bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphologic Risk Factor for ACL Rupture in Children Younger than Age 12: An Mri-Based Comparison
Authors: Fogleman Sarah A. , Carroll Alyssa N. , Edmonds Eric W. 
Published: May 2022

Background: There are findings in the adult and adolescent literature regarding anatomic variation that may lead to traumatic disruption of the anterior cruciate ligament (ACL). Previous studies have found an interaction between age and various morphologic risk factors but have been underpowered in assessing younger pediatric patients. Hypothesis/Purpose: The purpose of this study was to evaluate morphologic features of the knee in younger children to determine if any of these factors may contribute to risk of ACL injury in this age group. Methods: A retrospective review of knee MRIs was performed on pediatric patients evaluated at our facility for confirmed ACL rupture. Seven measures were performed and three ratios were calculated, which were compared to an age-matched control cohort previously used to establish and publish normative data of childhood knee MRIs. They were then grouped for statistical purposes by age: “child” aged 5 – 11 years, and “adolescents” aged 12 – 19 years. A generalized linear model was used to assess interaction between age and ACL status. Results: A total of 49 children age <12 years with ACL rupture were identified during the data collection period that met criteria for review. While intercondylar width and notch height index (NHI) were significant in the ACL-torn cohort at large (p=0.015 and p=0.001 respectively), this difference was not present in children. Conversely, tibial plateau to anterior tibial spine (ATS) height was different in ACL-torn children but not in adolescents (p=0.003). Notch Width Index (NWI) was significantly smaller in ACL torn children and adolescents (p<0.0001). When comparing age groups, NWI was the only variable that had minimal to no difference in the normal group, but a significant difference between children and adolescents in the ACL-torn group. No difference was found in Critical Notch Stenosis. Conclusion: Children and adolescents demonstrate the effect of multiple morphologic parameters on ACL tear risk. While there is overlap, there are risk factors specific to each age group. Uniquely, increased TP to ATS height was a risk factor for ACL tear in children. Despite the effect of age and ACL tear on NWI, there was no difference for Critical Notch Stenosis, suggesting that the current definition of critical notch stenosis should be adjusted. Given the difference between NWI in children and adolescents with ACL tear, it may be more appropriate to have age-based cutoffs for critical notch stenosis.
Factors Associated with Stiffness Following Pediatric and Adolescent ACL Reconstruction: Early Results from Score: A Multi-Center Quality Improvement Registry
Authors: Cooper Savannah , Adsit Lizzie R. , Schmitz Matthew , Ganley Theodore , Ellington Matthew , Rhodes Jason , Frank Jeremy , Mansour Alfred , Saper Michael , Parikh Shital , Mayer Stephanie , Wilson Philip , Shea Kevin , Ellis Henry B. ,   the SCORE group
Published: May 2022

Background: Anterior Cruciate Ligament reconstruction (ACLr) is commonly performed in pediatric and adolescent patients. The most common early complication associated with ACLr is stiffness, including motion loss and arthrofibrosis. There is minimal literature regarding risk factors for stiffness following ACLr in this age group. Hypothesis/Purpose: To evaluate the incidence and risk factors associated with stiffness following ACLr using a multi-center quality improvement registry. Methods: A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of ACLr was reviewed. Audit processes using CPT codes were designed to insure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Stiffness was defined as motion loss that prompted any deviation from the normal post-operative course (Clavien Dindo grade II or greater), including additional clinical or physical therapy (PT) visits, serial/dynamic splinting, or secondary surgery for stiffness (Clavien Dindo grade III). Each case of stiffness and associated complication form was secondarily reviewed to insure consistency of identification and grading. Demographic and peri-operative data were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons. Results: 2,839 ACLr cases (mean age 15.1, 6-19; female 46.9%) were identified, with stiffness reported in 4.2% of patients (including isolated flexion or extension and combined stiffness) and secondary surgery for stiffness (manipulation under anesthesia and/or lysis of adhesions) performed in 1.1% of patients. Loss of extension occurred in 3.8% of patients (59.3% females), while loss of flexion occurred in 3.1% of patients (49.4% females). Overall stiffness occurred with longer tourniquet times (93.0 min vs. 78.8 min, p<0.001) when used. Anterior displacement of medial or lateral meniscus tear were associated with nearly twice the incidence of extension loss (7.1%) and three times the incidence of surgery for stiffness (3.7%). Conclusion: Post-operative stiffness following ACLr is rare but may be associated with certain demographic and perioperative factors, such as female sex, prolonged tourniquet time, and certain concomitant injuries such as anteriorly displaced meniscus tears. The degree to which altered practices and/or additional monitoring/vigilance in the setting of such factors warrants additional study.
