52, 95% CI: US $234.28-286.82). The concussion base price was US $174.42 (95%CI: US $129.75-219.10) and each additional day cost US $5.99 (95% CI: $3.99-7.99). Conclusions: Our findings provide insight to potential costs associated with adolescent patients who are managed within the secondary school setting following a concussion. These results highlight the potential economic value of sports medicine professionals within the school setting. Other health care professionals not in the school setting may advise patients to first be evaluated and managed by the site athletic trainer if able and in accordance with state law, prior to an office visit to also reduce care costs as many athletic trainers do not charge for their services. Future research should examine how to decrease the economic burden for patients.
POST-CONCUSSION DIZZINESS SEVERITY PREDICTS DAILY STEP COUNT DURING RECOVERY AMONG ADOLESCENT ATHLETES
Authors: Smulligan Katherine L. , Seehusen Corrine N. , Wingerson Mathew J. , Wilson Julie C. , Howell David. R 
Published: May 2022

Background: Physical activity after concussion is an important aspect of appropriate management and may help to improve recovery time. However, symptom burden or functional deficits may be self-limiting and reduce activity level in the first weeks following a concussion. Purpose/Hypothesis: To examine dizziness and postural stability as potential predictors of physical activity level after concussion. We hypothesized that increased dizziness severity and more postural instability would predict lower step count acutely post-concussion. Methods: We initially evaluated athletes ages 12-18 years within 14 days of concussion using questionnaires and clinical tests to assess overall symptom burden, dizziness, and postural stability. Athletes were provided with an activity monitor that tracked daily step count for the subsequent two weeks after their initial care visit. Our primary outcome variable was daily step count (mean steps/day) during this two-week period. Potential predictor variables included participant characteristics (sex, age, time since injury, and history of: concussion, musculoskeletal injury, migraine, ADD, anxiety, depression), Post-Concussion Symptom Inventory (PCSI) total symptom burden, specific PCSI ratings of dizziness and balance impairment, and postural stability assessments [single and dual-task tandem gait (TG) and modified balance error scoring system (mBESS)]. To examine clinical predictors of activity we calculated Pearson correlation coefficients between mean steps/day and each potential predictor, and then included significantly correlated variables in a multiple linear regression model. Results: Athletes who participated in the study (n=35, mean 15.2±1.7 years of age, 49% female, mean steps/day=9195±3779) were initially evaluated a mean of 7.3±3.0 days post-concussion. PCSI dizziness rating (Pearson R=-0.49, p=0.003; Figure 1) and sex (mean difference=2449 steps/day, p=0.05) were associated with daily step count upon univariable evaluation and included in the multiple linear regression model. No other participant characteristics, symptom ratings, or objective balance or postural stability measures were significantly associated with steps/day (Table 1). In the multivariable model, PCSI dizziness rating (β=-1035; 95% CI: -191, -1880; p=0.018), but not sex, predicted average steps/day in the two weeks after initial clinical care visits. Conclusion: Self-reported dizziness severity assessed within 14 days of concussion predicted daily step count in the subsequent two weeks, while other measures of overall symptom severity and postural stability did not. Given the importance of physical activity for concussion recovery, identifying individuals with acute post-concussion dizziness may facilitate timely treatment of dizziness, potentially reducing a barrier to physical activity to improve recovery trajectories. [Figure: see text][Table: see text]
Managing Concussion Patients Via Telehealth Services Compared to In-Person Clinic Visits
Authors: Price August M. , Knell Gregory , Jones Carrie , Caze Todd J. , Abt John P. , Burkhart Scott O. 
Published: May 2022

Background: Sports medicine is increasingly relying on telehealth to provide patients with better access to care, timelier visits, and reduced cost. Telehealth technology is a growing modality that needs more research to demonstrate its utility in the clinical management of concussion. Hypothesis/Purpose: The purpose of this study was to compare the total number of visits, days since injury, and recovery time of pediatric concussion patients evaluated via telehealth versus those in-person. We hypothesized that telehealth patients would have fewer total visits, fewer days since injury, and shorter recovery times compared to in-person patients. Methods: Retrospective data from 2019-2021 were abstracted from the medical record for patients aged 4-18 years who were referred to a specialty pediatric concussion clinic. Demographic data included age, sex, and race/ethnicity. Concussion injury and treatment data were examined based on total number of visits, time since injury (days), and recovery time (days). Descriptive statistics were reported as proportions (counts), means (± standard deviations [SD]), and medians (interquartile range [IQR]), as appropriate. The difference between telehealth and in-person treatment data was tested using independent-samples median tests with a significance level set at 0.05. Results: A total of 381 patients were included in the study, 21.5% (82) were managed via telehealth services and 78.5% (299) were seen in-person. Of the telehealth patients, 40.2% (33) were males, 54.9% (45) were non-Hispanic white, and the mean age was 13.95 (±2.99) years. For in-person patients, 52.5% (157) were male, 56.2% (168) were non-Hispanic white, and the mean age was 14.75 (±2.05) years. Telehealth patients were seen a median 4.0 (IQR=2.0-6.0) days since injury and in-person patients were seen a median 3.0 (IQR=2.0-5.0) days since injury ( P =0.98). Telehealth patients’ median total visits was 2.0 (IQR=1.0-2.0), while in-person patients was 2.0 (IQR=2.0-3.0) ( P=0.36). Telehealth patients recovered a median 15.0 (IQR=9.0-22.3) days and in-person patients recovered a median of 16.0 (IQR=11-24) days ( P =0.58). Conclusion: In this preliminary study, telehealth and in-person patients did not differ based on concussion treatment and recovery. These findings demonstrate the potential equivalence of pediatric concussion telehealth and in-person treatments; however, future research should examine differences in treatment costs and treatment access (e.g., distance to clinic, insurance types, etc.), while also considering the potential influence of concussion severity on the likelihood to utilize telehealth versus in-person treatment.
Novel Mri Classification for Osteochondritis Dissecans of the Knee: A Validation Study
Authors: Feroe Aliya G. , Flaugh Rachel A. , Baxter Tara A. , Majumdar Aditi S. , Miller Patricia E. , Kocher Mininder S. 
Published: May 2022

Background: A simpler three-category magnetic resonance imaging (MRI) classification system for osteochondritis dissecans (OCD) of the knee was recently shown to have comparable reliability to the existing five-category Hefti system. The validity and clinical utility of this simpler system as an alternative to the Hefti system has yet to be established. Hypothesis/Purpose: The purpose of this study was to assess whether a novel, simpler three-category MRI classification system for OCD of the knee demonstrates equal or better validity and correlates more strongly with treatment than the five-category Hefti classification. Methods: Demographic data and arthroscopic findings were collected from the medical and surgical records of 144 knees of children and adolescents with arthroscopically diagnosed knee OCD. MRI assessment of OCD lesions was conducted by two independent raters. Inter-rater reliability for novel and Hefti classifications was assessed by estimating weighted kappa ( kw). Agreement between MRI classification and arthroscopic findings was assessed by estimating kw coefficients. Classifications were dichotomized into 1,2 versus 3 for the novel system, and the sensitivity and specificity of classification was estimated as compared to arthroscopic findings. Correlation between arthroscopic classification and treatment type was assessed by estimating Spearman’s coefficient. Results: There was substantial interrater agreement with the proposed system’s ratings on MRI ( kw=0.66; 955 CI=0.56-0.75) and moderate agreement for Hefti system’s ratings on MRI ( kw=0.57; 955 CI=0.47-0.67) (Table 1). There was no difference detected in the agreement statistics for the proposed versus Hefti classifications (p=0.89). Binary agreement of the novel classification using dichotomous categories was slightly worse than the three-category classification. When 1&2s were combined, the agreement was moderate with k=0.41 (95% CI=0.25-0.58) and when 2&3s were combined, the agreement was fair with k=0.34 (95% CI=0.21-0.48). There was strong correlation between novel classification on arthroscopy with treatment type ( r=0.85; 95% CI = 0.80-0.89) and between Hefti classification and treatment type ( r=0.82; 95% CI = 0.75-0.86) (Table 2). Conclusion: The validity and clinical utility of the proposed three-category MRI classification system for knee OCD is comparable to that of the five-category Hefti system. This simpler classification system provides a foundation for the subsequent establishment of an operative treatment algorithm for knee OCD. [Table: see text][Table: see text]