Biomechanical Analysis of Tibial Motion and ACL Graft Forces After ACLR with and without let at Varying Tibial Slopes
Authors: Pearce Stephanie S. , Bryniarski Anna R. , Gruskay Jordan A. , Brady Alex , Brown Justin R. , Vidal Armando F. , Godin Jonathan A. 
Published: May 2022

Background: Lateral extra-articular tenodesis (LET) is being performed with increasing frequency in the setting of anterior cruciate ligament reconstruction (ACLR) as a way to decrease rotational instability and graft failure rates, especially in young, active patients. The degree of posterior tibial slope has been shown to affect ACL graft failure rates.1 The effect of LET plus ACLRs on tibial motion and graft forces in the setting of varying tibial slopes has not been elucidated. Hypothesis/Purpose: LET will decrease tibial translation, tibial rotation, and ACL graft forces compared to ACLR alone with increasing tibial slope throughout knee range of motion. Methods: Twelve cadaveric knees (40.5 mean age, all female) were tested in 4 conditions (1: intact; 2: ACLR; 3: ACLR + LET; and 4: ACL cut) with varying posterior tibial slopes (5°, 10°, 15°, and 20°) at three flexion angles (0°, 30, ° and 60°). Specimens were mounted to a load frame which applied a 500-N axial load with 1 N-M of internal rotation torque (Figure 1). The amount of tibial translation was measured using a laser sensor and rotation was measured along the axis of the load frame. ACL graft forces were measured via a force transducer. Results: No clinically relevant difference was found in graft force (all differences <6.8 N, except the 5° posterior tibial slope at 30° of flexion showing a 12.1 N reduction with LET), anterior tibial translation (all differences <2.4 mm), or internal rotation (all differences < 1.59°). Compared to the intact state, the cut ACL state had higher anterior tibial translation (maximum increase +9.1 mm at slope 20°, Flexion 60°) and internal rotation (maximum increase +4.3° at slope 5°, flexion 30°). Higher ACL graft forces were observed with increasing posterior tibial slope (ACLR graft force at 0° of flexion was 81.6 N at 5°, 97.8 N at 10°, 107.0 N at 15°, 113.9 N at 20° of slope). Figure 2 shows ACL graft forces in N, Figure 3 shows anterior tibial translation in mm and Figure 4 shows internal rotation in degrees. All figures present data at 30°of flexion. Conclusion: No clinically relevant difference was shown with the addition of LET in the setting of ACLR for patients with posterior tibial slopes from 5° to 20° at flexion angles of 0°, 30°, and 60° in regards to graft force, anterior tibial translation, and internal tibial rotation under a 500 N compressive load. [Figure: see text][Figure: see text][Figure: see text][Figure: see text] Reference: 1. Bernhardson AS, Aman ZS, Dornan GJ, et al. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019;47(2):296-302. doi:10.1177/0363546518820302
Sagittal Plane Mobility in Adolsents with Femoroacetabular Impingment
Authors: Johnson Benjamin L. , Cooper Savannah , Wilson Philip L. , Morris William , Ellis Henry B. 
Published: May 2022

Background: Femoroacetabular impingement (FAI) is a dynamic degradative condition of the hip joint characterized by classic physical exam findings in combination with abnormal radiographs and/or MRI. Although this abnormal morphologic relationship contributes to FAI, the role of physical therapy to mitigate symptoms by improving strength and mobility of the hip remains the first line treatment. Despite this common treatment algorithm, limited knowledge exists on the effects of sagittal balance, lumbopelvic mobility, and its role in the development of treatment for symptomatic FAI. Hypothesis/Purpose: To review lumbopelvic mobility from standing to sitting position in adolescent athletes who present with clinical signs of FAI. Methods: Pelvic radiographic measurements in the sagittal plane were performed on a retrospective series of consecutive patients who presented with clinical diagnosis of FAI at a pediatric sports medicine institution from April 2019-March 2021. Standardized EOS dynamic lateral pelvic images were performed in standing and sitting positions to evaluate the differences in sacral slope, pelvic tilt, and pelvic incidence. Data from bi-positional radiographs were combined with standard measurements for FAI obtained on AP pelvis (lateral center edge angle, acetabular inclination) and 45 degree Dunn views (alpha angle), and patient reported outcomes (PROs) (mHHS, HOOS, UCLA). Differences in sacral slope from pre-treatment radiographs were used to determine comparison groups: those with a change vs. those with limited change between a sitting and standing position. Results: 76 adolescent patients (mean age 15.7 years [12-24]; 71.5% females) with sitting/standing lateral pelvis radiographs and a clinical diagnosis of FAI were identified. Between sitting and standing positions, there was no change in pelvic incidence, while significant differences were noted in sacral slopes and pelvic tilt (Table 1). Variability in sacral slope differences between sitting and standing were identified with 10 (13.9%) patients having minimal (<10o) change, while 8 (11.1%) demonstrated changes > 40o (Figure 1). Adolescent patients with FAI who demonstrated more mobility from sitting to standing position had a higher sacral slope in the standing position. No correlations were noted between pelvic incidence or sacral slope and radiographic measures associated with FAI, PROs or differences in those with variable changes in sacral slope from sitting to standing position. Conclusion: Lateral pelvic imaging may be an important tool for understanding dynamic hip impingement. In adolescent patients signs and symptoms with clinical FAI, significant variability exists in lumbopelvic mechanics, regardless of the severity of radiographic values. [Table: see text][Figure: see text]
The Efficacy of a Mental Skills Training Course for Collegiate Athletes
Authors: Griffith Kelsey L. , O’Brien Kimberly H.M. , McGurty Shannon , Miller Patricia E. , Hutchinson Lauren E. , Christino Melissa A. 
Published: May 2022

Background: Psychological skills training has been shown to improve performance in athletes. However, few studies have looked at the efficacy of mental skills training programs in young athletes. Hypothesis/Purpose: The purpose of this study was to evaluate satisfaction of collegiate athletes with a 6-session mental skills course, and to assess changes in mental toughness and coping skills before and after the course. Methods: We conducted a 6-session mental skills training program with Division I female collegiate athletes during the fall of 2020. Athletes completed pre-course, post-course, and 4-month questionnaires to assess efficacy of the course, as well as their satisfaction. Due to the COVID-19 pandemic, none of the athletes were actively competing at the time of the course or during follow-up surveys. Demographic information was collected and the Athletic Coping Skills Inventory (ACSI, range=0-84) and Mental Toughness Inventory (MTI, range=8-56) were used to assess coping skills and mental toughness at all time points. Satisfaction was assessed on a ten-point scale, with 10 being most satisfied. Results: Fifty-four Division I female athletes participated in the program. Mean age was 19.8 years, 61% reported training in their sport for 8 or more months a year, 26% reported history of mental health conditions, and 22% reported being injured or recovering from injury at the time of participation. For participants with paired pre- and post-course data (n=37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI=1.1-4.1; p=0.001) and ASCI scores improved by a mean 4.0 points (95% CI=0.6-7.4; p=0.02) from pre- to post-course. For participants with paired data for pre-course and four-month follow-up (n=25, 46.2%), no change was detected in mean MTI score (p=0.72). There was, however, a mean increase of 3.4 points in mean ASCI from pre-course to four-month follow-up (95% CI=0.4-6.4; p=0.03). Overall satisfaction had a median score of 9/10 at the post-course assessment, and eighteen participants (18/37, 48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Conclusion: Following a 6-session mental skills course in collegiate female athletes, mental toughness and coping skills scores significantly improved at post-course assessment. Athletes reported being highly satisfied with the content of the course and reported overall positive experiences. [Figure: see text]
Inter & Intra Tester Reliability of Motion Capture of Six Sports Task used for Return-to-Sport Testing
Authors: Chafetz Ross S , Warshauer Spencer , Ulman Sophia , Tulchin-Francis Kirsten , Paula Tatiana N ,   Shriners Sport Consortium, Franklin Corinna 
Published: May 2022

Background: Motion capture has become increasingly recognized as an important evaluation tool for guiding rehabilitation planning and in determining when it is safe to return to sport. To ensure motion capture utility in sports evaluations, it is important to establish training protocols across test centers. Hypothesis/Purpose: The purpose of this study was to evaluate the inter and intra tester reliability of return-to-sport testing using motion capture at three different motion analysis centers. Methods: A single tester and athlete traveled to three different motion analysis centers. On the first day, the first tester demonstrated marker placement and the execution of the six sports related tasks. The second tester completed the same protocol the same afternoon. On the following day, both testers repeated the process on the same athlete. The six tasks included the drop vertical jump (DVJ), deceleration, heel touch, lateral shuffle, 45° cut, and single leg hop. Kinematic data included trunk flexion/lean, pelvic obliquity, hip flexion/rotation/adduction, and knee valgus/flexion. Additionally, kinetics were analyzed for knee valgus moments. For each testing day, the mean, median, standard deviation, and range were calculated. To compare between days, differences between means and paired t-tests were calculated ( α=0.05). Results: Looking at inter tester reliability kinematics and kinetics, of the 48 calculated mean differences only two variables were statistically significant – DVJ moment (mean difference 0.22 Nm/kg, p=0.008) and lateral shuffle trunk flexion (mean difference 4.8 degrees, p=0.004). Looking at only the kinematic data, 95% (41/43) of the variables had mean differences that were four degrees or less. For intra tester reliability, of the 48 calculated mean differences three variables were statistically significant – DVJ knee flexion (mean difference 4.65 degrees, p=.041), DVJ trunk flexion (mean difference -3.7 degrees, p=0.03) and deceleration hip flexion (mean difference -5.71 degrees, p=0.034). Looking at only the kinematic data, all mean differences were less than 6 degrees, and 86% (37/43) were less than four degrees. Conclusion: This study demonstrates that after one training session, motion capture sports testing was remarkably consistent within and between testers at three different motion analysis centers. This strengthens the case that sports evaluations using motion capture is reproducible and can be replicated at novel centers with trained motion analysis personnel. To confirm inter and intra tester reliability, future studies should expand to more centers, additional testers, and athletes. [Table: see text]
Changing Trends in Treatment of Meniscal Tears in the Setting of Concomitant ACL Tear in Pediatric and Adolescent Patients: A Marketscan Insurance Database Study
Authors: Block Andrew M. , Eisenberg Matthew , Vopat Matt , Nepple Jeffrey 
Published: May 2022

Introduction: Meniscal tears are commonly present in patients undergoing anterior cruciate ligament (ACL) reconstruction. Decision-making between meniscus repair and partial meniscectomy involves a number of factors from tear pattern to surgeon expertise and available technology. While meniscal and ACL tears in pediatric and adolescent patients are rising in incidence, changes in treatment of meniscus tears in the setting of ACL reconstruction have not been previously demonstrated. Purpose: To describe the trends of meniscal repair or meniscectomy in the setting of an ACL reconstruction among pediatric and adolescent patients utilizing the MarketScan Database from 2006 to 2018. Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals younger than 18 years old. ACL reconstruction 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. Inclusion criteria included at least 180 days of insurance coverage after intervention. Relative rates of MY and MR were compared by year in the mid-2000s (2006-2007) were compared to the late 2010s (2017-18) and were sub-stratified by age and estimated skeletal maturity. Results: A total of 44,501 patient under 18 years of age undergoing ACL reconstruction were identified. Meniscal tears were present in 57.0% of patients and treated with partial meniscectomy in 30.3% (n=13,482) and meniscal repair in 26.7% (n=11,884). Prevalence of meniscal injury in setting of ACL-R increased significantly with age, with a 19% increase from <12 years old (40.4%) to 17 years old (59.4%, p <0.001). Over the 12-year time period, rates of meniscal tears treated at time of ACL-R was relatively constant (ranging from 56.5-60.4%) (Figure 1). However, the rates of meniscal repair increased significantly (Δ=21.2%, from 37.1% to 58.3%) as the rates of partial meniscectomy decreased (62.9% to 41.7%, p < 0.001) (Figure 2). Even with this increase in the number of repairs, there was no increase in overall rates of reoperation (4.2% v. 2.5%), including lysis of adhesions or subsequent meniscal procedures (meniscectomy, meniscal repair) over the time period analyzed. Conclusion: The current study demonstrates that at the time of ACL-R, meniscal pathology is common in pediatric patients. From 2006 to 2018, the rates of meniscal repair in the setting of ACL tears are steadily rising (32.8% to 51.8%) while partial meniscectomies are declining (67.2% to 48.2%), without an increase in early reoperation. [Figure: see text][Figure: see text]
Outcomes of Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients:2-Year Follow-Up
Authors: Perea Sofia Hidalgo , Cordasco Frank A. , Green Daniel W. 
Published: May 2022

Background: The quadriceps tendon (QUAD) autograft has recently become an alternative to the hamstring tendon autograft that demonstrates superior preliminary outcomes in pediatric anterior cruciate ligament reconstruction (ACLR). Purpose: To evaluate 2-year clinical and patient-reported functional outcomes of primary ACLR with soft tissue QUAD autograft in skeletally immature patients. Methods: Consecutive skeletally immature patients who underwent ACLR with QUAD autograft were included. All cases utilized full thickness soft tissue QUAD autograft without a bone plug and were performed on patients with open growth plates. Preoperative demographic and surgical data were collected ( Table 1 ). The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal (AE) and complete transphyseal (CT). Patients were followed for a minimum of 24 months with successive clinical visits or contacted via telephone. Information regarding the return to sports and concomitant or subsequent surgical procedures was collected. KT-1000 was performed post-operatively, and Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject at their 2-year follow-up appointment. Results: The final cohort included of 60 consecutive adolescent patients aged 11.1 to 17.1 (13.9 ±1.2) with a minimum follow-up of 2 years. One patient was lost to follow-up. Prior to surgery, 86% of patients reported playing team sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. 21 (35%) patients underwent AE and 39 (65%) underwent CT ACLR. Additionally, 35 (58%) underwent an a lateral extra-articular tenodesis procedure using the iliotibial band (ITB) with a modified Lemaire technique, and 5 (8%) patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum, both procedures were performed for non-modifiable risk factors as previously published for hamstring autograft ACLR. The rate of graft failure was 0%, and 10 patients had additional surgical procedures, of which 4 were concomitant removal of hardware for hemi-epiphysiodesis, 3 were contralateral ACLR, 3 were meniscal injuries that required surgical intervention and 2 were lysis of adhesions. The mean KT-1000 at 2-year follow-up was -0.36 ±0.75. The median Pedi-IKDC score was 87, and the median HSS-Pedi FABS score was 25. At 2 years after surgery, 90% patients reported returning to sports. Conclusion: This study reveals that QUAD autograft ACLR had a low failure rate when compared to previously reported studies of ACLR with hamstring autograft. Based on these results, we recommend this technique for skeletally immature patients undergoing ACLR. [Table: see text]